Abdominal Pain Flashcards
What are the 2 most significant properties of the pain?
-Site
-Character
What framework do we use to ask patients about pain?
SOCRATES:
S-Site
O-Onset
C-Character
R-Radiation
A-Association
T-Time
E-Exacerbating
S-Severity
What is the foregut made of?
Distal oesophagus → proximal half of 2nd part of duodenum (major duodenal papilla)
What innervates the foregut
T5-T9
What pain is the foregut the site of?
Epigastrium
What is the midgut made of?
Distal half of 2nd part of duodenum (major duodenal papilla) → proximal 2/3 of transverse colon
What innervates the pain in the midgut?
T10-T11
What pain is the midgut the site of?
umbilical
What is the hypogastrium also known as?
Suprapubic region
What is the hindgut made of?
Distal 1/3 of transverse colon → rectum
What innervates the pain in the hindgut?
L1-L2
What pain is the hindgut the site of?
Hypogastric pain
What is the parietal peritoneum?
Covering of abdominal wall anteriorly + covering of abdominal cavity posteriorly
What is visceral peritoneum?
- Peritoneum covering organs
- Liver peritoneum, colon peritoneum
What nerves supply the parietal peritoneum?
Phrenic nerves that supply sensation from central tendon to diaphragm → C3, C4, C5
What nerves supply the parietal peritoneum?
Phrenic nerves that supply sensation from central tendon to diaphragm → C3, C4, C5.
What nerve plexuses innervate the visceral peritoneum?
- Coeliac plexus
- Superior mesenteric plexus
- Inferior mesenteric plexus
Describe the deference’s in site of pain and characteristic between visceral and parietal peritoneum’s.
Visceral:
Site of pain- Embryological origin.
Character- Dull, Crampy burning
Parietal:
Site of pain- Well localized
Characteristic- sharp, ache
What are the two main categories of pain in the abdomen and what kind of pains do they cause?
Inflammation:
- Constant ‘aching’ pain
- Made worse by moving
- Persists until inflammation subsides
Obstruction of a muscular tube:
- Colicky ‘gripping’ pain
- Fluctuates in severity
- Patient moves to try and get comfortable
What character of pain do you find in each of these organs?
- Ureter
- Liver
- Biliary-colic
- Spleen
- Kidney
- Small or large bowel
- Ureter
Colicky - Liver
Constant e.g. could be hepatitis or liver abscess - Biliary-colic
Colicky e.g. stone trying to get through duct like bile duct - Spleen
Constant e.g. splenic abscess or rupture - Kidney
Constant e.g. pyelonephritis or abscess - Small or large bowel
Colicky
Where does gallbladder (right hypochondriac region) pain radiate?
Through to the back and right- this happens in 50% of cases
Where does stomach, duodenum, pancreas (epigastrium) pain radiate?
- Straight through to back- especially because pancreas and duodenum are retroperitoneal
- People with pancreatic cancer present with back pain because tumor infiltrates posteriorly
Where does the tail of the pancreas pain radiate to?
Through to the back and the left
Where does small bowel, caecum, retroperitoneal structures (umbilical region) pain radiate?
Doesn’t normally radiate as they’re visceral.
Where does left kidney (left lumbar region) pain radiate?
In loin and radiates to groin.
Where do the lower zone organs (appendix and caecum, bladder, transverse colon, uterus, adnexae, sigmoid colon) pain radiate?
- Lower abdominal pain rarely radiates
- Pain from structures deep in pelvis is referred to lower back/perineum
What does it signify when pain radiates?
Other structures are becoming involved.
Where does colicky abdominal pain usual come from?
The centre
Why does colicky pain happen?
Muscle contractions trying to excrete something
What does it mean if colicky pain turns constant?
There is ischaemia
Diagnose.
S → Central then shifts to right iliac region
O → Gradual
C → Constant
R → No radiation
A → Nausea, anorexia, fever
T → No previous pain
E → Worse on movement
S → Dull ache
Appendicitis
When wouldn’t someone with appendicitis have abdominal pain?
The location of their appendix is pelvic.
Diagnose
S → Central
O → Gradual
C → Colicky
R → No radiation
A → Vomiting, bowels not open
T → Previous colicky pain
E → Passing flatus relieves pain
S → Moderate
Small bowel obstruction
What is the commonest cause of small bowel obstructions?
Adhesions, scarring on the inside of abdominal wall post opp
Diagnose
S → Loin
O → Sudden onset
C → Colicky
R → To groin
A → Vomiting
T → Previous colicky pain
E → Cannot find a comfortable position
S → Severe 10/10
Right uretic colic, (kidney stone)
Diagnose
S → Right upper quadrant
O → Sudden onset
C → Colicky
R → To right shoulder
A → Nausea, indigestion
T → After eating
E → Fatty foods
S → Can be severe 10/10
Biliary colic
What is an outpouching of the small bowel that causes inflammation called?
Meckel’s diverticulitis
