Abdominal pain and likely source Flashcards
What are the proximal to distal contents of the small intestine? (DJI)
- Duodenum
- Jejunum
- Ileum
What are the broad divisions of the large intestine? (4)
- Colon
- Rectum
- Anal canal
- Anus
What are the contents of the colon? (6)
- Caecum
- Appendix
- Ascending colon
- Transverse “
- Descending “
- Sigmoid “
What are the divisions of the abdominal organs?
- Foregut
- Midgut
- Hind gut
What structures are found in the foregut? (4)
- Oesophagus- mid duodenum (includes stomach)
- Liver + gall bladder
- Spleen
- Half of pancreas
Structures of the midgut?
- Mid duodenum- proximal 2/3rd of transverse colon
2. Half of pancreas
Structures of hind gut?
Distal 1/3rd of transverse colon to proximal half of anal canal
What are the clinical anatomical divisions of the abdominal organs?
Quadrants- upper, lower RL
What is the function of the muscles found in the anterolateral abdominal wall?
Guards abdominal organs from injury
Guarding also stimulated in peritonitis
The _ lines the walls of the abdominopelvic cavity and the organs
Peritoneum- thin serous membrane
The peritoneum is a CONTINUOUS membrane. What is the difference between visceral and parietal peritoneum?
Parietal- on body wall
Visceral - covers the organs
Where is the peritoneal cavity?
Between the visceral and parietal peritoneum.
Peritoneal cavity- contains lubricating fluid
What is peritonitis?
Blood, pus, faeces in the peritoneal cavity. Causes inflammation of the peritoneum.
V painful
Define the specialised peritona detailed below
- Intraperitoneal
- Retro-peritoneal
- Omentum/ mesentery
- Intra-peritoneal- Visceral peritoneum covers the organ completely. Minimally mobile
- Retroperitoneal- only Anterior surface of organ covered. Located in retro-peritoneum.
- With mesentery- Visceral peritoneum wraps around the organs to form a double layer = mesentery
Very Mobile
What are the intraperitoneal and the retroperitoneal organs?
- Intra-peritoneal
- Stomach
- Liver + gall bladder
- spleen
- transverse colon
- Parts of the intestine - Retro peritoneal
- Kidney
- Ascending colon
- Descending colon
- Pancreas
What does the mesentery peritoneum do?
Connects organ to posterior body wall- Allows blood & neural supply
What does the Omentum do?
Double layer peritoneum connects stomach to other abdominal organs
What do peritoneal ligaments do? What are they? (2)
double layer peritoneum, connects organs to one another or body wall
- Hepato-gastric ligament
- Gastroduodenal ligament
Mesentery provide high levels of mobility. T/F?
True
How many layers does the Greater Omentum have?
4
Connects greater curvature of stomach to transverse colon
How many layers does the Lesser Omentum have?
2
Lesser curvature of stomach to liver
Has Free Edge
Omenta divide the the peritoneal cavity into the _ and _ sacs
Greater and lesser
Role of Omenta foramen?
Communicates between the two sacs
What is the name of the pouch of the peritoneum formed in males?
Rectovesical pouch
Name of the pouches of the peritoneum found in females?
- Recto-uterine (also known as Isle of Douglas
2. Vesico-uterine
Define Ascites. What is its most common pathological cause?
Fluid collection in peritoneal cavity
Most commonly caused by liver disease- cirrhosis, portal hypertension
What is Paracentesis/abdominocentesis?
Draining of Ascitic fluid
During abdominocentesis, the needle has to be placed lateral to the rectus sheath. Why?
To avoid bursting the inferior epigastric artery
Arises from external iliac- medial to deep inguinal ring
What are the 4 main things to consider in Abdominal pain?
- Location
- Timing
- Character
- Pain referral pattern
Difference between presentation of visceral and somatic pain?
Visceral- dull, achy
Somatic- from body wall, tends to be sharp & stabbing
What are the broad classifications of nerves that supply to the abdominal wall?
- Somatic sensory
- Somatic motor
- Sympathetic nerve fibres
What nerves supply the abdominal organs (including visceral peritoneum)
- Visceral afferents
- Enteric nervous system
- ANS
- Sympathetic: slows peristalsis (Abdominopelvic splancic nerves)
- parasympathetic: speeds peristalsis (Vagus, Pelvic splancic nerve)
At which levels of the spinal cord do the sympathetic nerve fibres leave to the abdominal organs?
T5 & L2
The sympathetic nerve fibres leave the sympathetic nerve chains within the _ _ nerves
Abdominopelvic splanchnic nerves
The sympathetic nerves of the abdominal organs synapse at the _ _
pre vertebral ganglia
How do the sympathetic nerves get from the post synapse to the abdominal organs?
Carried to the three different ganglion to Join the periarterial plexus.
Travel with the arteries and its branches to the
muscle/ glands of the organs
At which level do the sympathetic Nerve fibres for the adrenal gland leave?
T10-L1
Travel same as other sympathetic nerves except they synapse directly into the cells of the adrenal gland, not the pre vertebral ganglia
At which level does the Vagus nerve (parasympathetic nerve) enter for the abdominal organs ?
Level of oesophagus
Where does the vagus nerve go through to reach the abdominal organs and where does it synapse?
Through peri-arterial plexus
Synapses in ganglia present in walls of the organs
Supply nerve fibres unto distal end of transverse colon
Pelvic splanchnic nerves (S2,3,4) also supply parasympathetic nerve fibres to the abdominal organs
Where is abdominal pain of the Forgeut generally felt?
Epigastric region
Where is abdominal pain of the Midgut generally felt?
Umbilical region
Where is abdominal pain of the hind gut generally felt?
Pubic region
How do Visceral Afferent nerve fibres get from the abdominal organs to the CNS?
Pain fibres run along sympathetic fibres
At what levels of the spinal cord do the foregut, midgut, and hind gut structure afferents enter?
- Foregut - T6-9
- Midgut - T8-12
- Hindgut- T10-L2
How are the somatic motor, sensory and sympathetic nerves conveyed to the abdominal wall? (4)
- Thoracoabdominal nerves
- Subcostal nerve
- Iliohypogastric nerve
- Ilioinguinal nerve
Why does pain in appendicitis start as dull achy but change to sharp and stabbing?
Initially affects the umbilical region- as pain from midgut organs enter the spinal cord at that region
Progressively the appendix starts to irritate the parietal peritoneum. Somatic sensory nerves stimulated, i.e. sharp pain .
