Abdominal Pain Flashcards
What makes up the small intestine?
Duodenum (short)
Jejunum (long)
Ileum (long)
What makes up the large intestine (proximal to distal)?
Colon - Caecum - Appendix - Ascending colon - Transverse colon - Descending colon - Sigmoid colon Rectum Anal canal Anus
What are the abdominal organs of the foregut?
Oesophagus to mid-duodenum
Liver + gall bladder
Spleen
½ of pancreas
What are the abdominal organs of the midgut?
Mid-duodenum to proximal 2/3rds of Transverse colon
½ of pancreas
What are the abdomincal organs of the hindgut?
Distal 1/3rd of Transverse colon to Proximal ½ of Anal canal
What are the four quadrants?
Right Upper
Right Lower
Left Upper
Left Lower
What are the nine REGIONS?
Right Hypochondrium Epigastric Left Hypochondrium
Right Lumbar Umbilical Left Lumbar
Right Inguinal Pubic Left Inguinal
What is the role of the abdominal muscles?
contract to guard the abdominal organs when injury threatens
This guarding also occurs in peritonitis
What does the peritoneum line?
walls of the abdominopelvic cavity and organs
What does the parietal peritoneum line?
the body wall
What does the visceral peritoneum line?
the organs
What is the peritoneal cavity?
between the parietal and visceral peritoneum
contains a small amount of lubricating fluid
What will blood, pus, or faeces in the peritoneal cavity cause?
severe and painful inflammation of the peritoneum (peritonitis)
What are the three ways that organs are classed in the peritoneum?
- intraperitoneal
- retroperitoneal
- with a mesentery
Describe intraperitoneal organs?
Almost completely covered in visceral peritoneum
Minimally mobile
Describe retroperitoneal organs?
Only has visceral peritoneum on its anterior surface
Located in the retroperitoneum
Describe organs with a mesentery?
Covered in visceral peritoneum
Visceral peritoneum wraps behind the organ to form a double layer – mesentery
Mesentery suspends the organ from the posterior abdominal wall – very mobile
What is a mesentery?
two layers of visceral peritoneum that wraps around and organ and meets at the end
Name the 5 intraperitoneal organs?
Liver + gall bladder Stomach Spleen (not GI Tract- Lymphatic) Parts of small intestine Transverse colon
Name the 5 retroperitoneal organs?
Kidneys (not GI Tract - Renal) Adrenal gland (not GI Tract – Endocrine) Pancreas Ascending colon Descending colon
What 3 formations occur during peritoneal formation?
Mesentery - Usually connects organ to posterior body wall
Omentum (Greater and Lesser) - Double layer of peritoneum that passes from stomach to adjacent organs
Peritoneal ligaments - Double layer of peritoneum connect organs to one another or body wall
What is the role of the greater omentum?
moves to cover any pathology to try to stop it from spreading
What is the role of the lesser omentum?
splits the visceral pleura into two sacs
Describe the greater omentum?
Four-layered
Hangs like apron
Attaches the greater curvature of stomach to transverse colon
Describe the lesser omentum?
Double-layered
Runs between lesser curvature of stomach and duodenum to liver
Has a free edge
Name the 3 parts of the portal triad? Where does it lie?
hepatic artery
bile duct
portal venule
- free edge of the lesser omentum
What two ligaments does the lesser sac make up?
Hepatogastric ligament
Hepatoduodenal ligament
What are the names of the two pouches that the peritoneum creates in a female?
Vesico-uterine pouch
Recto-uterine pouch (pouch of Douglas)
What is the name of the pouch that the peritoneum creates in a male?
Rectovesical pouch
What is the importance of the pouches made by the peritoneum?
can allow the drainage of excess fluid
What is Ascites? and how can it be treated?
Fluid in the peritoneal cavity
paracentesis/Abdominocentesis
What is Ascites commonly caused by?
liver disease
- Cirrosis
- Portal hypertension
Where must the needle be placed in paracentesis? what does this avoid?
lateral to the rectus sheath
- avoids the inferior epigastric artery
Describe visceral pain?
from an organ
tends to be dull, achy and nauseating
Describe somatic pain?
from the body wall
tends to be sharp and stabbing
What is colicky pain?
pain comes and goes
What nerves are in contact with the visceral peritoneum?
Visceral afferents (sensory nerves)
The enteric nervous system
The autonomic motor nerves
What nerves are in contact with the parietal peritoneum?
(same nerves as the body wall that it is in contact with)
Somatic sensory nerves
Somatic motor nerves
Sympathetic nerve fibres
Where do the sympathetic nerves NORMALLY come from? Where do they come from for the abdomen?
T1-L2
for the abdomen T5-L2
How do sympathetic nerve fibres get from the CNS to the abdominal organs?
Leave the spinal cord between levels T5 and L2
Enter the sympathetic chains (bilaterally) but do not synapse
Leave the sympathetic chains within abdominopelvic splanchnic nerves
Synapse at prevertebral ganglia which are located anterior to the aorta at the exit points of the major branches of the abdominal aorta
Postsynaptic sympathetic nerve fibres pass from the prevertebral ganglia onto the surface of the arterial branches leaving the abdominal aorta
They take part in “periarterial plexuses” with other nerve fibres
What is unique about the adrenal glands sympathetic nerve supply?
DO NOT synapse at prevertebral ganglia
How does the parasympathetic nerve CNX (vagus nerve) reach the abdominal organs?
presynaptic parasympathetic nerve fibres enter abdominal cavity on surface of the oesophagus (“vagal trunks”)
travel into the periarterial plexuses around the abdominal aorta
carried to the walls of the organs where they synapse in ganglia
supply parasympathetic nerve fibres to the GI tract + abdominal organs up to the distal end of the transverse colon
How does the parasympathetic nerve Pelvic Splanchnic Nerves (S2,3,4) reach the abdominal organs?
Presynaptic parasympathetic nerve fibres
smooth muscle/glands of the descending colon to anal canal
What region does foregut pain present?
epigastric
What region does midgut pain present?
umbilical
What region does hind gut pain present?
pubic region
At what vertebral level do visceral afferents corresponding to the foregut structures leave?
T6-T9
At what vertebral level do visceral afferents corresponding to the midgut structures leave?
T8-T12
At what vertebral level do visceral afferents corresponding to the hindgut structures leave?
T10-L2
What is referred pain?
pain from organs tends to be perceived by the patient in the dermatomes of the levels at which the visceral afferents for that organ enter the spinal cord
- ie pain of an organ is translated to body wall pain
