Abdominal pain Flashcards
What do most intra-abdominal diseases present with?
Pain alon
Careful Hx never waster
What are the two most significant properties of pain?
Site and Character
What is SOCRATES?
Site Onset Character Radiation Associations Time Exacerabating/Relieving factors Severity
What are the different natures of pain?
Burning Throbbing Stabbing Constricting Colicky Aching
What are the abdomino-pelvic regions?
R + L Hypochondriac R+L Lumbar R+L Illiac Epigastric Umbilical Suprapubic/Hypogastric
What are the 4 abdomino pelvic quadrants?
RUQ
LUQ
RLQ
LLQ
What are the different planes in the abdomen?
Transpyloric Subcostal Supracristal Intertubercular Interspinous
At what level is the Transpyloric plane?
L1
What does the Transpyloric plane cut across?
Pylorus of Stomach Neck of Pancreas Fundus of Gallbladder Renal Hilum Duodenojejunal Flexure End of Spinal Cord (adult)
At what level is the subcostal plane?
L3
Over origin of the IMA
At what level is the supracristal plane?
L4
Over bifurcation of the Aorta
What comprises the foregut?
Distal oesophagus → proximal half of 2nd part of duodenum
What comprises the midgut?
Distal half of 2nd part of duodenum → proximal 2/3 of transverse colon
What comprises the hindgut?
Distal 1/3 of transverse colon → rectum
What are the two causes of the most painful abdominal pain?
Inflammation
Obstruction of muscular tube
What are the features of pain caused by inflammation?
Constant pain (‘aching’)
Made worse by movement
Persists until inflammation subsides
What are the features of pain caused by tube obstruction?
Colicky pain (‘gripping’) Fluctuates in severity Move to try and get comfortable
What does prolonged obstruction of a hollow viscus cause?
Distension
Constant stretching pain
Different from ache of inflammation & not colicky
Where does pain associated with the gallbladder radiate?
Through to the back & the right
Where does pain associated with the stomach, duodenum and pancreas radiate?
Straight through to the back
Where does pain associated with the tail of the pancreas radiate?
Through to the back & the left
What is found in the right hypochondriac region?
Gallbladder
What is found in the epigastric region?
Stomach, duodenum and pancreas
What is found in the left hypochondriac region?
Tail of the pancreas
What is found in the right lumbar region?
Kidney
What is found in the umbilical region?
Small bowel
Caecum
Retroperitoneal structures
What is found in the left lumbar region?
Kidney
What is found in the right illiac region?
Appendix & caecum
What is found in the leftt illiac region?
Sigmoid colon
What is found in the suprapubic area?
Tx colon
Bladder
Uterus & adnexae
What is the parietal peritoneum?
Lining of the abdominal wall
What is the visceral peritoneum?
Covers organs and hollow structures
What is the sensory nerves to the visceral peritoneum?
Coelic plexus - foregut
Superior mesenteric plexus - midgut
Inferior mesenteric plexus - hindgut
Vagus - non-specific
What is the sensory innervation to the parietal peritoneum?
Segmental via spinal nerves
What is pain in the gut and right shoulder associated with?
Phrenic
What is visceral innervation?
Autonomic
Sympathetic – T1 – T12, L1,L2
Parasympathetic – CN III, VII, IX, X, S2 - 4
What is the character if visceral pain?
Dull, crampy, burning
What is the character of parietal pain?
Sharp, ache
What organs are associated with colicky pain?
Ureter - kidney stones
Gallbladder - biliary system
Small Bowel
What organs are associated with constant pain?
Kidney
Spleen
Liver
Where would kidney pain radiate?
In loin & radiates to groin
What is typical of uretic colic pain?
Severe pain intensity that slowly fluctuates
What is typical of biliary ‘colic’?
Comes and goes quickly
But lasts persistently
What is typical of intestinal colic?
Less severe
Moderate-mild
More frequent
Where does lower abdominal pain radiate?
Lower abdominal pain rarely radiates
Pain from structures deep in the pelvis referred to lower back/perineum
What are general features of pain radiation?
Colicky abdominal pain is referred to the centre (Visceral sensation)
Pain from parietal inflammation felt over inflamed area (Somatic sensation)
When pain radiates it signifies other structures are becoming involved
Small bowel pain doesn’t radiate but may move when somatic as well as visceral nerves become irritated
What causes RUQ pain?
Gallstones
Cholangitis
Hepatitis
Liver abscess
What causes LUQ pain?
Splenic abscess
Acute splenomegaly
Splenic rupture
What causes RLQ pain?
Appendicitis Crohn’s Disease Ovarian cyst/torsion Ectopic pregnancy Hernias Renal colic
What causes LLQ pain?
Diverticulitis Ulcerative colitis Constipation Ovarian cyst/torsion PID Ectopic pregnancy Hernias Renal colic
What causes umbilical pain?
Appendicitis (early)
Mesenteric adenitis
Meckel’s diverticulitis
What causes epigastric pain?
Oesophagitis Peptic ulcer Perforated ulcer Pancreatitis Biliary tract disease
What causes suprapubic pain?
Urinary retention
Cystitis
Uterine fibroid
Endometriosis
What causes right lumbar pain?
Renal colic
Pyelonephritis
Ovarian cyst Ovarian mass
Ovarian torsion
What causes left lumbar pain?
Renal colic
Pyelonephritis
Ovarian cyst Ovarian mass
Ovarian torsion
How might a patient with appendicitis present?
Central then shifts iliac Gradual Constant pain No radiation Nausea, anorexia, fever Furry tongue and ketotic smell No previous pain Worse on movement Dull ache
How might a patient with a bowel obstruction present?
Central pain Gradual onset Colicky No radiation Vomiting, bowels not open Previous colicky pain Passing flatus relieves pain Moderate severity
How might a patient with uteric colic present?
Loin pain Sudden onset Colicky Radiating to groin Vomiting Previous colicky pain Cannot find comfortable position 10 severity
How might a patient biliary with present?
Right upper quadrant Sudden onset Colicky Right shoulder radiation Nausea, indigestion After eating Fatty foods Can be 10/10 severity
What is the most common form of bowel obstruction?
Adhesions post-surgery or congenital
Fibrotic tissue in abdomen
Scar tissue
If forms closed loop has a great chance of becoming ischameic
Why is biliary colic pain worse after eating?
Particularly fatty foods
CCK signals for bile to be released
