Abdominal pain

Question 1

What organs make up the foregut?

Answer 1

oesophagus, stomach, duodenum, biliary tree

Question 2

What organs make up the midgut?

Answer 2

rest of small bowel, large bowel up till splenic flexure

Question 3

what organs make up the hindgut?

Answer 3

rest of large bowel to superior anal canal

Question 4

What vessel supplies the foregut?

Answer 4

coeliac axis

Question 5

What vessel supplies the midgut?

Answer 5

superior mesenteric artery

Question 6

What vessel supplies the hindgut?

Answer 6

inferior mesenteric artery

Question 7

Which artery covers the SMA and IMA?

Answer 7

marginal artery

good anastamoses so collateral supply to colon

Question 8

What causes visceral abdominal pain?

Answer 8

distention, inflammation or ischaemia of hollow viscous or solid organs

Question 9

What pain fibres transmit visceral abdominal pain?

Answer 9

c fibres

Question 10

How does visceral pain feel?

Answer 10

dull, achey, poorly localised

Question 11

What is visceral pain localisation dependent on?

Answer 11

embryological origin eg. foregut, midgut, hindgut

Question 12

Where is foregut visceral pain felt?

Answer 12

epigastrium

Question 13

Where is midgut visceral pain felt?

Answer 13

umbilicus

Question 14

Where is hindgut visceral pain felt?

Answer 14

hypogastric

Question 15

What causes somato-parietal pain?

Answer 15

inflammation, stretching or tearing of the parietal peritoneum

Question 16

Where are the pain receptors for somato-parietal pain?

Answer 16

parietal peritoneum, muscle and skin

Question 17

Which pain fibres transmit somato-parietal pain and to where?

Answer 17

myelinated A delta fibres to specific dorsal root ganglia

Question 18

What is somato-parietal pain like?

Answer 18

sharp, more intense and localised

Question 19

What are signs of somato-parietal pain?

Answer 19

tenderness
guarding
rigidity
rebound

Question 20

Why does referred pain occur?

Answer 20

when organs share common nerve pathway

Question 21

Where can gallbladder pain refer to?

Answer 21

right shoulder tip

Question 22

In which type of ulcer is pain relieved by eating?

Answer 22

duodenal

Question 23

In which type of ulcer is pain worsened by eating?

Answer 23

gastric

Question 24

What causes pain in the RUQ radiating to back after a fatty meal?

Answer 24

biliary colic

Question 25

How does diverticulitis present ?

Answer 25

left lower quadrant colicky pain
fever
raised inflammatory markers
raised white cells

Question 26

What does Severe central abdominal pain radiating to the back suggest?

Answer 26

abdominal aortic aneurysm

Question 27

Does bowel obstruction cause guarding and rebound tenderness?

Answer 27

no not unless ischaemia is occuring

Question 28

Which blood test can indicate ischaemia?

Answer 28

high lactate

Question 29

How does small bowel obstruction look on AXR?

Answer 29

dilated bowel in central abdomen

Valvulae conniventes visible (lines completely crossing the bowel)

Question 30

How does large bowel obstruction look on AXR?

Answer 30

dilated bowel in periphery

haustral lines - go half way across

Question 31

How can bowel obstruction be managed conservatively?

Answer 31

nil by mouth
insert NG tube to “suck” and decompress bowel
start IV fluids + urinary catheter

Question 32

A 45 year old woman has 1 year of recurrent intermittent abdominal pain radiating to the back. The pain is 8/10 in severity, can last several hours and resolves spontaneously. She has lost 2 kg over the past 7 months. She is an ex-smoker and was a heavy drinker until 6 months ago.Her temperature is 36.8°C, pulse rate 74 bpm, BP 128/84 mmHg and oxygen saturation 99% breathing air. Her abdomen is soft and not distended, with mild tenderness in the epigastric region.

Which is the most likely diagnosis? 
A. Cholangiocarcinoma 
B. Chronic pancreatitis 
C. Mesenteric ischaemia
 D. Pancreatic cancer 
E. Peptic ulcer

Answer 32

B. chronic pancreatitis