abdominal pain Flashcards
What does transpyloric plane (L1) go through?
Pylorus of stomach, neck of pancreas, fundus of gallbladder, renal hilum, duodenojejunal flexure & end of spinal cord
What does subcostal plane (L3) go through?
Origin of IMA
What does supracristal plane (L4) go through?
Bifurcation of aorta
What structures are in each of the 9 segments of the abdomen?
Right hypochondriac: gallbladder.
Epigastrium: stomach, duodenum, pancreas.
Left hypochondriac: tail of pancreas.
Right lumbar & left lumbar: kidneys.
Umbilical: small bowel, caecum, retroperitoneal structures.
Right iliac: appendix and caecum.
Hypogastric: transverse colon, bladder, uterus.
Left iliac: sigmoid colon
What are the foregut structures? Midgut? Hindgut?
- Foregut: distal oesophagus, stomach, proximal half of duodenum, liver, gallbladder, pancreas, spleen.
- Midgut: distal half of the duodenum, rest of the small intestine (jejunum + ileum), caecem, ascending colon, proximal 2/3rds of the transverse colon.
- Hindgut: distal 1/3rd of transverse colon, descending colon, sigmoid colon, rectum
What blood vessel supplies foregut, midgut, hindgut?
Foregut - coeliac trunk. Midgut - SMA. Hindgut - IMA
What are the features of parietal pain?
- Caused by irritation of fibres innervating parietal peritoneum.
- Somatic innervation, site of pain well localised (localized to dermatome superficial to site of pain), with sharp ache.
- Can get tenderness, guarding, and as it develops further, rigidity and rebound terdenress
- Phrenic nerve C3,4,5 picks up sensation from right shoulder too so pain can refer there for parietal peritoneum.
What are the features of visceral pain?
- Due to stretching of hollow viscus of capsule of solid viscus.
- Visceral fibres enter spinal cord at different levels so pain poorly localized and characterised (dull, cramping, burning).
Where do foregut organs produce pain? Midgut organs? Hindgut organs?
Foregut organs produce pain in epigastric region.
Midgut in periumbilical region.
Hindgut hypogastric pain
What kind of pain does inflammation produce + example?
Constant acheing pain made worse by movement. Eg. Hepatitis, cholecystitis.
What kind of pain does obstruction of a muscular tube produce + example?
Colicky pain fluctuates in severity. Eg. Ureteric colic, biliary colic, gallstones, intestinal obstruction
What kind of pain does prolonged obstruction of muscular tube cause and what does this indicate?
May change from colicky to constant stretching pain - can indicate ischaemia
In terms of pain, what are the differences between ureteric, biliary and intestinal colic?
Ureteric very painful. Biliary colic painful but less, with mid-fluctuations. Intestinal colic less painful.
What does it indicate when colicky pain becomes constant?
When something is becoming ischaemic (needs intervention)
Where does gallbladder pain radiate to? Epigastric pain (stomach, duodenum, pancreas)? Tail of pancreas?
Gallbladder radiates to back and right.
Epigastric pain to back.
Tail of pancreas to back & left
Where does kidney pain radiate to? Small bowel pain?
Kidney pain radiates to loin & groin (down ureters).
Small bowel pain usually doesn’t radiate but since small bowel moves pain can move
Where does lower abdominal pain radiate?
Rarely radiates but structures deep in pelvis referred to lower back/perineum.
In general where does colicky abdominal pain radiate to and why? Where is parietal inflammation felt?
Generally colicky abodminal pain radiates to centre (visceral sensation).
When can small bowel pain move?
When somatic and visceral nerves become irritated
What would gradual constant pain central shifting to right iliac region + fever, nausea, anorexia indicate?
appendicitis
What would central gradual colicky pain + vomiting, unopened bowels, passing gas indicate?
Bowel obstruction
What are adhesions?
After surgery can leave scar inside abdomen (bands of fibre), these adhesions can trap bit of bowel twisting it and causing obstruction (can become ischaemic)
What would sudden loin colicky pain radiating to groin with vomiting, very severe indicate?
ureteric colic
What would right upper quadrant colicky pain + right shoulder radiation, nausea, after eating fatty foods indicate?
biliary colic
