Abdominal Pain and the Likely Source

Question 1

What does the small intestine consist of?

Answer 1

Duodenum
Jejenum
Ileum

Question 2

What does the large intestine consist of?

Answer 2

Colon - caecum, appendix, ascending colon, transverse colon, descending colon, sigmoid colon
Rectum
Anal canal
Anus

Question 3

The hepatic flexure is the junction between

Answer 3

Ascending colon and transverse colon

Question 4

The junction between the transverse colon and the descending colon is known as

Answer 4

Splenic flexure

Question 5

What abdominal organs are found in the foregut?

Answer 5

Oesophagus - mid-duodenum, liver, gall bladder, spleen and half of pancreas

Question 6

What abdominal organs are found in the midgut?

Answer 6

Mid-duodenum - proximal 2/3rds of transverse colon, second half of pancreas

Question 7

What abdominal organs are found in the hindgut?

Answer 7

Distal third of transverse colon to proximal half of anal canal

Question 8

What are the regions of the abdomen?

Answer 8

Right hypochondrium Epigastric Left hypochondrium
Right lumbar Umbilical Left lumbar
Right inguinal Hypogastric Left inguinal

Question 9

What are the muscles of the anterolateral abdominal wall?

Answer 9

Rectus abdominus
External oblique
Internal oblique
Transverse abdominus

Question 10

What causes the anterolateral abdominal muscles to tense?

Answer 10

The peritoneum underneath it becoming inflamed

Question 11

Describe the membrane of peritoneum

Answer 11

Thin
Transparent
Semi-permeable
Serous

Question 12

Explain the peritoneal cavity’s location and how it becomes inflamed

Answer 12

The peritoneal cavity is located within visceral and parietal peritoneum. If blood, pus or faeces enters the cavity it becomes inflamed

Question 13

Describe an intraperitoneal organ

Answer 13

An intraperitoneal organ is completely covered in visceral peritoneum and have limited mobility

Question 14

Describe an intraperitoneal organ with a mesentery

Answer 14

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

Question 15

Describe a retroperitoneal organ

Answer 15

Retroperitoneal organs only have peritoneum on its anterior surface

Question 16

List intraperitoneal organs

Answer 16

Liver
Gall bladder
Spleen
Stomach
Parts of small intestine
Transverse colon

Question 17

List retroperitoneal organs

Answer 17

Kidneys
Pancreas
Adrenal gland
Ascending colon
Descending colon

Question 18

Define mesentery

Answer 18

Mesentery connects the organ to the posterior body wall. It is a connective tissue with blood, lymph vessels, nodes, nerves and fat

Question 19

What is omentum?

Answer 19

Omentum is a double layer of peritoneum that attaches the stomach to other organs

Question 20

Describe the attachment of greater omentum and the number of layers

Answer 20

Greater omentum is four-layered and attaches greater curvature of the stomach to the transverse colon

Question 21

Describe the attachment of lesser omentum and the number of layers

Answer 21

Lesser omentum is double-layered and attaches the lesser curvature of the stomach and duodenum to liver

Question 22

How is the peritoneal cavity divided?

Answer 22

The lesser omentum divides the peritoneal cavity into a lesser and greater sac

Question 23

Explain peritoneal ligaments and give examples

Answer 23

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

Question 24

How are “pouches” of peritoneum formed?

Answer 24

The inferior aspect of peritoneum drapes over the superior aspect of pelvic organs, forming pouches

Question 25

What are the pouches of peritoneum found in males and females?

Answer 25

Males - rectovesical pouch | Females - vesicouterine and rectouterine pouch

Question 26

Describe what ascites is, what causes it and how it is treated

Answer 26

Ascites is the collection of fluid in the peritoneal cavity. It is caused by liver disease and is treated by abdominocentesis

Question 27

What four things should be found out about a patient's abdominal pain?

Answer 27

Location Character Timing Referral

Question 28

What nerves supply the organs of the abdominal cavity and the visceral peritoneum?

Answer 28

Visceral afferents Enteric nervous system Autonomic nervous system (sympathetic and parasympathetic)

Question 29

What nerves supply the abdominal wall?

Answer 29

Somatic sensory Somatic motor Sympathetic fibres

Question 30

What pathway does sympathetic fibres take to supply abdominal organs?

Answer 30

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

Question 31

What is unique about the pathway of sympathetic fibres supplying the adrenal gland?

Answer 31

These fibres are carried with the periarterial plexuses to the adrenal gland where they snapse onto cells

Question 32

What pathway do parasympathetic fibres from the vagus nerve take to supply the abdominal organs?

Answer 32

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

Question 33

What pathway do parasympathetic fibres from the pelvic splanchnic nerves take to supply the abdominal organs?

Answer 33

These fibres come from S2, S3 and S4, and go on to supply the hindgut

Question 34

Where is pain from the foregut felt?

Answer 34

Epigastric region

Question 35

Where is pain from the midgut felt?

Answer 35

Umbilical region

Question 36

Where is pain from the hindgut felt?

Answer 36

Hypogastric region

Question 37

Where do visceral afferent fibres from the foregut enter the spinal cord?

Answer 37

T6-T9

Question 38

Where do visceral afferent fibres from the midgut enter the spinal cord?

Answer 38

T8-T12

Question 39

Where do visceral afferent fibres from the hindgut enter the spinal cord?

Answer 39

T10-L2

Question 40

What nerves supply somatic motor, somatic sensory and sympathetic fibres to the abdominal wall?

Answer 40

Thoracoabdoinal nerves Subcostal nerve Iliohypogastric nerve Ilioinguinal nerve

Question 41

Describe the pain presentation of appendicitis

Answer 41

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