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BRS Y2 > Abdominal Pain > Flashcards

Abdominal Pain Flashcards

1
Q

What do most intra abdominal disease present with?

A

Pain only

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2
Q

What are the 2 most significant characteristics of pain?

A

Site and character

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3
Q

How do we take history of pain?

A 
SOCRATES:
site
onset
character
radiation
associated symptoms
time
exacerbations
severity
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4
Q

What does the transpyloric plane divide?

A

Upper zone and middle/lower zone

Everything above it is the upper zone

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5
Q

What vertebral level is the transpyloric plane at?

A

L1

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6
Q

What is seen at the transpyloric plane?

A 
Pylorus of Stomach
Neck of Pancreas
Fundus of Gallbladder
Renal Hilum
Duodenojejunal Flexure
End of Spinal Cord (adult)
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7
Q

What vertebral level is the subcostal plane at?

A

L3

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8
Q

What can be found at the subcostal plane?

A

Origin of the inferior mesenteric artery

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9
Q

What vertebral level is the supracristal plane at?

A

L4

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10
Q

What can be found at the supracristal plane?

A

Bifurcation of aorta

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11
Q

What is everything below the supracristal plane known as?

A

The lower zone

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12
Q

What organs is pain in the right hypochondriac region associated with?

A

Gallbladder

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13
Q

What organs is pain in the right lumbar region associated with?

A

Kidney

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14
Q

What organs is pain in the right iliac region associated with?

A

Appendix and caecum

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15
Q

What organs is pain in the epigastric region associated with?

A

Stomach, duodenum and pancreas

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16
Q

What organs is pain in the umbilical region associated with?

A

Small bowel
Caecum
Retroperitoneal structures

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17
Q

What organs is pain in the right hypogastric region associated with?

A

Transverse colon
Bladder
Uterus
Adnexae

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18
Q

What organs is pain in the left hypochondriac region associated with?

A

Pancreas

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19
Q

What organs is pain in the left lumbar region associated with?

A

Kidney

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20
Q

What organs is pain in the left iliac region associated with?

A

Sigmoid colon

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21
Q

What does the foregut encompass?

A

Distal oesophagus to proximal half of 2nd part of duodenum

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22
Q

What does the midgut encompass?

A

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

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23
Q

What does the hindgut encompass? What artery supplies it?

A

Distal 1/3 of transverse colon to rectum, supplied by inferior mesenteric artery

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24
Q

What is the blood supply to the foregut?

A

Coeliac trunk

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25
Q

What is the blood supply to the midgut?

A

Superior mesenteric artery

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26
Q

What is the blood supply to the hindgut?

A

Inferior mesenteric artery

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27
Q

What is the innervation of the visceral peritoneum?

A

Foregut by the coeliac plexus
Midgut by the superior mesenteric plexus
Hindgut by the inferior mesenteric plexus

28
Q

What is the innervation of the parietal peritoneum?

A

It is sectionally innervated

29
Q

What does the sensory supply of the phrenic nerve cover? Why is this significant?

A

Right diaphragm ASWELL AS right shoulder, even is the pain originates in the abdomen the patient may complain of right shoulder pain too

30
Q

What spinal nerves are involved in the sympathetic innervation of the visceral pleura?

A

T1-T12, L1, L2

31
Q

What nerves are involved in the parasympathetic innervation of the visceral pleura?

A

CNIII, VII, IX, X, S2-4

32
Q

What nerves are involved in the innervation of the parietal pleura?

A

Somatic nerves

33
Q

What is the character of pain originating from the visceral pleura?

A

Dull, crampy, burning

34
Q

What is the character of pain originating from the parietal pleura?

A

Sharp, achy

35
Q

What is the innervation for sensation for the foregut?

A

T5-T9

36
Q

What is the innervation for sensation for the midgut?

A

T10-T11

37
Q

What is the innervation for sensation for the hindgut?

A

L1-L2

38
Q

What is the site of pain for the foregut?

A

Epigastrium

39
Q

What is the site of pain for the midgut?

A

Umbilical

40
Q

What is the site of pain for the hindgut?

A

Hypogastrium

41
Q

What are the 2 main categories for character of abdominal pain?

A

Inflammation

Obstruction of a muscular tube

42
Q

How will patients complain of pain caused by inflammation in the abdomen?

A

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

43
Q

How will patients complain of pain caused by obstruction of a muscular tube in the abdomen?

A 
Colicky pain (‘gripping’)- gets very intense and then relaxes 
Fluctuates in severity
Move to try and get comfortable (very specific)
44
Q

What does prolonged obstruction of a hollow viscus cause? Why is this important

A

Distention

Its important as it indicates a change in blood supply that causes ischaemia

45
Q

What will patients complain of when a prolonged obstruction of a hollow viscus causes distention?

A

Constant stretching pain

Different from ache of inflammation & not colicky

46
Q

When should you be worries about ischaemia in abdominal pain?

A

When colicky pain becomes constant

47
Q

Is kidney pain colicky or constant?

A

Constant

48
Q

Is liver pain colicky or constant?

A

Constant

49
Q

Is biliary pain colicky or constant?

A

Colicky

50
Q

Is spleen pain colicky or constant?

A

Constant

51
Q

Is pain from trauma colicky or constant?

A

Constant

52
Q

Is bowel pain colicky or constant?

A

Colicky

53
Q

Where will gallbladder pain radiate?

A

Through to the back and right

54
Q

Where will stomach/duodenum pain radiate?

A

Straight through to the back

55
Q

Where will pancreas pain radiate?

A

Through to the back and the left

56
Q

Where will kidney pain radiate?

A

Starts in loin and goes to groin

57
Q

Where will small bowel/caecum/retroperitoneal structures pain radiate?

A

Doesn’t normally radiate

58
Q

Where will lower abdominal pain radiate?

A

It usually doesn’t

59
Q

What does radiating pain mean?

A

Other structures are becoming involved

60
Q

What other than abdominal problems can cause abdominal pain?

A

Cardiac causes

Lung causes

61
Q

Go through SOCRATES for appendicitis

A 
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
62
Q

What is important to remember with appendicitis pain?

A

It may not be central or right if their appendix is anatomically somewhere else

63
Q

Go through SOCRATES for bowel obstruction

A 
Central pain
Gradual onset
Colicky pain
No radiation
Vomiting, bowels not open
Previous colicky pain
Passing flatus relieves pain
Moderately severe pain
64
Q

What is the most common cause of bowel obstruction?

A

Adhesions, these are areas of scarring tissue (that can arise after surgery)

65
Q

Go through SOCRATES for ureteric colic

A 
Loin pain
Sudden onset
Colicky
Radiates to the groin
Vomiting
Previous colicky pain
Cannot find a comfortable position
10/10 very severe pain
66
Q

Go through SOCRATES for biliary colic

A 
Right upper quadrant
Sudden onset
Colicky
Radiates to right shoulder
Nausea, indigestion
Worse after eating
Associated with fatty foods
Can be 10/10 pain
67
Q

What other than kidney problems can present with loin to groin pain?

A

Rupture of an aortic aneurysm

BRS Y2 (85 decks)

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