Acute abdomen

Question 1

Definition of acute abdominal pain

Answer 1

• new abdominal pain
• acute onset <10 days
• diagnosed accurately only 45-65%

Question 2

Innervation of the parietal peritoneum

Answer 2

• abdominal wall and parietal peritoneum have SOMATIC nerve supply
• segmental nerve supply: T5-L2
• leads to well-localised pain (somatic pain)
• diaphragm: C3-C5. Pain often radiates to the tip of the shoulder.
• these nerves are sensitive to: tactile, thermal, chemical stimuli

Question 3

Autonomic innervation of the abdomen

Answer 3

• both the solid and hollow viscera (organs of the GI system) are innervated by autonomic nerves
• these are sympathetic nerves via the presacral (L1-L2) and splanchnic (T6-T12) plexuses
• pain is not well localised but location can give clue

Question 4

Where does foregut, midgut and hindgut pain refer to?

Answer 4

Foregut: upper abdomen

Midgut: central abdomen

Hindgut: lower abdomen

Question 5

Nine abdominal regions

Answer 5

Formed by the subcostal and transtubercular planes

Question 6

Where is the appendix located?

Answer 6

Right inguinal region

Question 7

Describe the progression of appendix pain

Answer 7

• starts in umbilical region due to inflammation of the appendix
• when inflammation spreads to the parietal peritoneum you feel it in right inguinal region

Question 8

Difference in pattern between small gut and large gut colicky pain

Answer 8

Small gut: midabdomen, higher frequency

Large gut: lower abdomen (i.e. hindgut structures), lower frequency

Question 9

Colicky vs non-colicky pain

Answer 9

Colic: means pain due to contractions. Usually due to an obstruction (so the gut starts contracting to overcome the obstruction)

Question 10

What are the 3 most common conditions you want to rule out when someone comes in with acute upper abdominal pain (epgastric pain)?

Answer 10

1. Peptic ulcer (could be gastric or duodenal)
2. Pancreatitis
3. Gallstones (which can lead to cholecystitis- inflammation of the gall bladder)

Question 11

Overall causes of acute epgastric pain

Answer 11

Pancreatitis

Peptic ulcer

Myocardial infarction

Acute cholecystitis

Perforated oesophagus

Question 12

Causes of RUQ pain

Answer 12

Acute cholecystitis

Duodenal ulcer

Appendicitis

Question 13

Causes of LUQ pain

Answer 13

Aortic aneurysm

Gastric ulcer

Perforated colon

Ruptured spleen

Question 14

Causes of umbilical pain

Answer 14

Intestinal obstruction

Acute pancreatitis

Early appendicitis

Aortic aneurysm

Diverticulitis

Question 15

Causes of RLQ pain

Answer 15

Appendicitis

Salpingitis- inflammation of the fallopian tubes

Ruptured ectopic pregnancy

Renal/ureteric stones

Perforated caecum

Question 16

Causes of LLQ pain

Answer 16

Salpingitis

Sigmoid diverticulitis

Ruptured ectopic pregnancy

Renal/ureteric stones

Question 17

Causes of suprapubic pain

Answer 17

• bladder problems eg cystitis
• if it’s colicky then you start thinking of large bowel problems

Question 18

What is peritonitis?

Answer 18

Inflammation of the peritoneum. Starts off with visceral peritoneum then can spread to parietal peritoneum

Question 19

Common causes of peritonitis

Answer 19

1. duodenal ulcer
2. diverticulitis
3. intestinal obstruction

Question 20

Features of peritonitis

Answer 20

• pain comes on suddenly, well localised
• constant, not colicky
• aggravated by movement and breathing