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BRS YR2 > Abdominal Pain > Flashcards

Abdominal Pain Flashcards

1
Q

What are the 2 most significant properties of pain?

A
  • site
  • character
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2
Q

What does SOCRATES stand for?

A 
Site 
Onset
Character
Radiation
Associated symptoms
Time
Exacerbating factors
Severity
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3
Q

What are the 4 abdominopelvic quadrants?

A

Right Upper
Right Lower
Left Upper
Left Lower

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4
Q

What are the 9 adbominopelvic regions?

A
  • right hypochondriac
  • epigastric
  • left hypochondriac
  • right lumbar
  • umbilical
  • left lumbar
  • right iliac
  • hypogastric
  • left iliac
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5
Q

What is in the transpyloric plane?

A
  • pylorus of the stomach
  • neck of the pancreas
  • fundus of the gall bladder
  • renal hilum
  • duodenojejunal flexure
  • end of the spinal cord (adult)
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6
Q

What do most intra-abdominal diseases present with?

A

pain alone

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7
Q

Where is the intertubercular plane?

A

passes through the iliac fossa, around L5

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8
Q

Where is the transpyloric plane?

A

L1

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9
Q

Where is the subcostal plane?

A

L3

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10
Q

What happens at the subcostal plane?

A

the origin of the inferior mesenteric artery

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11
Q

Where is the supracristal plane?

A

L4

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12
Q

What happens at the supracristal plane?

A

Bifurcation of the aorta

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13
Q

What happens at the transpyloric plane?

A

origin of the superior mesenteric acid

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14
Q

What tends to cause pain in the right hypochondriac region?

A

gallbladder

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15
Q

What tends to cause pain in the epigastric region?

A

stomach, duodenum and pancreas

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16
Q

What tends to cause pain in the left hypochondriac region?

A

pancreas/spleen

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17
Q

What tends to cause pain in the right lumbar region?

A

kidney (right)

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18
Q

What tends to cause pain in the umbilical region?

A
  • small bowel
  • caecum
  • retroperitoneal structures
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19
Q

What tends to cause pain in the left lumbar region?

A

kidney

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20
Q

What tends to cause pain in the right iliac region?

A
  • appendix
  • caecum
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21
Q

What tends to cause pain in the hypogastric region?

A
  • transverse colon
  • bladder
  • uterus
  • ovaries
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22
Q

What tends to cause pain in the left iliac region?

A

sigmoid colon

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23
Q

What is in the foregut?

A

distal oseophagus to the proximal half of the descending duodenum

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24
Q

What is in the midgut?

A

distal half of the descending duodenum to the proximal 2/3 of the transverse colon

  • small bowel
  • appendix
  • caecum
  • ascending colon
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25
Q

What is in the hindgut?

A

distal 1/3 of the transverse colon to the rectum

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26
Q

What supplies the foregut?

A

the celiac trunk

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27
Q

What is the celiac trunk comprised of?

A
  • hepatic artery
  • splenic artery
  • left gastric artery
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28
Q

What supplies the midgut?

A

superior mesenteric artery

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29
Q

What supplies the hindgut?

A

inferior mesenteric artery

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30
Q

What does the parietal peritoneum cover?

A
  • anterior abdominal wall
  • posterior abdominal cavity
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31
Q

What does the visceral peritoneum cover?

A

covers the organs themselves

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32
Q

What 2 structures are extra/retroperitoneal?

A
  • pancreas
  • duodenum
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33
Q

What supplies the parietal peritoneum?

A
  • phrenic nerves
  • sensation to the central tendon of the diaphragm (C3, C4 and C5)
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34
Q

Why do diaphragmatic problems cause right shoulder pain?

A

Because sensation in both the diaphragm and the right shoulder is transmitted by the phrenic nerves (C3,4,5)

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35
Q

Where does the phrenic segmental innervation of the parietal peritoneum originate?

A

T6-L2

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36
Q

What supplies the umbilicus?

A

T10

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37
Q

What provides parasympathetic innervation of the visceral peritoneum?

A
  • the vagus nerve (CNX)
  • parasympathetic sensation from S2-S4
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38
Q

What level does the sympathetic innervation of the visceral peritoneum originate from?

A

T1-L2

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39
Q

What are the different plexuses involved in the sympathetic innervation of the visceral peritoneum?

A
  • celiac plexus
  • superior mesenteric plexus
  • inferior mesenteric plexus
40
Q

Where is the site of pain with the visceral plexus? DELETE

A

embryological origin

41
Q

How is pain from the parietal plexus localised?

A

well-localised

42
Q

What is the character of pain from the visceral plexus?

A
  • dull
  • crampy
  • burning
43
Q

What is the character of pain from the parietal plexus?

A
  • sharp
  • ache
44
Q

What innervates the foregut?

A

Vagus nerve T5-T9

45
Q

What innervates the midgut?

A

Vagus nerve and lesser splanchnic T10-T11

46
Q

What innervates the hindgut?

A

Lumbar splanchnic nerves L1-L2

47
Q

Where is the site of pain from the foregut?

A

epigastrium

48
Q

Where is the site of pain from the midgut?

A

umbilical

49
Q

Where is the site of pain from the hindgut?

A

hypogastrium

50
Q

What is the type of innervation of the parietal peritoneum?

A

somatic

51
Q

What is the type of innervation of the visceral peritoneum?

A

autonomic sympathetic and parasympathetic

52
Q

How does pain caused by inflammation tend to present?

A
  • constant pain ‘aching’
  • made worse by movement
  • persists until inflammation subsides
53
Q

How does pain caused by obstruction of a muscular tube tend to present?

A
  • colicky pain ‘gripping’
  • severity fluctuates
  • movement to try and get comfortable
54
Q

How does pain caused by prolonged obstruction of a hollow viscus (causing distension) tend to present?

A
  • constant stretching pain
  • different from the ache of inflammation and not colicky, sign of future ischaemia.
55
Q

What type of pain would ureter problems present with?

A

colicky pain

56
Q

What type of pain would liver problems present with?

A

constant pain

57
Q

What type of pain would biliary colic present with?

A

colicky

58
Q

What type of pain would spleen problems present with?

A

constant

abscess or rupture

59
Q

What type of pain would kidney problems present with?

A

constant

abscess, pylonephritis

60
Q

What type of pain would bowel obstruction present with?

A

colicky

61
Q

Why is biliary colic not actually colic?

A

intensity and minor fluctuations rather than actual fluctuations

62
Q

When does colicky pain become constant?

A

ischaemia

63
Q

Where does biliary colic pain tend to radiate?

A

through to the back, on the right

64
Q

Where does epigastric pain tend to radiate?

A

straight through the back (retroperitoneal structures)

65
Q

In what disease does sitting up and leaning forward relieve the pain?

A

pancreatitis

66
Q

Where does left hypochondriac pain (tail of pancreas) tend to radiate?

A

through to the back, on the left

67
Q

Where does right lumbar (kidney) pain tend to radiate?

A

in the loin and radiates to the groin (from the kidney, through the ureter towards the bladder)

68
Q

Where does umbilical pain tend to radiate?

A

doesn’t normally radiate (due to being mostly visceral innervation)

69
Q

Where does left lumbar (kidney) pain tend to radiate?

A

in the loin and radiates to the groin (from the kidney, through the ureter towards the bladder)

70
Q

What condition can present with ureteric colic (only on the left)?

A

abdominal aortic aneurysm

71
Q

Where does lower abdominal pain tend to radiate?

A
  • rarely radiates
  • pain from deep in the pelvis structures refers to lower back/perineum
72
Q

Generally, where does colicky abdominal pain radiate to?

A

the centre of the abdomen due to visceral sensation

73
Q

Generally, where does pain from parietal inflammation radiate to?

A

doesn’t tend to radiate, only felt over the inflamed area

74
Q

What does radiating pain indicate?

A

other structures are becoming involved

75
Q

What may happen with small bowel pain?

A
  • no radiation, but pain may move
  • as somatic and visceral nerves become irritated
76
Q

How does pain from appendicitis tend to present?

A
  • initially central
  • shifts to the right iliac region
77
Q

What can happen with the appendix that makes examination difficult?

A

can be retro-caecal, pain with pressure is not seen

78
Q

In which disease does passing flatus relieve pain?

A

bowel obstruction

79
Q

What is the most common cause of small bowel obstructions?

A

adhesions/fibrous bands (post-op?)

80
Q

What tends to be the most painful form of colic?

A

ureteric (stone in ureter)

81
Q

What causes pain to worsen after consumption of fatty food?

A

biliary colic

82
Q

What is biliary colic?

A

pain trying to pass stones

83
Q

What is cholecystitis?

A
  • stone stuck in the cystic duct
  • bile is unable to pass
  • wall continues to produce mucus
  • causing infection
84
Q

How does cholecystitis present?

A
  • murphy’s sign
  • localised pain (referal unlikely)
85
Q

What diseases cause right hypochondriac pain?

A
  • gallstones
  • cholangitis
  • hepatitis
  • liver abscess
86
Q

What diseases cause epigastric pain?

A
  • perforated ulcer
  • peptic ulcer
  • oesophagitis
  • pancreatitis
  • biliary tract disease
87
Q

What diseases cause left hypochondriac pain?

A
  • splenic abscess
  • acute splenomegaly
  • splenic rupture
88
Q

What diseases cause umbilical pain?

A
  • appendicitis (early)
  • mesenteric adenitis
  • Meckel’s diverticulitis
89
Q

What is mesenteric adenitis?

A
  • inflammatory bowel
  • reactive lymphnodes cause the pain
  • often mistaken for appendicitis
90
Q

What is Meckel’s diverticulitis?

A
  • out pouching of small bowel
  • contains ectopic pancreatic or gastric tissue
  • can lead to diverticulitis
91
Q

What diseases cause left lumbar pain?

A
  • renal colic
  • pyelonephritis
  • ovarian cyst
  • ovarian mass
  • ovarian torsion
92
Q

What diseases cause left iliac region pain?

A
  • diverticulitis
  • ulcerative colitis
  • constipation
  • ovarian cyst/torsion
  • PID
  • ectopic pregnancy
  • obstructive hernias
  • renal colic
93
Q

What diseases cause hypogastric pain?

A
  • urinary retention
  • cystitis
  • uterine fibroid
  • endometriosis
94
Q

What diseases cause right iliac region pain?

A
  • appendicitis (late)
  • Crohn’s disease
  • ovarian cyst/torsion
  • ectopic pregnancy
  • hernias
  • renal colic
95
Q

What diseases cause right lumbar region pain?

A
  • renal colic
  • pyelonephritis
  • ovarian cyst
  • ovarian torsion
  • ovarian mass
96
Q

Which other symptom indicates appendicitis?

A

Anorexia

97
Q

Why does eating fatty foods worsen biliary colic?

A

triggers release of bile from the gallbladder

BRS YR2 (67 decks)

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