Abdominal Pain Flashcards
What is the level of the transpyloric plane?
L1
Which structures pass through the transpyloric plane?
- First lumbar vertebrae (L1)
- Pylorus of stomach
- Neck of pancreas
- Fundus of gallbladder
- Renal hilum
- Duodenojejunal flexure
- End of spinal cord
What is the interspinous plane?
Horizontal plane through the anterior superior iliac spines, marking the boundary of the umbilical region superiorly and the hypogastric region.
At what vertebral level is the supracristal plane?
L4
At what level does the abdominal aorta bifurcate?
L4
What happens at the supracristal plane?
Supracristal plane: Horizontal plane through the iliac crest at the L4 vertebral level.
• Passes through the umbilical and left/right lumbar regions.
• Used to divide the lower and upper abdominal quadrants.
• Level at which the abdominal aorta bifurcates into the left and right common iliac artery.
At what level does the subcostal plane exist?
L3
What is the subcostal plane?
Subcostal plane: Transverse plane which bisects the body at the level of the 10th costal margin, and the vertebra body L3.
What vertebral level is the origin of the inferior mesenteric artery?
L3
What are the 9 abdominal regions?
Right and left hypochondriac Epigastric Right and left lumbar Umbilical Right and left iliac region Hypogastric
In which abdominal region does the gallbladder reside in?
Right hypochondriac region
What structures are associated with the epigastric region?
Stomach, duodenum and pancreas
Which structure is associated with the left hypochondriac region?
Pancreas
The kidneys are associated with which two abdominal regions?
Right and left lumbar regions
Which structures are associated with the umbilical region of the abdomen?
Small bowel
Caecum
Retroperitoneal structures
Which structure is associated with the right iliac region?
Appendix and caecum
Which structures are associated with the hypogastric region?
Transverse colon
Bladder
Uterus and adenxa
The sigmoid colon is associated with which abdominal region?
Left iliac region
What forms the foregut?
The distal oesophagus till the proximal half of the 2nd part of the duodenum
What supplies the foregut?
Coeliac trunk
What are the three main branches of the coeliac trunk?
Left gastric, common hepatic and splenic artery
What forms the midgut
Distal half of 2nd part of duodenum Proximal 2/3 of transverse colon.
What supplies the midgut?
The superior mesenteric artery
What forms the hindgut?
Distal 1/3 of transverse colon till the rectum
What supplies the hindgut?
The inferior mesenteric artery
What lines the abdominal and pelvic cavities?
Parietal peritoneum
What lines the external surfaces of the abdominal organs?
Visceral peritoneum
Which nerves arise from the coeliac plexus?
The greater and lesser splanchnic nerves
What is the innervation of the midgut?
Superior mesenteric plexus
What is the innervation of the hindgut?
Inferior mesenteric plexus
What are the nerve roots for the parasympathetic innervation of the bladder?
Pelvic nerves (S2-S4)
Which nerve innervates the gastrointestinal tract?
Vagus nerve
Which nerve innervates the diaphragm?
The phrenic nerve
What are the nerve roots of the phrenic nerve?
C3-5
Where does referred pain from the phrenic nerve go to?
Radiates to the shoulder
What is the difference in innervation between the visceral and parietal peritoneum?
Visceral is autonomic whereas parietal is somatic
What are sympathetic nerve roots of the visceral peritoneum?
T1-T12
L1-2
What is the parasympathetic roots of the visceral peritoneum,?
IX, X, III, VII and S2-4
What is the character of pain regarding the visceral peritoneum?
Dull, crampy and burning
What is the site of pain with the visceral peritoneum?
Embryological in origin
What is the site of pain for parietal peritoneum?
Well-localised
What is the character of pain for parietal peritoneum?
Sharpe, ache
What is the innervation for sensation of the foregut?
T5-T9
What is the innervation for sensation of the midgut?
T10-T11
What is the innervation for sensation of 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
How is pain by inflammation characterised?
- Constant pain (aching)
- Made worse by movement
- Persists until inflammation subsides + associated with somatic sensation.
How is pain characterised by obstruction?
- Colicky pain (gripping)
- Fluctuates in severity
- Move to try and get comfortable
What is the consequence of prolonged obstruction of a hollow viscus?
Can cause distention- constant stretching pain, that is different from inflammation and not colicky
There is a risk of ischaemia
What is the definition of colicky pain?
Colicky pain describes an intermittent form of pain that begins and stops abruptly due to muscular contractions of a hollow tube in an attempt to relieve the obstruction
Which structures are associated with colicky pain?
- Colon
- Gall bladder
- Ureter
What is colicky pain associated with?
Accompanied by sweating and vomiting + visceral sensation (referred centre)
How is ureteric colic pain characterised?
Associated with intense and fluctuating pain
How is biliary colic pain characterised?
Refers to constant intense pain for a prolonged period of time until relaxing
How is intestinal colic pain characterised?
• Intestinal colic refers to frequent contractions of pain, although the intensity of pain is comparatively less.
Where does gallbladder related pain radiate to?
Through to the back and the right
Where does epigastric related pain radiate to?
Straight through to the back
Where does pancreas related pain radiate to?
Through to the back and the left
Where does kidney related back radiate to?
Loin radiates to the groin
Where does umbilical related pain typically radiate to?
No radiation
Describe the radiation pattern of pain for lower abdominal pain?
Pain originating from structure deep within the pelvis is referred to the lower back/perineum.
N/B: Minimal radiation
