Abdominal pain Flashcards
What structures are in the transpyloric plane L1 (6)
- Pylorus of Stomach
- Neck of Pancreas
- Fundus of Gallbladder
- Renal Hilum
- Duodenojejunal Flexure
- End of Spinal Cord (adult)
what structures are in the subcostal plane? L3
origin of IMA (3 letters = L3)
what structures are in the supracritsal plane? L4
bifurcation of the aorta (L4 for 4 chambers of the heart)
what organ corresponds to pain in the right hypochondriac region?
gallbladder
which organs corresponds to pain in the epigastric region?
stomach, duodenum, pancreas
what organ corresponds to pain in the left hypochondriac region?
pancreas
what organ corresponds to pain in the right lumbar region?
kidney
what organ corresponds to pain in the left lumbar region?
kidney
which organs corresponds to pain in the umbilical region?
- small bowel
caecum - retroperitoneal structures
which organs corresponds to pain in the right iliac region?
appendix and caecum
which organs corresponds to the hypogastric region of the abdomen?
- Tx colon
- Bladder
- Uterus and adnexae
which organs corresponds to pain in the left iliac region?
sigmoid colon
does small bowel pain usually radiate?
no
-> moves when somatic and when visceral nerves are irritated
innervation to visceral peritoneum from ?
T6 -> L3
Vagus nerve
S2-S4
innervation to parietal peritoneum from ?
T6-> L3
phrenic nerves
character of visceral pain?
dull, crampy, burning
character of parietal pain?
sharp, ache
innervation of sensation to foregut from?
T5 -> T9
innervation of sensation to midgut from?
t10->t11
innervation of sensation to HINDgut from?
L1-L2
where is the site of foregut pain?
epigastrium
where is the site of midgut pain?
umbilical
where is the site of hindgutpain?
hypogastrium
the two most painful abdomen conditions
- inflammation
2. obstruction of a muscular tube
features of inflammation pain
- constant pain
- worse by movement
- persists until inflammation subsides
features of obstruction of a muscular tube
- colicky pain
- fluctuates in severity
- move to try and get comfy
pain caused by prolonged obstruction of a hollow viscus causing distension:
- constant stretching pain
- different rom ache of inflammation and not colicky
organs which present with colicky pain
- kidneys - stones
- gall bladder- stones
- intestines (obstruction)
organs which present with constant pain
- liver
- spleen
- kidney
how does gall bladder pain radiate (upper zone)
through to the back and right
how does pancreas pain radiate (upper zone)
through to the back and left
how does stomach, duodenum and pancreas pain radiate (upper zone)
straight through to the back
how does kidney pain radiate (central zone)
in loin and radiates to groin
how does small bowel, caecum and retroperitoneal structure pain radiate (central zone)
doesn’t normally
how does lower zone pain radiate?
- rarely radiates
inc structures like sigmoid colon, transverse colon, bladder, uterus, adnexae, appendix and caecum
What can pain in the right hypochondriac indicate?
Gallstones
Cholangitis
Hepatitis
Liver abscess
What can pain in the epigastric region indicate?
Oesophagitis Peptic ulcer Perforated ulcer Pancreatitis Biliary tract disease
What can pain in the left hypochondriac indicate?
Splenic abscess
Acute splenomegaly
Splenic rupture
What can pain in the left lumbar indicate?
Renal colic Pyelonephritis Ovarian cyst Ovarian mass Ovarian torsion
What can pain in the umbilical region indicate?
Appendicitis (early)
Mesenteric adenitis (often affects lymph nodes)
Meckel’s diverticulitis
What can pain in the right lumbar indicate?
Renal colic Pyelonephritis Ovarian cyst Ovarian mass Ovarian torsion
What can pain in the right iliac indicate?
Appendicitis (late) Crohn's disease Ovarian cyst/torsion Ectopic pregnancy Hernias Renal colic
What can pain in the hypogastrium indicate?
Urinary retention
Cystitis
Uterine fibroid
Endometriosis
What can pain in the left iliac indicate?
Diverticulitis Ulcerative colitis Constipation Ovarian cyst/ torsion PID Ectopic pregnancy Hernias Renal colic
