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LC Gastroenterology Week 1 > Abdominal Pain and the Likely Source > Flashcards

Abdominal Pain and the Likely Source Flashcards

1
Q

What are the 3 parts of the small intestine?

A

Duodenum
Jejunum
Ileum

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2
Q

What is the large intestine made up of?

A 
Colon Colon
	- Caecum
	- Appendix
	- Ascending colon
	- Transverse colon
	- Descending colon
	- Sigmoid colon
Rectum
Anal canal
Anus
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3
Q

What are the organs of the abdomen?

A 
Liver,
Oesophagus (terminal/distal)
Stomach
Gallbladder
Pancreas
Large intestine 
Small intestine
Rectum 
Anus

Spleen
kidneys
Adrenal glands

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4
Q

What are the organs of the foregut?

A

Oesophagus to mid-duodenum
Liver + gall bladder
Spleen
½ of pancreas

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5
Q

What are the organs of the midgut?

A

Mid-duodenum to proximal 2/3rds of Transverse colon

½ of pancreas

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6
Q

What are the organs of the hindgut?

A

Distal 1/3rd of Transverse colon to Proximal ½ of Anal canal

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7
Q

Name the 9 regions of the abdomen?

A 
Right and left Hypochondrium 
Epigastric
Right and left lumbar
Umbilical
Right and left inguinal 
Pubic
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8
Q

Where is the subcostal plane?

A

Just under the level of the right, left Hypochondrium and epigastric

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9
Q

Where is the transtubecular plane?

A

Just under the right, left lumbar and umbilical

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10
Q

What are the muscles of the abdominal wall?

A

Rectus abdominis

External oblique
Internal oblique
Transverse abdominis

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11
Q

Describe guarding?

A

The muscles automatically contract to ‘guard’ the organs when injury threatens…

Occurs in peritonitis

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12
Q

What does the peritoneum line?

A

The walls of the abdominopelvic cavity and organs

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13
Q

Describe the 2 aspects of the peritoneum?

A

Parietal - on the body wall

Visceral - engulfing the organs

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14
Q

Where do you find the peritoneal cavity?

A

Between the visceral and parietal layers

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15
Q

What is peritonitis?

A

Inflammation of the peritoneum, caused by blood, pus or faces in there peritoneal cavity.

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16
Q

Describe intraperitoneal organs?

A

Almost completely covered in visceral peritoneum

Minimally mobile

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17
Q

Describe organs with a mesentery (intraperitoneal)?

A

Covered in visceral peritoneum
Visceral peritoneum wraps behind the organ to form a double layer – mesentery
Mesentery suspends the organ from the posterior abdominal wall – very mobile

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18
Q

Describe retroperitoneal organs?

A

Only has visceral peritoneum on its anterior surface

Located in the retroperitoneum

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19
Q

What is mesentery?

A

When the visceral peritoneum wraps behind the organ to form a double layer

(double layer of peritoneum coming together)

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20
Q

What are the intraperitneal organs of the abdomen?

A 
Liver + gall bladder
Stomach
Spleen (not GI Tract- Lymphatic)
Parts of small intestine
Transverse colon
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21
Q

What are the retroperitoneal organs of the abdomen?

A 
Kidneys (not GI Tract - Renal)
Adrenal gland (not GI Tract – Endocrine)
Pancreas
Ascending colon
Descending colon
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22
Q

Describe mesentery, what does it connect?

A

Connects organs to posterior body wall

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23
Q

Describe the omentum, the greater and lesser?

A

Double layer of peritoneum that passes from stomach to adjacent organs

Lesser - forms between liver and stomach
Greater - forms off the greater curve of stomach

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24
Q

Describe the peritoneal ligaments?

A

Doble layer of peritoneum connect organs to one another or the body wall

e.g. falciform ligament

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25
Q

What does the mesentery provide in terms of mobility?

A

High level of mobility

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26
Q

What are the 3 different parts of mesentery we need to know?

A

The mesentery proper - of the small intestine

Transverse and sigmoid mesocolon

Mesoappendix - connects appendix to ceacum

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27
Q

Where is the attachment site for the mesentery proper?

A

Post. abdominal wall

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28
Q

Describe the greater omentum?

  • what does it attach
A

Four-layered - 2 double layers folding on itself
Hangs like apron - overhangs the small intestine etc.

Attaches the greater curvature of stomach to transverse colon

Can prevent infection by moving to the site of infection to try and control it

29
Q

Describe the lesser omentum?

  • where does it run between?
A

Double layered

Runs between lesser curvature of the stomach And the duodenum to liver

Has a free edge on the right hand side (separates the sacs, lesser and greater) (can find the portal triad in here)

30
Q

What divides the peritoneal cavity into a greater and lesser sac?

A

The omenta

31
Q

How do the 2 sacs communicate?

A

Through the omental foramen (Foramen of winslow)

32
Q

Where does the portal triad lie in?

A

The free edge (hepatoduodenal) of the lesser omentum

33
Q

What is the pouches formed by the peritoneum called?

  • in males and females?
A

Males - rectovesical pouch (between bladder and rectum)

Female - vesico-uterine pouch (between bladder and uterus)
recto-uterine pouch (Pouch of douglas) (between rectum and uterus)

34
Q

What is ascites?

A

collection of fluid in the peritoneal cavity

35
Q

What can ascites be caused by and thus further go on to cause?

A

Can be caused by cirrhosis and from that can cause portal hypertension

36
Q

How can you remove the fluid?

A

Paracentesis/Abdominocentesis

37
Q

Where must the needle be places in paracentesis?

  • and why
A

LATERAL to the recuts sheath - to avoid the inferior epigastric artery

38
Q

Where does the inferior epigastric arise from?

A

The external iliac artery, medial to the deep inguinal ring

39
Q

Describe visceral and somatic pain?

A

Visceral pain - hard to localise, dull achy

Somatic pain - easier to localise, sharp, stabbing

40
Q

What is colicky pain?

A

The pain comes and goes

41
Q

What is the enteric nervous system?

A

an extensive network of nerves found only within the walls of the GI tract which can act independently of other parts of the nervous system to bring about peristalsis but can also be influenced by autonomic motor nerves

42
Q

What are efferent nerves?

A

Efferent - effector nerve = exit

43
Q

How do the sympathetic nerve fibres get from the CNS to the abdominal organs?

A

Leave the spinal cord between levels T5 and L2

44
Q

Where do the sympathetic nerves leave the sympathetic chain?

A

Within the abdominopelvic splanchnic nerves

45
Q

Where is pain felt from organs in the foregut?

A

Epigastric region

46
Q

Where is pain felt from the organs in the midgut?

A

Umbilical region

47
Q

Where is pain felt from the organs in the hindgut?

A

Pubic region

48
Q

Where do the foregut structures pain enter the spinal cord (from visceral afferents)?

A

T6-T9

49
Q

Where do the midgut structures pain enter the spinal cord (from visceral afferents)?

A

T8-T12

50
Q

Where do the handgun structure pain enter the spinal cord (from visceral afferents)?

A

T10-L2

51
Q

What does proximal mean?

A

Nearer to the centre of the body

52
Q

What nerves might be found in organs within the abdomen cavity?

A 
Visceral afferents (sensory nerves)
Enteric nervous system 
Autonomic motor nerves 
- can influence ENS 
- Para - speeds up peristalsis 
- Sympathetic - slows down peristalsis
53
Q

What nerves might be found in the abdomen wall of the abdomen cavity?

A

Somatic sensory
Somatic motor
Sympathetic nerve fibres

54
Q

Where do the sympathetic nerves of the abdomen organs synapse?

A

At pre vertebral ganglia located anterior to the aorta at the exit points of the major branches of the abdomen aorta.

55
Q

Where do the postsynaptic sympathetic nerve fibres pass from the prevertebral ganglia to?

A

The pass onto the surface of the arterial branches leaving the abdominal aorta

56
Q

What do the postsynaptic nerve fibres take part in with other nerve fibres?

A

They take part in periaterial plexuses with other nerve fibres (parasympathetic and visceral afferent)

As they “hitch a ride” with the arteries, and their branches, towards (or away from if sensory) the smooth muscle and glands of the organs

57
Q

Describe how the adrenal gland is unique?

A

Sympathetic nerve fibres for the adrenal gland leave the spinal cord (T10-L1)

Enter the abdominopelvic splanchnic nerves

DO NOT synapse at prevertebral ganglia

Are carried with periarterial plexuses to the adrenal gland

Synapse directly onto cells of the adrenal gland

58
Q

Describe how the vagus nerve (parasympathetic nerve) get from CNS to the abdominal organs?

A

presynaptic parasympathetic nerve fibres enter abdominal cavity on surface of the oesophagus (“vagal trunks”)

travel into the periarterial plexuses around the abdominal aorta

carried to the walls of the organs where they synapse in ganglia

supply parasympathetic nerve fibres to the GI tract + abdominal organs up to the distal end of the transverse colon

59
Q

What does the vague nerve supply in the abdomen?

A

supply parasympathetic nerve fibres to the GI tract + abdominal organs up to the distal end of the transverse colon

60
Q

where do parasympathetic nerve fibres synapse?

A

On the organ wall

61
Q

Describe where the pelvic splanchnic nerves exit the spinal cord?

A

S2,3,4

62
Q

What do the Pelvic Splanchnic Nerves (S2,3,4)

supply?

A

smooth muscle/glands of the descending colon to anal canal

63
Q

How do visceral afferent nerve fibres get from the abdominal organs to the CNS?

A

Pain fibres from the vast majority of the abdominal organs run alongside sympathetic fibres back to the spinal cord

64
Q

Where might liver of gallbladder pain be referred to?

A

Shoulder/neck

65
Q

Describe the thoracoabdominal nerves?

A

7th-11th Intercostal nerves
Travel anteriorly, then leave the intercostal spaces, travel in the plane between the internal oblique and transversus abdominis, as thoracoabdominal nerves

66
Q

What level is the subcostal nerve and what ramus is it?

A

T12 anterior ramus

67
Q

What level is the iliohypogastic nerve and what ramus?

A

Half of L1 anterior ramus

68
Q

What level is the ilioinguinal nerve and what ramus?

A

Other half of L1 anterior ramus

LC Gastroenterology Week 1 (11 decks)

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