Abdominal Pain and the Likely Source Flashcards
What does the small intestine consist of?
Duodenum
Jejenum
Ileum
What does the large intestine consist of?
Colon - caecum, appendix, ascending colon, transverse colon, descending colon, sigmoid colon
Rectum
Anal canal
Anus
The hepatic flexure is the junction between
Ascending colon and transverse colon
The junction between the transverse colon and the descending colon is known as
Splenic flexure
What abdominal organs are found in the foregut?
Oesophagus - mid-duodenum, liver, gall bladder, spleen and half of pancreas
What abdominal organs are found in the midgut?
Mid-duodenum - proximal 2/3rds of transverse colon, second half of pancreas
What abdominal organs are found in the hindgut?
Distal third of transverse colon to proximal half of anal canal
What are the regions of the abdomen?
Right hypochondrium Epigastric Left hypochondrium
Right lumbar Umbilical Left lumbar
Right inguinal Hypogastric Left inguinal
What are the muscles of the anterolateral abdominal wall?
Rectus abdominus
External oblique
Internal oblique
Transverse abdominus
What causes the anterolateral abdominal muscles to tense?
The peritoneum underneath it becoming inflamed
Describe the membrane of peritoneum
Thin
Transparent
Semi-permeable
Serous
Explain the peritoneal cavity’s location and how it becomes inflamed
The peritoneal cavity is located within visceral and parietal peritoneum. If blood, pus or faeces enters the cavity it becomes inflamed
Describe an intraperitoneal organ
An intraperitoneal organ is completely covered in visceral peritoneum and have limited mobility
Describe an intraperitoneal organ with a mesentery
Intraperitoneal organs with a mesentery are covered in visceral peritoneum which wraps around the organ to form a double layer. The mesentery suspends the organ from the posterior abdominal wall
Describe a retroperitoneal organ
Retroperitoneal organs only have peritoneum on its anterior surface
List intraperitoneal organs
Liver Gall bladder Spleen Stomach Parts of small intestine Transverse colon
List retroperitoneal organs
Kidneys Pancreas Adrenal gland Ascending colon Descending colon
Define mesentery
Mesentery connects the organ to the posterior body wall. It is a connective tissue with blood, lymph vessels, nodes, nerves and fat
What is omentum?
Omentum is a double layer of peritoneum that attaches the stomach to other organs
Describe the attachment of greater omentum and the number of layers
Greater omentum is four-layered and attaches greater curvature of the stomach to the transverse colon
Describe the attachment of lesser omentum and the number of layers
Lesser omentum is double-layered and attaches the lesser curvature of the stomach and duodenum to liver
How is the peritoneal cavity divided?
The lesser omentum divides the peritoneal cavity into a lesser and greater sac
Explain peritoneal ligaments and give examples
Peritoneal ligaments are double layers of peritoneum that connect organs to one another or to the body wall. Examples include: Splenorenal ligament Gastrosplenic ligament Hepatogastric ligament Hepatoduodenal ligament
How are “pouches” of peritoneum formed?
The inferior aspect of peritoneum drapes over the superior aspect of pelvic organs, forming pouches
What are the pouches of peritoneum found in males and females?
Males - rectovesical pouch
Females - vesicouterine and rectouterine pouch
Describe what ascites is, what causes it and how it is treated
Ascites is the collection of fluid in the peritoneal cavity. It is caused by liver disease and is treated by abdominocentesis
What four things should be found out about a patient’s abdominal pain?
Location
Character
Timing
Referral
What nerves supply the organs of the abdominal cavity and the visceral peritoneum?
Visceral afferents
Enteric nervous system
Autonomic nervous system (sympathetic and parasympathetic)
What nerves supply the abdominal wall?
Somatic sensory
Somatic motor
Sympathetic fibres
What pathway does sympathetic fibres take to supply abdominal organs?
Travel from CNS, through spinal cord and exit between T5-L2
Enter sympathetic chains but do not synapse and leave sympathetic chain within abdominopelvic splanchinic nerves
Nerves synapse at prevertebral ganglia anterior to aorta
Postsynaptic fibres pass from prevertebral ganglia onto branches of the abdominal aorta
“Hitch a ride” with these arteries towards smooth muscle
What is unique about the pathway of sympathetic fibres supplying the adrenal gland?
These fibres are carried with the periarterial plexuses to the adrenal gland where they snapse onto cells
What pathway do parasympathetic fibres from the vagus nerve take to supply the abdominal organs?
Presynaptic parasympathetic fibres enter the abdominal cavity on the surface of the oesophagus
They travel into the periarterial plexuses around the abdominal aorta and are carried to the walls of the aorta where they synapse in ganglia
The fibres supply the GI tract up to the distal end of the transverse colon
What pathway do parasympathetic fibres from the pelvic splanchnic nerves take to supply the abdominal organs?
These fibres come from S2, S3 and S4, and go on to supply the hindgut
Where is pain from the foregut felt?
Epigastric region
Where is pain from the midgut felt?
Umbilical region
Where is pain from the hindgut felt?
Hypogastric region
Where do visceral afferent fibres from the foregut enter the spinal cord?
T6-T9
Where do visceral afferent fibres from the midgut enter the spinal cord?
T8-T12
Where do visceral afferent fibres from the hindgut enter the spinal cord?
T10-L2
What nerves supply somatic motor, somatic sensory and sympathetic fibres to the abdominal wall?
Thoracoabdoinal nerves
Subcostal nerve
Iliohypogastric nerve
Ilioinguinal nerve
Describe the pain presentation of appendicitis
Appenditicits is a dull pain initially before becoming sharp. This is because the appendix is a midgut organ and so pain is felt in the umbilical region
As the inflammation worsens, it irritates the parietal peritoneum, meaning it becomes somatic and therefore sharp
