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Z YEAR 2 BRS GASTRO > Abdominal Pain Tutorial > Flashcards

Abdominal Pain Tutorial Flashcards

1
Q

How does most intrabdominal disease present?

A
  • pain alone

- careful history important

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2
Q

What are the two most significant properties of pain?

A
  • site
  • character
  • if you know these you have good chance of making correct diagnosis
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3
Q

How do you take an abdominal pain history?

A

socrates

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4
Q

What could the nature of the abdominal pain be?

A
  • Burning
  • Throbbing
  • Stabbing
  • Constricting
  • Colicky
  • aching
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5
Q

What are the abdominopelvic regions?

A
  1. Right hypochrondriac region
  2. Left hypochondriac region
  3. Epigastric region
  4. Umbilical region
  5. hypogastric region
  6. right lumbar region
  7. left lumbar region
  8. right iliac region
  9. left iliac region
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6
Q

What are the abdominopelvic quadrants?

A
  1. Right upper quadrant (RUQ)
  2. Left upper quadrant (LUQ)
  3. Right lower quadrant (RLQ)
  4. Left lower quadrant (LLQ)
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7
Q

What are the different planes?

A
  1. Transpyloric plane
  2. Subcostal plane
  3. Supracristal plane
  4. Intertubercular plane
  5. Interspinous plane
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8
Q

What level is the transpyloric plane?

A

L1

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9
Q

Where is the interspinous plane?

A

line through anterior superior iliac spines

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10
Q

Where is the intertubercular plane?

A

line through iliac tuberclew (L5)

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11
Q

What is at the transpyloric plane?

A
  1. Pylorus of Stomach
  2. Neck of Pancreas
  3. Fundus of Gallbladder
  4. Renal Hilum
  5. Duodenojejunal Flexure
  6. End of Spinal Cord (adult)
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12
Q

What level is the subcostal plane at?

A

L3

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13
Q

What is at the subcostal plane?

A

Origin of Inferior Mesenteric Artery

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14
Q

What level is the supracristal plane?

A

L4

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15
Q

What is at the supracristal plane?

A

Bifurcation of the aorta

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16
Q

What is in the left hypogastric region?

A

pancreas

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17
Q

What is in the right hypogastric region?

A

gallbladder

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18
Q

What is in the epigastric region?

A
  1. stomach
  2. duodenum
  3. pancreas
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19
Q

What is in the right lumbar region?

A

kidney

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20
Q

What is in the left lumbar region?

A

kidney

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21
Q

What is in the right iliac region?

A
  1. appendix

2. caecum

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22
Q

What is in the left iliac region?

A

sigmoid colon

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23
Q

What is in the umbilical region?

A
  1. small bowel
  2. caecum
  3. retroperitoneal structures
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24
Q

What is in the hypogastric region?

A
  1. transverse colon
  2. bladder
  3. uterus
  4. adnexae
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25
Q

Where is the foregut?

A

Distal oesophagus → proximal half of 2nd part of duodenum

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26
Q

Where is the midgut?

A

Distal half of 2nd part of duodenum → proximal 2/3 of transverse colon

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27
Q

Where is the hindgut?

A

Distal 1/3 of transverse colon → rectum

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28
Q

What is small bowel pain like?

A

does not usually radiate but it does MOVE when somatic as well as visceral nerves are irritated

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29
Q

What are the different nerve plexus?

A

CP – coeliac plexus
SMP – superior mesenteric plexus
IMP – Inferior mesenteric plexus

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30
Q

What is the visceral innervation?

A
  1. Autonomic
  2. Sympathetic:
    - T1-T12
    - L1,L2
  3. Parasympathetic:
    - CN III
    - CN VII
    - CN IX
    - CN X
    - S2, S3, S4
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31
Q

What is the site of pain for the visceral?

A

embryological origin

32
Q

What is the character of pain for the visceral?

A
  • dull
  • crampy
  • burning
33
Q

What is the parietal innervation?

A

somatic

34
Q

What is the site of pain for parietal?

A

well-localised

35
Q

What is the character if pain for parietal?

A
  • sharp

- ache

36
Q

What is the innervation for sensation for the foregut?

A

T5-T9

37
Q

What is the innervation for sensation for the midgut?

A

T10-T11

38
Q

What is the innervation for sensation for the hindgut?

A

L1-L2

39
Q

What is the site of pain for the foregut?

A

epigastrum

40
Q

What is the site of pain for the midgut?

A

umbilical

41
Q

What is the site of pain for the hindgut?

A

hypogastrum

42
Q

What are the 2 categories that most painful conditions in the abdomen fall into?

A
  • Inflammation

- Obstruction of a muscular tube

43
Q

What is inflammation pain like?

A
  • Constant pain (‘aching’)
  • Made worse by movement
  • Persists until inflammation subsides
44
Q

What is obstruction of muscular tube pain like?

A
  • Colicky pain (‘gripping’)
  • Fluctuates in severity
  • Move to try and get comfortable
45
Q

What does prolonged obstruction of a hollow viscus cause? What is the pain like?

A

-distension
•Constant stretching pain
•Different from ache of inflammation & not colicky - ?ischaemia

46
Q

If there is pain in the kidney stone what is the pain like?

A

colicky

47
Q

If there is pain in the liver what is the pain like?

A

constant

48
Q

If there is pain in the billiary what is the pain like?

A

colicky

49
Q

If there is pain in the spleen what is the pain like?

A

constant

50
Q

If there is pain in the kidneys what is the pain like?

A

constant

51
Q

If there is pain in the bowel what is the pain like?

A

colicky

52
Q

What is the radiation of the pain of the right hypochondriac region (gallbladder)?

A

through to the back and the right

53
Q

What is the radiation of the pain of the left hypochondriac region (pancreas)?

A

through to the back and the left

54
Q

What is the radiation of the pain of the epigastrum (stomach, duodenum, pancreas)?

A

straight through to the back

55
Q

What is the radiation of the pain of the right lumbar region (kidney)?

A

In loin and radiates to groin

56
Q

What is the radiation of the pain of the left lumbar region (kidney)?

A

In loin and radiates to groin

57
Q

What is the radiation of the pain of the umbilical region (small bowel, caecum, retroperitoneal structures)?

A

Doesn’t normally radiate

58
Q

How does lower abdominal pain radiate?

A
  • Lower abdominal pain rarely radiates

* Pain from structures deep in the pelvis referred to lower back/perineum

59
Q

In general where is colicky abdominal pain referred to?

A

the centre (Visceral sensation)

60
Q

In general where is pain from parietal inflammation felt?

A

over inflamed area (Somatic sensation)

61
Q

What does it signify when pain radiates?

A

other structures are becoming involved

62
Q

When does small bowel pain radiate?

A

doesn’t radiate but may move when somatic as well as visceral nerves become irritated

63
Q

What does right hypochondriac region pain indicate?

A
  1. Gallstones
  2. Cholangitis
  3. Hepatitis
  4. Liver abscess
64
Q

What does left hypochondriac region pain indicate?

A
  1. Splenic abscess
  2. Acute splenomegaly
  3. Splenic rupture
65
Q

What does epigastric region pain indicate?

A
  1. Oesophagitis
  2. Peptic ulcer
  3. Perforated ulcer
  4. Pancreatitis
  5. Biliary tract disease
66
Q

What does umbilical region pain indicate?

A
  1. Appendicitis (early)
  2. Mesenteric adenitis
  3. Meckel’s diverticulitis
67
Q

What does hypogastric region pain indicate?

A
  1. Urinary retention
  2. Cystitis
  3. Uterine fibroid
  4. Endometriosis
68
Q

What does right lumbar region pain indicate?

A
  1. Renal colic
  2. Pyelonephritis
  3. Ovarian cyst
  4. Ovarian mass
  5. Ovarian torsion
69
Q

What does left lumbar region pain indicate?

A
  1. Renal colic
  2. Pyelonephritis
  3. Ovarian cyst
  4. Ovarian mass
  5. Ovarian torsion
70
Q

What does right iliac region pain indicate?

A
  1. Appendicitis
  2. Crohn’s Disease
  3. Ovarian cyst/torsion
  4. Ectopic pregnancy
  5. Hernias
  6. Renal colic
71
Q

What does left iliac region pain indicate?

A
  1. Diverticulitis
  2. Ulcerative colitis
  3. Constipation
  4. Ovarian cyst/torsion
  5. PID
  6. Ectopic pregnancy
  7. Hernias
  8. Renal colic
72
Q

What is ureteric colic pain?

A

Intense

73
Q

What is biliary colic pain?

A

constantly prolonged high intensity

74
Q

What is intestinal colic pain?

A

sinsuodal

75
Q

When does colicky pain become constant?

A

bowel / ischemia (act very quick)

Z YEAR 2 BRS GASTRO (15 decks)

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