Abdominal Pain Flashcards
Transpyloric plane
L1 Pylorus of stomach Neck of pancreas Fundus of gallbladder Renal Hilum Duodenojejunal flexure End of spinal cord
Subcostal plane
L3
Origin of inferior mesenteric artery
Supracristal plane
L4
Bifurcation of aorta
Right hypochondriac
Gallbladder
Epigastric
Stomach, duodenum and pancreas
Left hypochondriac
Pancreas or spleen
Right lumbar
Kidney
Umbilical
Small bowel, caecum, retroperitoneal structures
Left lumbar
Kidney
Right iliac
Appendix and caecum
Hypogastric
Transverse colon
Bladder
Uterus
Ovaries
Left iliac
Sigmoid colon
Foregut
Distal oesophagus to proximal half of second part of duodenum
Supplied by celiac trunk
T5-9
Midgut
Distal half of second part of duodenum to proximal 2/3 of transverse colon
Supplied by superior mesenteric artery
T10-11
Hindgut
Distal 1/3 of transverse colon to rectum
Supplied by inferior mesenteric artery
L1-2
Parietal peritoneum
Covering of abdominal wall anteriorly and abdominal cavity posteriorly
Visceral peritoneum
Covers organs
Extra or retroperitoneal organs
Duodenum and pancreas
Parietal peritoneum supply
Phrenic nerve supply
Central tendon to diaphragm
C3-5
Also right shoulder
Segmental inner action is T5 to L2
Umbilicus is T10
Visceral peritoneum supply
Parasympathetic supply from vagus nerve - 10th cranial nerve
Also CN III, VII, IX, X
Parasympathetic receptor or sensation S2 to S4
Sympathetic autonomic chain T1 to L2
Visceral site of pain
Embryological origin
Difficult to localise
Parietal site of pain
Well localised
Visceral pain character
Dull
Crampy
Burning
Parietal pain character
Sharp
Ache
Inflammation pain
Constant pain - aching
Made worse by movement
Persists until inflammation subsided
Obstruction pain
Colicky pain - gripping
Fluctuates in severity
Move to try and get comfortable
Prolonged obstruction pain
Cause distention
Constant stretching pain
Different from ache of inflammation and not colicky - changes to constant pain - impending ischaemia
Right hypochondriac radiation
Through to back and right
Epigastric radiation
Straight through to the back
Left hypochondriac radiation
Through to back and left
Right lumbar radiation
In loin and radiates to groin
Umbilical radiation
Does not normally radiate
Left lumbar radiation
In loin and radiated to groin
Right iliac radiation
Rarely radiates
Pain deep in pelvis refereed to lower back/Perineum
Hypogastric radiation
Rarely radiates
Pain deep in pelvis refereed to lower back/Perineum
Left iliac radiation
Rarely radiates
Pain deep in pelvis refereed to lower back/Perineum
Pain radiate signifies
Other structures being involved
Visceral sensation
Colicky abdominal pain referred to centre
Somatic sensation
Pain from parietal inflammation felt over inflamed area
Small bowel pain
Doesn’t radiate but may move when somatic and well as visceral nerves become irritated
