Anatomy: Abdominal Pain and Likely Source Flashcards
What does small intestine consist of?
Duodenum, jejunum and ileum
What does large intestine consist of?
Colon= Caecum, appendix, ascending colon, transverse colon, descending colon & sigmoid colon
- Rectum
- Anal canal
- Anus
What does the colon consist of?
Caecum, Appendix Ascending colon Transverse colon Descending colon Sigmoid colon
What are the 9 regions of the abdomen divided into?
3 Mid-clavicular Subcostal Trans-tubercular
9 Regions of the Stomach?
-Right/ Left Hypochondrium
- Epigastric
- Right/ left lumbar
- Umbilical
- Right/left inguinal
- Pubic
4 Quadrants of abdomen?
Right upper Left upper Right Lower Left lower
3 parts of abdomen based on embryological origins?
Foregut Midgut Hindgut
Organs in foregut?
Oesophagus to mid-duodenum -Liver, gall bladder, spleen and 1/2 pancreas
Organs in midgut?
Mid-duodenum to proximal 2/3 of transverse colon -1/2 pancreas
Organs in hindgut?
Distal 1/3 of transverse colon to proximal 1/2 of anal canal
Layers of abdomen from outside in?
External oblique Internal oblique Transverse abdominis Parietal peritoneum
What is the peritoneal cavity?
Space between the parietal and visceral layers
How are organs classified in regards to the peritoneum?
Intraperitoneal= Liver (almost completely covered in visceral peritoneum, min. mobile) Retroperitoneal= Pancreas and kidneys- only has visceral peritoneum on anterior surface- located in retroperitoneum With a mesentery= Part of intestines- covered in visceral peritoneum, wraps itself behind the organ to form a double layer (v. mobile as mesentery suspends organs from posterior abdominal wall)
What does the peritoneum look like?
Thin Transparent Semi-permeable Serous membrane
What is the peritoneum?
Serous membrane which lines walls of abdominopelvic cavity and organs
How many layers does the peritoneum have? Their names? Where they lie in relation to eachother?
2 layers Visceral and parietal Parietal lies in contact with body wall (soma) Visceral lies in contact with with organs
What does peritoneum do?
Secretes small amount of lubricating fluid
Condensations of Peritoneum?
Double layers which attach organs to each other or the abdominal wall
What do omenta do?
Divide peritoneal cavity into greater and lesser sac
How do the greater and lesser sac communicate and which one is bigger?
Communicate through omental foreman The lesser sac is smaller
Where does the portal triad lie?
Free edge of lesser omentum
What is the pouch of duglas and how is it formed?
The inferior aspect of the peritoneum drapes over the superior aspect of the pelvic organs and forms pouches -Pouch of duglas is the rector-uterine pouch in females
How many pouches in men compared to women?
2 in women ( vesicle uterine and recto-uterine) 1 in men (rectovesicle)
What is ascites?
XS fluid in peritoneal cavity called ascetic fluid
How do you treat ascites?
Drain XS fluid in paracentesis
How to do a paracentesis?
-Place needle lateral to rectal sheath -Avoid inferior epigastric artery (which ascends anterior to abdominal wall) -Use ultrasound
Main 4 questions for stomach pain?
-Location? Visceral or somatic -Character? Dull, achy & nauseating or sharp &stabbing -Timing? Come and go -Pain referral pattern? Is pain showing classical distribution suggesting specific organ
Difference between visceral and somatic pain?
Visceral- hard to localize, dull and achy/ nauseating Somatic- Localized easily, sharp and stabbing
Sympathetic nerve fibers to get from CNS to abdominal organs?
-Leave spinal cord between T5 and L2 -Enter sympathetic chain bilaterally but do not synapse -Leave sympathetic chain within abdominopelvic splanchnic -Synapse at pre-vertebral ganglia (located anterior to aorta) at exit points of major branches of abdominal aorta (Not for adrenal gland)
Sympathetic nerve fibers to get from CNS to abdominal organs in regards to adrenal gland?
Unique -Sympathetic nerve fibers for this leave spinal cord at T10 to L1 -Then enter the abdomenopelvic sphlanchnic nerves -DONT synapse at pre-vertebral ganglia -Carried with parietal plexus to adrenal glands -Synapse directly into cells
Parasympathetic nerve fibers to get from CNS to abdominal organs?
-Pre-synaptic parasympathetic nerve fibers enter abdominal cavity on surface of the oesphagus -Travel to peritoneal plexuses around abdominal aorta -Carried into walls of the organs where they synapse in ganglia -Supply parasympathetic nerve fibers to the GI tract + abdominal organs up to the distal end of transverse colon
What do pain fibres from vast majority of abdomen run alongside?
Sympathetic fibres back to spinal cord
When do Foreguts structures nerve fibers enter spinal cord?
T6-T9
When do Hindguts structures nerve fibers enter spinal cord?
T10- L2
When do Midguts structures nerve fibers enter spinal cord?
T8-T12
Issue in midgut?
Will present as pain in umbilical region (mid-duodenum to proximal 2/3 of transverse colon, 1/2 of pancreas)
Issue in foregut?
Will present as epigastric pain (oesphagus to mid-duodenum & liver, gall bladder, spleen and 1/2 of pancreas)
Issue in hindgut?
Present as pain in pubic region (distal 1/2 of transverse colon to proximal 1/2 of anal canal)
Issue in hindgut?
Present as pain in pubic region (distal 1/2 of transverse colon to proximal 1/2 of anal canal)
Thoracoabdominal nerves?
7th-11th Intercostal nerves they travel anteriorly, the leave the ICS, travel in plane between internal oblique and transversus abdominis
Appendicitis Pain?
Initially dull, aching pain Then becomes sharper at a point right in the iliac fossa Pain from midgut organs tend to be felt in umbilical region because visceral afferents from these organs enter spinal cord at T6
Pain referral nerves image?
Stomach regions diagram?
