ABDOMINAL PAIN Flashcards
How do most intra-abdominal diseases present?
Pain alone
When taking a patient history what technique should you use?
SOCRATES
What do the letters of SOCRATES stand for?
Site Onset Character Radiation Associations Time course Exacerbating/relieving factors Severity
What are the abdominopelvic regions top to bottom, left to right?
Left hypochondriac region
Epigastric region
Right hypochondriac region
Left lumbar region
Umbilical region
Right lumbar region
Left iliac region
Hypogastric/superpubic region
Right iliac region
What are the abdominopelvic quadrants top to bottom, left to right?
Right upper quadrant (RUQ)
Left upper quadrant (LUQ)
Right lower quadrant (RLQ)
Left lower quadrant (LLQ)
What vertebrae level is the transpyloric plane and what structures are present?
L1
Pylorus of stomach Neck of pancreas Fundus of gallbladder Renal hilum Duodenojejunal flexure
What vertebrae level is the subcostal plane and what structures are present?
L3
Origin of inferior mesenteric artery
What vertebrae level is the supracristal plane and what structures are present?
L4
Bifurcation of the aorta
What structures are present in the left hypochondriac region?
Pancreas
Spleen
What structure is present in the right hypochondriac region?
Gallbladder
What structures are present in the epigastric region?
Stomach
Duodenum
Pancreas
What structure is present in the left lumbar region?
Kidney
What structure is present in the right lumbar region?
Kidney
What structures are present in the umbilical region?
Small bowel
Caecum
Retroperitoneal structures
What structures are present in the left iliac region?
Sigmoid colon
What structures are present in the right iliac region?
Appendix
Caecum
What structures are present in the hypogastric/superpubic region?
Transverse colon
Bladder
Uterus and adnexae
What is the blood supply/nerve innervation for sensation of the foregut and what structures comprise it?
Celiac trunk/T5-T9
Distal oesophagus –> proximal half of 2nd part of duodenum
What is the blood supply/nerve innervation for sensation of the midgut and what structures comprise it?
Superior mesenteric artery/T10-T11
Distal half of 2nd part of duodenum –> proximal 2/3 of transverse colon
What is the blood supply/nerve innervation for sensation of the hindgut and what structures comprise it?
Inferior mesenteric artery/L1-L2
Distal 1/3 of transverse colon –> rectum
What is the character of visceral pain?
Dull, crampy, burning
Hard to localise
What is the character of parietal pain?
Sharpe, ache
Easy to locate
How does pain from inflammation in abdomen present?
Constant pain (aching) made worse by movement Persists until inflammation subsides
How does pain from obstruction of a muscular tube in abdomen present?
Colicky pain (gripping) Fluctuates with severity Move to try and get comfortable
How does pain from prolonged obstruction of a hollow viscus causing distension in abdomen present?
Constant stretching pain - originally colicky but changes
Different from inflammatory ache
Patients who have this can have ischaemia which is emergency
How does ureteric pain usually present?
Colicky
How does liver pain usually present?
Constant
How does gall bladder pain usually present?
Colicky
How does spleen pain usually present?
Constant
How does kidney pain usually present?
Constant
How does intestinal pain usually present?
Colicky
What different about biliary colic pain compared to the rest?
Maintains a high intensity and gently fluctuates
How does right hypochondriac pain radiate?
Through to the back and right
How does left hypochondriac pain radiate?
Through to the back and left
How does epigastric pain radiate?
Straight through to the back
How does right/left lumbar pain radiate?
In loin and radiates to groin
How does umbilical pain radiate?
Doesn’t normally radiate
How does lower abdominal pain radiate?
Rarely radiates
Does small bowel pain radiate?
No but it may move when somatic or when visceral nerves become irritated
