Acute Abdomen

Question 1

What are the different types of pain?

Answer 1

Somatic pain

• Musculoskeletal pain
• Parietal pain

Visceral pain

• Internal organ/tissue pain
  
  • Hollow organ pain
  • Referred pain

**Neuropathic pain **

Question 2

Musculoskeletal pain

Answer 2

• Comes from skin and underlying tissue
• Usually well-localised
• Usually ‘intense’ in nature
• Examples include:
  
  • Tension headache
  • Arthritis
  • Limb fracture

Question 3

Parietal pain

Answer 3

Pain which arises from the parietal layer of the peritoneum (somatic innervation/spinal nerves)

• Sharp, localised, persistent, worse with movement
• Examples include:
  
  • Peritonitis
  • Pleurisy

Question 4

Visceral pain

Answer 4

Pain from internal organs or pain from tissues arising from visceral peritoneum

• Often not extensively innervated (autonomic NS)
• May be dull, poorly localised, intermittent, midline
• Often described as aching or squeezing
• Caused by compression in and around organs, or by stretching of organ capsule or abdominal cavity
• Examples include:
  
  • Gastric ulcer
  • Irritable bowel syndrome
  • Endometriosis
• Special types
  
  • Hollow-organ pain (‘Colicky’ pain)
  • Referred pain

Question 5

Colicky pain

Answer 5

Comes and goes in waves, related to peristaltic movements

Examples include:

• Renal colic
• Biliary colic

Question 6

Referred pain

Answer 6

Pain perceived at a location other than the site of the painful stimulus

Examples include:

1. AMI
2. Pancreas
3. Diaphragm

Question 7

Neuropathic pain

Answer 7

• Pain due to lesions affecting the somatosensory system (CNS or PNS)
• May be continuous or paroxysmal
• Often associated with abnormal sensations:
  
  • Dysaesthesia
  • Allodynia
  • Phantom limb pain

Question 8

Abdominal pain location

Answer 8

1. upper abdomen: pathology is usually upper GI (stomach, duodenum, liver, gallbladder, pancreas)
2. central abdomen: usually small bowel
3. lower abdomen: usually large bowel, rectum or pelvic organs

Question 9

Define acute abdominal pain

Answer 9

Pain which has been present for less than 24 - 48 hours. Onset may be sudden OR gradual

Question 10

Common causes of acute abdominal pain

Answer 10

• Acute gastroenteritis
• Acute appendicitis
• Irritable bowel syndrome
• Ovulation pain / dysmenorrhoea

Question 11

Serious/not to be missed causes of acute abdominal pain

Answer 11

• Cardiovascular / Respiratory
  
  • MI, pneumonia, ruptured AAA, dissecting aortic aneurysm, mesenteric artery occlusion/embolism
• Neoplasia
  
  • large/small bowel obstruction
• Severe infection
  
  • acute peritonitis, ascending cholangitis, abscess
• Perforated viscus
• Pancreatitis
• Small bowel obstruction / strangulated hernia
• **Sigmoid volvulus **

Question 12

Acute abdominal pain ‘pitfalls’

Answer 12

1. Acute appendicitis
2. Musculosketetal
3. Pulmonary - PE, pneumonia
4. Faecal impaction (elderly)
5. Herpes zoster (“shingles”)

Question 13

Chronic or recurrent abdominal pain common causes

Answer 13

1. Irritable bowel syndrome
2. Peptic ulcer/gastritis
3. Ovulation/period pain/dysmenorrhoea

Question 14

Serious causes of chronic or recurrent abdominal pain

Answer 14

Vascular

• mesenteric artery ischaemia, AAA

Neoplasia

• cancer of bowel, stomach or pancreas - ovarian tumours

Severe infections - hepatitis, PID

Question 15

‘Pitfall’ causes of chronic or recurrent abdominal pain

Answer 15

1. Adhesions
2. Coeliac disease
3. Food allergies
4. Lactose intolerance
5. Constipation
6. Chronic pancreatitis
7. Crohns Disease / Ulcerative Colitis
8. Endometriosis
9. Diverticulitis