Anatomy: Abdominal Pain and Likely Source

Question 1

What does small intestine consist of?

Answer 1

Duodenum, jejunum and ileum

Question 2

What does large intestine consist of?

Answer 2

Colon= Caecum, appendix, ascending colon, transverse colon, descending colon & sigmoid colon

• Rectum
• Anal canal
• Anus

Question 3

What does the colon consist of?

Answer 3

Caecum, Appendix Ascending colon Transverse colon Descending colon Sigmoid colon

Question 4

What are the 9 regions of the abdomen divided into?

Answer 4

3 Mid-clavicular Subcostal Trans-tubercular

Question 5

9 Regions of the Stomach?

Answer 5

-Right/ Left Hypochondrium

• Epigastric
• Right/ left lumbar
• Umbilical
• Right/left inguinal
• Pubic

Question 6

4 Quadrants of abdomen?

Answer 6

Right upper Left upper Right Lower Left lower

Question 7

3 parts of abdomen based on embryological origins?

Answer 7

Foregut Midgut Hindgut

Question 8

Organs in foregut?

Answer 8

Oesophagus to mid-duodenum -Liver, gall bladder, spleen and 1/2 pancreas

Question 9

Organs in midgut?

Answer 9

Mid-duodenum to proximal 2/3 of transverse colon -1/2 pancreas

Question 10

Organs in hindgut?

Answer 10

Distal 1/3 of transverse colon to proximal 1/2 of anal canal

Question 11

Layers of abdomen from outside in?

Answer 11

External oblique Internal oblique Transverse abdominis Parietal peritoneum

Question 12

What is the peritoneal cavity?

Answer 12

Space between the parietal and visceral layers

Question 13

How are organs classified in regards to the peritoneum?

Answer 13

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)

Question 14

What does the peritoneum look like?

Answer 14

Thin Transparent Semi-permeable Serous membrane

Question 15

What is the peritoneum?

Answer 15

Serous membrane which lines walls of abdominopelvic cavity and organs

Question 16

How many layers does the peritoneum have? Their names? Where they lie in relation to eachother?

Answer 16

2 layers Visceral and parietal Parietal lies in contact with body wall (soma) Visceral lies in contact with with organs

Question 17

What does peritoneum do?

Answer 17

Secretes small amount of lubricating fluid

Question 18

Condensations of Peritoneum?

Answer 18

Double layers which attach organs to each other or the abdominal wall

Question 19

What do omenta do?

Answer 19

Divide peritoneal cavity into greater and lesser sac

Question 20

How do the greater and lesser sac communicate and which one is bigger?

Answer 20

Communicate through omental foreman The lesser sac is smaller

Question 21

Where does the portal triad lie?

Answer 21

Free edge of lesser omentum

Question 22

What is the pouch of duglas and how is it formed?

Answer 22

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

Question 23

How many pouches in men compared to women?

Answer 23

2 in women ( vesicle uterine and recto-uterine) 1 in men (rectovesicle)

Question 24

What is ascites?

Answer 24

XS fluid in peritoneal cavity called ascetic fluid

Question 25

How do you treat ascites?

Answer 25

Drain XS fluid in paracentesis

Question 26

How to do a paracentesis?

Answer 26

-Place needle lateral to rectal sheath -Avoid inferior epigastric artery (which ascends anterior to abdominal wall) -Use ultrasound

Question 27

Main 4 questions for stomach pain?

Answer 27

-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

Question 28

Difference between visceral and somatic pain?

Answer 28

Visceral- hard to localize, dull and achy/ nauseating Somatic- Localized easily, sharp and stabbing

Question 29

Sympathetic nerve fibers to get from CNS to abdominal organs?

Answer 29

-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)

Question 30

Sympathetic nerve fibers to get from CNS to abdominal organs in regards to adrenal gland?

Answer 30

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

Question 31

Parasympathetic nerve fibers to get from CNS to abdominal organs?

Answer 31

-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

Question 32

What do pain fibres from vast majority of abdomen run alongside?

Answer 32

Sympathetic fibres back to spinal cord

Question 33

When do Foreguts structures nerve fibers enter spinal cord?

Answer 33

T6-T9

Question 34

When do Hindguts structures nerve fibers enter spinal cord?

Answer 34

T10- L2

Question 35

When do Midguts structures nerve fibers enter spinal cord?

Answer 35

T8-T12

Question 36

Issue in midgut?

Answer 36

Will present as pain in umbilical region (mid-duodenum to proximal 2/3 of transverse colon, 1/2 of pancreas)

Question 37

Issue in foregut?

Answer 37

Will present as epigastric pain (oesphagus to mid-duodenum & liver, gall bladder, spleen and 1/2 of pancreas)

Question 38

Issue in hindgut?

Answer 38

Present as pain in pubic region (distal 1/2 of transverse colon to proximal 1/2 of anal canal)

Question 39

Issue in hindgut?

Answer 39

Present as pain in pubic region (distal 1/2 of transverse colon to proximal 1/2 of anal canal)

Question 40

Thoracoabdominal nerves?

Answer 40

7th-11th Intercostal nerves they travel anteriorly, the leave the ICS, travel in plane between internal oblique and transversus abdominis

Question 41

Appendicitis Pain?

Answer 41

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

Question 42

Pain referral nerves image?

Answer 42

Question 43

Stomach regions diagram?

Answer 43