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Year 2 Gastro > Abdominal pain > Flashcards

Abdominal pain Flashcards

1
Q

What do most intra-abdominal diseases present with?

A

Pain alon

Careful Hx never waster

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2
Q

What are the two most significant properties of pain?

A

Site and Character

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3
Q

What is SOCRATES?

A 
Site
Onset
Character
Radiation
Associations
Time
Exacerabating/Relieving factors
Severity
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4
Q

What are the different natures of pain?

A 
Burning
Throbbing
Stabbing
Constricting
Colicky
Aching
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5
Q

What are the abdomino-pelvic regions?

A 
R + L Hypochondriac
R+L Lumbar
R+L Illiac
Epigastric
Umbilical 
Suprapubic/Hypogastric
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6
Q

What are the 4 abdomino pelvic quadrants?

A

RUQ
LUQ
RLQ
LLQ

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7
Q

What are the different planes in the abdomen?

A 
Transpyloric
Subcostal
Supracristal
Intertubercular
Interspinous
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8
Q

At what level is the Transpyloric plane?

A

L1

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9
Q

What does the Transpyloric plane cut across?

A 
Pylorus of Stomach
Neck of Pancreas
Fundus of Gallbladder
Renal Hilum
Duodenojejunal Flexure
End of Spinal Cord (adult)
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10
Q

At what level is the subcostal plane?

A

L3

Over origin of the IMA

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11
Q

At what level is the supracristal plane?

A

L4

Over bifurcation of the Aorta

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12
Q

What comprises the foregut?

A

Distal oesophagus → proximal half of 2nd part of duodenum

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13
Q

What comprises the midgut?

A

Distal half of 2nd part of duodenum → proximal 2/3 of transverse colon

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14
Q

What comprises the hindgut?

A

Distal 1/3 of transverse colon → rectum

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15
Q

What are the two causes of the most painful abdominal pain?

A

Inflammation

Obstruction of muscular tube

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16
Q

What are the features of pain caused by inflammation?

A

Constant pain (‘aching’)
Made worse by movement
Persists until inflammation subsides

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17
Q

What are the features of pain caused by tube obstruction?

A 
Colicky pain (‘gripping’)
Fluctuates in severity
Move to try and get comfortable
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18
Q

What does prolonged obstruction of a hollow viscus cause?

A

Distension
Constant stretching pain
Different from ache of inflammation & not colicky

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19
Q

Where does pain associated with the gallbladder radiate?

A

Through to the back & the right

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20
Q

Where does pain associated with the stomach, duodenum and pancreas radiate?

A

Straight through to the back

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21
Q

Where does pain associated with the tail of the pancreas radiate?

A

Through to the back & the left

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22
Q

What is found in the right hypochondriac region?

A

Gallbladder

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23
Q

What is found in the epigastric region?

A

Stomach, duodenum and pancreas

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24
Q

What is found in the left hypochondriac region?

A

Tail of the pancreas

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25
Q

What is found in the right lumbar region?

A

Kidney

26
Q

What is found in the umbilical region?

A

Small bowel
Caecum
Retroperitoneal structures

27
Q

What is found in the left lumbar region?

A

Kidney

28
Q

What is found in the right illiac region?

A

Appendix & caecum

29
Q

What is found in the leftt illiac region?

A

Sigmoid colon

30
Q

What is found in the suprapubic area?

A

Tx colon
Bladder
Uterus & adnexae

31
Q

What is the parietal peritoneum?

A

Lining of the abdominal wall

32
Q

What is the visceral peritoneum?

A

Covers organs and hollow structures

33
Q

What is the sensory nerves to the visceral peritoneum?

A

Coelic plexus - foregut
Superior mesenteric plexus - midgut
Inferior mesenteric plexus - hindgut

Vagus - non-specific

34
Q

What is the sensory innervation to the parietal peritoneum?

A

Segmental via spinal nerves

35
Q

What is pain in the gut and right shoulder associated with?

A

Phrenic

36
Q

What is visceral innervation?

A

Autonomic
Sympathetic – T1 – T12, L1,L2
Parasympathetic – CN III, VII, IX, X, S2 - 4

37
Q

What is the character if visceral pain?

A

Dull, crampy, burning

38
Q

What is the character of parietal pain?

A

Sharp, ache

39
Q

What organs are associated with colicky pain?

A

Ureter - kidney stones
Gallbladder - biliary system
Small Bowel

40
Q

What organs are associated with constant pain?

A

Kidney
Spleen
Liver

41
Q

Where would kidney pain radiate?

A

In loin & radiates to groin

42
Q

What is typical of uretic colic pain?

A

Severe pain intensity that slowly fluctuates

43
Q

What is typical of biliary ‘colic’?

A

Comes and goes quickly

But lasts persistently

44
Q

What is typical of intestinal colic?

A

Less severe
Moderate-mild
More frequent

45
Q

Where does lower abdominal pain radiate?

A

Lower abdominal pain rarely radiates

Pain from structures deep in the pelvis referred to lower back/perineum

46
Q

What are general features of pain radiation?

A

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

47
Q

What causes RUQ pain?

A

Gallstones
Cholangitis
Hepatitis
Liver abscess

48
Q

What causes LUQ pain?

A

Splenic abscess
Acute splenomegaly
Splenic rupture

49
Q

What causes RLQ pain?

A 
Appendicitis
Crohn’s Disease
Ovarian cyst/torsion
Ectopic pregnancy
Hernias
Renal colic
50
Q

What causes LLQ pain?

A 
Diverticulitis
Ulcerative colitis
Constipation
Ovarian cyst/torsion
PID
Ectopic pregnancy
Hernias
Renal colic
51
Q

What causes umbilical pain?

A

Appendicitis (early)
Mesenteric adenitis
Meckel’s diverticulitis

52
Q

What causes epigastric pain?

A 
Oesophagitis
Peptic ulcer
Perforated ulcer
Pancreatitis
Biliary tract disease
53
Q

What causes suprapubic pain?

A

Urinary retention
Cystitis
Uterine fibroid
Endometriosis

54
Q

What causes right lumbar pain?

A

Renal colic
Pyelonephritis
Ovarian cyst Ovarian mass
Ovarian torsion

55
Q

What causes left lumbar pain?

A

Renal colic
Pyelonephritis
Ovarian cyst Ovarian mass
Ovarian torsion

56
Q

How might a patient with appendicitis present?

A 
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
57
Q

How might a patient with a bowel obstruction present?

A 
Central pain
Gradual onset
Colicky
No radiation
Vomiting, bowels not open
Previous colicky pain
Passing flatus relieves pain
Moderate severity
58
Q

How might a patient with uteric colic present?

A 
Loin pain
Sudden onset 
Colicky
Radiating to groin
Vomiting
Previous colicky pain
Cannot find comfortable position 
10 severity
59
Q

How might a patient biliary with present?

A 
Right upper quadrant
Sudden onset
Colicky
Right shoulder radiation
Nausea, indigestion
After eating 
Fatty foods 
Can be 10/10 severity
60
Q

What is the most common form of bowel obstruction?

A

Adhesions post-surgery or congenital
Fibrotic tissue in abdomen
Scar tissue
If forms closed loop has a great chance of becoming ischameic

61
Q

Why is biliary colic pain worse after eating?

A

Particularly fatty foods

CCK signals for bile to be released

Year 2 Gastro (10 decks)

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