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POM unit 5 > abdominal pain > Flashcards

abdominal pain Flashcards

1
Q

what are the pain receptors for the enteric nervous system

A

nociceptors, free nerve endings between the smooth muscle layers, serial surface, mesentery, mucosa. cell bodies in the dorsal root ganglion

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2
Q

what do the receptors respond to?

A

mechanical and chemical: stretch and tissue injury products.

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3
Q

what fibers carry the pain signal?

A

predominantly unmyelinated c fibers, and small A delta fibers

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4
Q

what are the C fibers for?

A

visceral sensation

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5
Q

what are the A belt fibers for/

A

this is pain transmission

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6
Q

where do the afferent paths run?

A

with regional splanchnic through the sympathetic chain and terminate in the dorsal horn

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7
Q

what kind of localization is there for visceral

A

poor

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8
Q

what pathways carry the sensation?

A

spinorecticular, spinothalamic and dorsal column

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9
Q

how does the sensation of pain elicit arousal?

A

because there are synapses in the RAS

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10
Q

where does pain relay in the brain?

A

the thalamus

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11
Q

where do pain sensation ultimately register?

A

in the cortex, and pain mapping is done by the somatosensory cortex.

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12
Q

what do the efferent fibers do?

A

they are descending fibers that modulate pain and are predominantly inhibitory

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13
Q

where do the efferents originate?

A

in the cortex, limbic with projections to the medulla and the midbrain.

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14
Q

where do the efferent fibers project?

A

to the dorsal horn, where they modify the input form the ascending system. they also give the sympathetic and parasympathetic supply

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15
Q

what causes referred pain?

A

visceral afferent neurons and somatic afferents synapsing on second order neurons it he spinal cord -central convergence. all spinal neurons that receive input from the viscera also get input from the skin.

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16
Q

what is hyperalgesia of the muscle often accompanied by?

A

spasm

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17
Q

Kehr’s sign

A

subdiaphragmatic irritation-iosalateral shoulder or supraclavicular pain

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18
Q

what is nociceptive abdominal pain

A

stimulation of peripheral nociceptors caused by mechanical: stretch, distention or injury: inflammation and ischemia

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19
Q

what is neuropathic abdominal pain

A

pain originating independently from nociception. structural or functional changes in the pain pathways peripheral or central causes this. examples are diabetic neuropathy and functional pain syndrome,

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20
Q

what is classic pain signals of gastroenteritis?

A

self-limiting, resolving in short period.

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21
Q

what is classic colicky pain?

A

periods of pain and resolution. this is classic muscular surges found in the blocked tublar syndrome. (renal colic, GI colic)

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22
Q

what is the classsic pain signals of appendicitis

A

linear, progressively worsening pain.

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23
Q

what are the classic pain signals of rupture or aortic aneurysm

A

catastrophic onset, sudden, very severe.

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24
Q

what are the right sided abdominal quadrant names

A

hypochondrium, lumbar and iliac

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25
Q

what are the center quadrant names

A

epigastric, umbilical, and hypogastric

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26
Q

what are the left sided abdominal names

A

hypochondrium, lumbar and iliac

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27
Q

characteristics of peritonitis

A

quiet abdomen, diminished movements, loss of abdominothroacic breathing pattern. distention and or lump, cullen/turners sign

28
Q

cullen’s sign

A

superficial edema and bruising in the umbilical region

29
Q

rovsing’s sign

A

when palpation of the left lower quadrant increases the pain felt due to appendicitis

30
Q

carnett test

A

determines if the abdominal pain is arising from the abdominal wall or the intraabdominal cavity. patient raises head and the abdominal musculature is tensed. if there is greater pain on repeat palpation then the pain is in the abdominal wall

31
Q

what does hypoactive bowel sounds indicate?

A

peritonitis

32
Q

what does hyperactive bowel sounds indicate?

A

enteritis, colitis, early part of the obstruction

33
Q

where does a peptic ulcer or gastroduodenal pain originate

A

epigastric that radiates to the back

34
Q

what is the character of peptic ulcer pain?

A

gnawing, burning, lasting for 1-3 hours. aggravated by food

35
Q

what relieves pain from gastric ulcer

A

fasting. food aggravates.

36
Q

what relieves a duodenal ulcer pain

A

eating will relieve the pain. pain will come back at night when fasting ensues.

37
Q

where does acute pancreatitis present?

A

epigastric radiating to the back.

38
Q

character of acute pancreatitis

A

deep boring, severe, usually lasting 24 hours.

39
Q

what relieves pancreatic pain?

A

sitting upright.

40
Q

what other symptoms are associated with pancreatitis,

A

nausea and vomiting and associated ileus.

41
Q

how does obstruction present

A

colicky pain, intermittent, crampy, poorly localized. it has a waxing, waning character

42
Q

what is characteristic of proximal obstruction

A

vomiting, with transient relief. f

43
Q

what characterizes distal obstruction

A

distention, obstipation

44
Q

what happens if the bowel becomes ischemic?

A

the pain becomes sharp and localized.

45
Q

intestinal angina

A

post prandial and occurs in individuals with insufficient blood flow to meet demands of the mesentery causes sitphobia

46
Q

sitphobia

A

aversion to food.

47
Q

tenesmus

A

frequent and painful indication to evacuate bowels with a feeling of incomplete evacuation

48
Q

what is the cause of hepatic pain?

A

deep lesions are typically painless. hepatic pain is caused by stretching of glissons capsule by inflammation, vascular engorgement, rapidly expanding lesions

49
Q

splenic pain?

A

LUQ occurs with stretching of the splenic capsule and infarction -look for sickle cell.

50
Q

appendicitis presentation

A

PANT: pain, anorexia, nausea, tenderness. pain is initially periumbilical but when it becomes involved with the parietal peritoneum it becomes localized to the RLQ. test with mcburney’s point

51
Q

diseases of the RLQ

A

appendicitis, terminal ileus, crohns, tuboovarian, ectopic, ruptured ovarian cyst, reanl disorders, uretic calculus, pyogenic sacroilitis, salpingitis

52
Q

diseases of the RUQ

A

acute cholecystitis, biliary colic, hepatic inflammation or distention

53
Q

diseases of the LUQ

A

splenic

54
Q

disease of the LLQ

A

diverticulitis, colitis, sacroilitis, tuboovarian

55
Q

diseases off the central abdomen

A

gastroenteritis, peptic ulcer, small bowel colic, acute pancreatitis.

56
Q

what to keep in mind when there is an adult female with acute abdominal pain?

A

ectopic

57
Q

what to keep in mind when there is upper abdominal pain?

A

cardiac and respiratory differentials.

58
Q

chronic abdominal wall pain syndrome

A

women, depression and obesity, superficial pain localized to small area with significant tenderness and dysethesia. +carnett sign

59
Q

causes of CAWPS

A

entrapment neuropathy, hernia. rectus nerve entrapment, ilioinguinal and iliohypogastric nerve entrapment. spontaneous rectus sheath hematoma.

60
Q

median arcuate ligament syndrome/celiac artery compression syndrome MALS

A

congenital displacement of the arcuate ligament hat compresses and irritates the celiac ganglion

61
Q

presentation of MALS

A

women 20-40, epigastric pain after eating that causes anorexia and weight loss. there is typically a bruit in the epigastric region. USG doppler shows increased velocity in the celiac artery

62
Q

superior mesenteric syndrome

A

compression of the 3rd portion of the duodenum by the abdominal aorta and the overlying SMA. the mesenteric is lost and this can occur

63
Q

presentation of superior mesenteric syndrome

A

early satiety, nausea, vomiting, post prandial abdominal pain and abdominal distention. symptoms tend to improve after weight gain.

64
Q

irritable bowel syndrome

A

recurrent bowel pain or discomfort >_ 3days/month in the last 3 months with improvement on defecation, changes in the frequency of stool, change in the form or appearance of stool

65
Q

functional abdominal pain syndrome

A

subgroup of somatoform, more common in women, psychosocial component with a history of sexual abuse common. typical pain is almost always there, constant, relatively unchanging in character, intensity and location. nocturnal pain is considered organic, however functional pain can awaken from sleep.

66
Q

FAPS suggestive clues on exam

A

absence of autonomic features on exam (tachycardia, diaphoresis) there is usually a discrepancy between the stethoscope pressure eliciting pain and the examiners hand.

67
Q

treatment options for FAPS

A

opiates, NSAIDs, topical lidocaine, tricyclic AD

POM unit 5 (12 decks)

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