Abdominal Pain Flashcards
Visceral peritoneum
Predominately medaited by unmyelinated C-fibers
Pain is dull, cramp or aching
Pain receptors on serosal surfaces of the abdemon, mesentery
Visceral pain perceived along the spiunal segments where visceral affarent nerves enter the spinal cord
Most GI is perceived at midline
Pain from one structure will be able to be lateralized bc only one side
Referred pain becasue visceral and somatic synapse on same dorsal horn nuclei and impulses transmitted via the spinothalamic pathway to the brain
Right shoulder
Left should
Left lower chest and midline mid back
Diaphrag irriation from ulcer, liver, cholecystitis
Diaphrag irritation from ulcer or splenic rupture
Stomach/duodenum
Right scap
Midline to left mid-back
Perumbilical pain
Gallbladder/biliary tree
Pancreas
Small intestine
Unilateral flank to groin Hypogastric/lower back Uni hypogastric Midline hypogastric Midline presacral
Kidney/ureter Colon Overaises/tests Uterus Rectum
Pareital peritonuem
Somatic nerve innervation
Innervate overlying abdominal wall as well
May experience curaneous pain with pressure over the skin
Pain is accentuated by pressure changes like moving or sneezing
Lie motionless in bed and resist movement
Rebound tenderness
Abdominal wall pain
Obstruction of gollow viscera
Occurs bc of muscle spasm of pressure….tends to be constant and aching and worse with movement or prolonged standing
Central mech of viscerally mediated…small bowel is intermittent and poorly localized periumb pain….gallbladder with sudden distension is RUQ
Vasc disturbances
Parietal peritoneal inflamm
Variable presentation but due to ischemia…pain out of porpotiotn to exam…mesenteric thrombosis produces constant or IM and poorly localized generalized ab pain
Steady and sharp locally over inflamed area…tonic spam…pressure changes worse
Eval of abdominal pain
If acute, consider surgical abdomen - intestinal obstruction and peritonotis
Intestinal obstruction - pain, anorexia, bloating, N/V…emesis can consist of undigested food but may progress…hugh pitched or absent bowel sounds…get CT
Peritonitis - usually with signs of sepsis…lie very still and motion make worse…will have muscle spasms
Gastroenteritis Acute mesenteric ishcemia Chronic mesenteric ischemia Small bowel obstruction Intussusception
acute to subacute and mild to mod…N/V and diarrhea
Acute, severe and persistent pain with hx of afib
Intestinal angina (self-limited pain after eating)…ass with weight loss and eating of smaller meals
Aucte, severe and peristent pain…associate wit hnasuea and emesis
Acute and intermittent at 15-30 minute intervals
Associated with anoreixa, N/V
Spontaneous bact peritonitis DKA Ruptured aortic anuerysm IDS Constipation
Acute to subacute mode to severe pain…hx of cirrhosis
Pain asnd tenderness that shift…hx of diabetes
Ab or back pain and associated with hypotension or pulsatile ab mass
Chronic and mild to mod paine worse with eating and stres but relieved by defacation…acute onset of diarrhea or coinstipation
Chronic, intermittent mild to mod paid
Fecal impacted if acute,sever,e and anorexia
PUD
GERD
Gastritis
Gastroparesis
Subacute to chronic mild to mod relieved or worsened by eating…perforation with acute exacerbation and guarding
Chronic midl to mod worse with eating and lying down…regurg and heartburn
Acute to chornic mild to mod pain worse with eating…aspirin, NSAIDs and alcool
Chonirc, insidois post prandial fullness improved ith eating smlaller meals and ass with vomiting and weight loss
Acute panc
MI
Acute, sudden onset of knife like peigastric pain radiating to the back
Mod to severe after exertion
Biliary colic Cholecystitis Cholangitis Acute hep Urolithiasis Pyelonerhitis
IM, acute pain proviked by eating in the
Acute severe and lastin 4-6 hours
Acute severe…associated with high fever and jaundice
Subacute onset of mild to mod…alcohol or esxp to hep
Spastic pain radiatiing to groin or testicld
Poorly localized with CVA tenderness
