Abdominal Pain Flashcards
When taking a history from a patient presenting with abdominal pain, what 8 salient points about the pain will help you make the correct diagnosis?
SOCRATES
Site, onset, character, radiation, associated pain, time, exacerbating factors, severity
Name the 9 quadrants of the abdomen from left (patients right) to right and top to bottom
Right hypochondriac region, epigastric region, left hypochondriac region, right lumbar region, umbilical region, left lumbar region, right Iliac region, hypogastric region, left iliac region
What intra-abdominal organs produce pain in the right hypochondriac region?
Gallbladder and liver
What intra-abdominal organs produce pain in the epigastric region?
Stomach, duodenum and pancreas
What intra-abdominal organs produce pain in the left hypochondriac region?
Pancreas
What intra-abdominal organs produce pain in the right lumbar region?
Kidney
What intra-abdominal organs produce pain in the umbilical region?
Small bowel
What intra-abdominal organs produce pain in the left lumbar region?
Kidney
What intra-abdominal organs produce pain in the right iliac region?
Appendix and caecum
What intra-abdominal organs produce pain in the hypogastric region?
Bladder, uterus and adnexae (ovaries, fallopian tubes, and ligaments that hold the reproductive organs in place)
What intra-abdominal organs produce pain in the left iliac region?
Sigmoid colon
What are the three parts of the GI tract?
Foregut, midgut, hindgut
Which artery supplies the foregut
Celiac trunk
Which artery supplies the midgut?
Superior mesenteric artery
which artery supplies the hindgut?
Inferior mesenteric artery
The coeliac trunk, superior mesenteric artery and inferior mesenteric artery are all supplied by which blood vessel?
Abdominal aorta
What type of main would you expect in kidney stones?
Colicky
What type of pain is often produced by the liver?
Constant
The spleen often causes colicky or constant pain?
Constant
The kidney often produces which type of pain?
Constant
What radiation of pain would you expect the gallbladder to produce?
Through to the back and to the right
What radiation of pain would you expect the pancreas to produce?
Through to the back
What radiation of pain would you expect the kidneys to produce?
In the loin and radiates to the right groin
What radiation of pain would you expect from the small bowel?
Doesn’t normally radiate
Left loin to groin pain can be indicative of what?
A ruptured aortic aneurysm
What is the most likely diagnosis with the history of abdominal pain:
S Central then shifts to right iliac region
O Gradual onset
C Constant
R No radiation
A Nausea, anorexia, fever
T No previous pain
E Worse on movement
S Dull ache
Appendicitis
What is the most likely diagnosis with the history of abdominal pain:
§ Central
O Gradual onset
C Colicky
R None
A Vomiting, bowels not open
IT Previous colicky pain
E Passing flatus relieves pain
S Moderate
Bowel obstruction
What is the most likely diagnosis with the history of abdominal pain :
S Loin
O Sudden onset
C Colicky
R To groin
A Vomiting
Previous colicky pain
E Cannot find a comfortable position
S Severe - 10/10
Urteric colic
What is the most likely diagnosis with the history of abdominal pain:
S Right upper quadrant
O Sudden onset
C Colicky
R Right shoulder
A Nausea, indigestion
T After eating
E Fatty foods
S Can be 10/10
Biliary colic / cholecystitis
What GI structures make up the foregut?
Distal oesophagus -> proximal half of 2nd part of duodenum
What GI structures make up the midgut?
Distal half of 2nd part of duodenum -> proximal 2/3 of transverse colon
What GI structures make up the hindgut?
Distal 1/3 of transverse colon -> superior portion of rectum
What is the visceral sensory innervation in the foregut?
T5-T9 - epigastrium
What is the visceral sensory innervation in the midgut?
T10-T11 - umbilical
What visceral sensory innervation is in the hindgut?
L1-L2 - hypogastrium
Which nerve is responsible for sensory supply of the diaphragm? What other body part does it cover and what affect does this have?
Phrenic nerve (C3,4,5)
Covers the right shoulder so right shoulder can often be a site of refered pain
Diaphragm and right shoulder pain are indicative of what?
Cholecystitis
When does colicky pain from the bowel become constant?
When the bowel becomes ischaemic
What is the difference in colicky pain in: Urteric colic, intestinal colic, biliary colic?
• ureteric colic - relatively frequent andvery intensepain
• intestinal colic - more frequent andless intensepain
• biliary ‘colic’ - patients describe as being constant as pain lasts a long time before it relaxes
