Abdominal Pain

Question 1

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?

Answer 1

SOCRATES
Site, onset, character, radiation, associated pain, time, exacerbating factors, severity

Question 2

Name the 9 quadrants of the abdomen from left (patients right) to right and top to bottom

Answer 2

Right hypochondriac region, epigastric region, left hypochondriac region, right lumbar region, umbilical region, left lumbar region, right Iliac region, hypogastric region, left iliac region

Question 3

What intra-abdominal organs produce pain in the right hypochondriac region?

Answer 3

Gallbladder and liver

Question 4

What intra-abdominal organs produce pain in the epigastric region?

Answer 4

Stomach, duodenum and pancreas

Question 5

What intra-abdominal organs produce pain in the left hypochondriac region?

Answer 5

Pancreas

Question 6

What intra-abdominal organs produce pain in the right lumbar region?

Answer 6

Kidney

Question 7

What intra-abdominal organs produce pain in the umbilical region?

Answer 7

Small bowel

Question 8

What intra-abdominal organs produce pain in the left lumbar region?

Answer 8

Kidney

Question 9

What intra-abdominal organs produce pain in the right iliac region?

Answer 9

Appendix and caecum

Question 10

What intra-abdominal organs produce pain in the hypogastric region?

Answer 10

Bladder, uterus and adnexae (ovaries, fallopian tubes, and ligaments that hold the reproductive organs in place)

Question 11

What intra-abdominal organs produce pain in the left iliac region?

Answer 11

Sigmoid colon

Question 12

What are the three parts of the GI tract?

Answer 12

Foregut, midgut, hindgut

Question 13

Which artery supplies the foregut

Answer 13

Celiac trunk

Question 14

Which artery supplies the midgut?

Answer 14

Superior mesenteric artery

Question 15

which artery supplies the hindgut?

Answer 15

Inferior mesenteric artery

Question 16

The coeliac trunk, superior mesenteric artery and inferior mesenteric artery are all supplied by which blood vessel?

Answer 16

Abdominal aorta

Question 17

What type of main would you expect in kidney stones?

Answer 17

Colicky

Question 18

What type of pain is often produced by the liver?

Answer 18

Constant

Question 19

The spleen often causes colicky or constant pain?

Answer 19

Constant

Question 20

The kidney often produces which type of pain?

Answer 20

Constant

Question 21

What radiation of pain would you expect the gallbladder to produce?

Answer 21

Through to the back and to the right

Question 22

What radiation of pain would you expect the pancreas to produce?

Answer 22

Through to the back

Question 23

What radiation of pain would you expect the kidneys to produce?

Answer 23

In the loin and radiates to the right groin

Question 24

What radiation of pain would you expect from the small bowel?

Answer 24

Doesn’t normally radiate

Question 25

Left loin to groin pain can be indicative of what?

Answer 25

A ruptured aortic aneurysm

Question 26

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

Answer 26

Appendicitis

Question 27

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

Answer 27

Bowel obstruction

Question 28

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

Answer 28

Urteric colic

Question 29

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

Answer 29

Biliary colic / cholecystitis

Question 30

What GI structures make up the foregut?

Answer 30

Distal oesophagus -> proximal half of 2nd part of duodenum

Question 31

What GI structures make up the midgut?

Answer 31

Distal half of 2nd part of duodenum -> proximal 2/3 of transverse colon

Question 32

What GI structures make up the hindgut?

Answer 32

Distal 1/3 of transverse colon -> superior portion of rectum

Question 33

What is the visceral sensory innervation in the foregut?

Answer 33

T5-T9 - epigastrium

Question 34

What is the visceral sensory innervation in the midgut?

Answer 34

T10-T11 - umbilical

Question 35

What visceral sensory innervation is in the hindgut?

Answer 35

L1-L2 - hypogastrium

Question 36

Which nerve is responsible for sensory supply of the diaphragm? What other body part does it cover and what affect does this have?

Answer 36

Phrenic nerve (C3,4,5) Covers the right shoulder so right shoulder can often be a site of refered pain

Question 37

Diaphragm and right shoulder pain are indicative of what?

Answer 37

Cholecystitis

Question 38

When does colicky pain from the bowel become constant?

Answer 38

When the bowel becomes ischaemic

Question 39

What is the difference in colicky pain in: Urteric colic, intestinal colic, biliary colic?

Answer 39

• ureteric colic - relatively frequent and very intense pain • intestinal colic - more frequent and less intense pain • biliary 'colic' - patients describe as being constant as pain lasts a long time before it relaxes