Abdominal Pain Flashcards
What do most intra abdominal disease present with?
Pain only
What are the 2 most significant characteristics of pain?
Site and character
How do we take history of pain?
SOCRATES: site onset character radiation associated symptoms time exacerbations severity
What does the transpyloric plane divide?
Upper zone and middle/lower zone
Everything above it is the upper zone
What vertebral level is the transpyloric plane at?
L1
What is seen at the transpyloric plane?
Pylorus of Stomach Neck of Pancreas Fundus of Gallbladder Renal Hilum Duodenojejunal Flexure End of Spinal Cord (adult)
What vertebral level is the subcostal plane at?
L3
What can be found at the subcostal plane?
Origin of the inferior mesenteric artery
What vertebral level is the supracristal plane at?
L4
What can be found at the supracristal plane?
Bifurcation of aorta
What is everything below the supracristal plane known as?
The lower zone
What organs is pain in the right hypochondriac region associated with?
Gallbladder
What organs is pain in the right lumbar region associated with?
Kidney
What organs is pain in the right iliac region associated with?
Appendix and caecum
What organs is pain in the epigastric region associated with?
Stomach, duodenum and pancreas
What organs is pain in the umbilical region associated with?
Small bowel
Caecum
Retroperitoneal structures
What organs is pain in the right hypogastric region associated with?
Transverse colon
Bladder
Uterus
Adnexae
What organs is pain in the left hypochondriac region associated with?
Pancreas
What organs is pain in the left lumbar region associated with?
Kidney
What organs is pain in the left iliac region associated with?
Sigmoid colon
What does the foregut encompass?
Distal oesophagus to proximal half of 2nd part of duodenum
What does the midgut encompass?
Distal half of 2nd part of duodenum to proximal 2/3 of transverse colon
What does the hindgut encompass? What artery supplies it?
Distal 1/3 of transverse colon to rectum, supplied by inferior mesenteric artery
What is the blood supply to the foregut?
Coeliac trunk
What is the blood supply to the midgut?
Superior mesenteric artery
What is the blood supply to the hindgut?
Inferior mesenteric artery
What is the innervation of the visceral peritoneum?
Foregut by the coeliac plexus
Midgut by the superior mesenteric plexus
Hindgut by the inferior mesenteric plexus
What is the innervation of the parietal peritoneum?
It is sectionally innervated
What does the sensory supply of the phrenic nerve cover? Why is this significant?
Right diaphragm ASWELL AS right shoulder, even is the pain originates in the abdomen the patient may complain of right shoulder pain too
What spinal nerves are involved in the sympathetic innervation of the visceral pleura?
T1-T12, L1, L2
What nerves are involved in the parasympathetic innervation of the visceral pleura?
CNIII, VII, IX, X, S2-4
What nerves are involved in the innervation of the parietal pleura?
Somatic nerves
What is the character of pain originating from the visceral pleura?
Dull, crampy, burning
What is the character of pain originating from the parietal pleura?
Sharp, achy
What is the innervation for sensation for the foregut?
T5-T9
What is the innervation for sensation for the midgut?
T10-T11
What is the innervation for sensation for the hindgut?
L1-L2
What is the site of pain for the foregut?
Epigastrium
What is the site of pain for the midgut?
Umbilical
What is the site of pain for the hindgut?
Hypogastrium
What are the 2 main categories for character of abdominal pain?
Inflammation
Obstruction of a muscular tube
How will patients complain of pain caused by inflammation in the abdomen?
Constant pain (‘aching’)
Made worse by movement
Persists until inflammation subsides
How will patients complain of pain caused by obstruction of a muscular tube in the abdomen?
Colicky pain (‘gripping’)- gets very intense and then relaxes Fluctuates in severity Move to try and get comfortable (very specific)
What does prolonged obstruction of a hollow viscus cause? Why is this important
Distention
Its important as it indicates a change in blood supply that causes ischaemia
What will patients complain of when a prolonged obstruction of a hollow viscus causes distention?
Constant stretching pain
Different from ache of inflammation & not colicky
When should you be worries about ischaemia in abdominal pain?
When colicky pain becomes constant
Is kidney pain colicky or constant?
Constant
Is liver pain colicky or constant?
Constant
Is biliary pain colicky or constant?
Colicky
Is spleen pain colicky or constant?
Constant
Is pain from trauma colicky or constant?
Constant
Is bowel pain colicky or constant?
Colicky
Where will gallbladder pain radiate?
Through to the back and right
Where will stomach/duodenum pain radiate?
Straight through to the back
Where will pancreas pain radiate?
Through to the back and the left
Where will kidney pain radiate?
Starts in loin and goes to groin
Where will small bowel/caecum/retroperitoneal structures pain radiate?
Doesn’t normally radiate
Where will lower abdominal pain radiate?
It usually doesn’t
What does radiating pain mean?
Other structures are becoming involved
What other than abdominal problems can cause abdominal pain?
Cardiac causes
Lung causes
Go through SOCRATES for appendicitis
Visceral Umbilical central abdominal pain Then later localises to the right as it affects parietal peritoneum Constant pain Doesn’t tend to radiate May have nausea, anorexia and fever No previous pain Worse on movement Dull ache
What is important to remember with appendicitis pain?
It may not be central or right if their appendix is anatomically somewhere else
Go through SOCRATES for bowel obstruction
Central pain Gradual onset Colicky pain No radiation Vomiting, bowels not open Previous colicky pain Passing flatus relieves pain Moderately severe pain
What is the most common cause of bowel obstruction?
Adhesions, these are areas of scarring tissue (that can arise after surgery)
Go through SOCRATES for ureteric colic
Loin pain Sudden onset Colicky Radiates to the groin Vomiting Previous colicky pain Cannot find a comfortable position 10/10 very severe pain
Go through SOCRATES for biliary colic
Right upper quadrant Sudden onset Colicky Radiates to right shoulder Nausea, indigestion Worse after eating Associated with fatty foods Can be 10/10 pain
What other than kidney problems can present with loin to groin pain?
Rupture of an aortic aneurysm