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Y3 Lecture week IV > Causes of Abdo pain > Flashcards

Causes of Abdo pain Flashcards

1
Q

What organs does the… contain:

A. Foregut

B. Midgut

C. Hindgut

A

A. Foregut -> stomach, duodenum

B. Midgut -> small intestine

C. Hindgut -> large bowel (colon)

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1
Q
A
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2
Q

Abdo pain: Where is the pain felt usually (location)?

A. one organ

B. Two organs

A

A. one organ -> central pain (e.g. gut, stomach, colon pain)

B. Two organs -> lateral pain (e.g. kidney stone groin/ leg/ testicle)

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3
Q

Abdo pain: Where is the pain felt usually (location)?

A. Visceral peritoneum

B. Parietal peritoneum

A

A. Visceral peritoneum (organ lining) -> pain felt on relevant dermatome

B. Parietal peritoneum (abdominal cavity) -> pain is centralised

e.g. gut pain/ colon - starts with central pain - then peritoneal involvement -> localising pain

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4
Q

Small bowel pain

  • what nerve?
  • which dermatomes?
  • around which anatomical landmark?
A

Gut pain

Nerve: splanchnic nerve (SNS)

Dermatome: T7 - T9

Location: above the umbilicus

*earlier pain - epigastric pain

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5
Q

Colon pain

  • dermatome
A

Colon pain

  • T12 suprapubic pain
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6
Q

Potential causes of duodenal ulcer

A
  • H pylori
  • NSAIDs
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7
Q

Location of duodenal ulcer

A

1st or 2nd part of duodenum

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8
Q
  • When the pain would usually start with a duodenal ulcer?
  • character/description
  • What makes it worse?
A
  • Epigastric/central -> may radiate into the back
  • burning pain
  • pain is less when eaten food with duodenal ulcer
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9
Q

What structures may duodenal ulcer erode into?

a. posterior
b. anterior

A

posterior ulcer - gastro-duodenal a.

anterior ulcer - superior pancreaticoduodenal a.

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10
Q

Potential complication of duodenal ulcer?

A

May penetrate and hit the artery

  • Upper GI bleed
  • haematemesis/ Malena
  • peritonitis
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11
Q

Signs and symptoms of peritonitis

*what’s seen on the chest x-ray?

A
  • severe pain
  • ileus (bowel movements stop/ blockage)

* on chest x ray - errect -> free air under diaphragm (pneumoperitoneum)

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12
Q

Causes of appendicitis

A
  • infection
  • faecolith - hardened stool blocks the outlet of the appendix -> stasis mucous in -> potential infection
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13
Q

Appendicitis

  • where does the pain usually start?
  • where does the pain progress? name of the location
A

Appendicitis

  • early central/umbilical pain T10
  • later progresses into right iliac fossa (McBurney’s point)
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14
Q

What does it mean?

  • ileus
  • guarding
  • rebound
A
  • ileus - bowel stops working
  • guarding - abdominal wall tenses (guards the viscera) upon touching it
  • rebound - pain when we take a hand off e.g. the abdominal wall (we only test once as it’s a strong pain)
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15
Q

Vitamin B12

  • Where do we get it from?
  • what’s needed for its absorption?
  • is it absorbed?
A

diet (meat and milk)

absorption:

  • by the intrinsic factor (from parietal cells )
  • ileal absorption
16
Q
  1. B12 deficiency
    - what condition for it leads to
  2. No intrinsic factor
    - what condition does it lead to?
  3. what other condition may impact B12 absorption as it leads to # ileum?
A
  1. No B12 -> impaired cell division -> megaloblastic anaemia
  2. no intrinsic factor -> pernicious anaemia
  3. no ileum, no B12 - Crohn’s disease
17
Q

When do we get the colic?

A

When the muscular tube is blocked

18
Q

Examples of causes of the blockage causing colic

  • intrinsic
  • mural
  • extrinsic
A

Intrinsic - stones/ bolus

Mural - scars/ tumour

Extrinsic - mass/adhesion

19
Q

What are the other symptoms associated with colic causing:

A. Proximal blockage

B. Distal blockage

A

A. Proximal blockage -> colic with early vomiting (eating and vomiting in a few minutes after)

B. Distal blockage -> colic with constipation and late vomiting (20 minutes or so after the food)

20
Q

What symptoms does the patient get with blocked bile duct?

Location of pain

A. initially

B. Later

A
  • pain - slow and colic
  • jaundice (dark urine, pale stool)

Pain:
A. initially: epigastric

B. later: spreads to the right (but not always)

21
Q

Common causes of duodenal blockage

A. babies

B. adults

A

A. pyloric stenosis (projectile vomit in first few weeks of life)

B. old duodenal ulcers, neurological problems (e.g. pylorus does not relax)

22
Q

Symptoms of blocked duodenum

A
  • early satiety (fullness)
  • vomiting after meals
  • some pain
23
Q

Features on the X ray of blocked ileum

A
24
Q

Causes of ileal blockage

A
  • Crohn’s disease -> scarred and narrowed intestine
  • gallstones -> that go into the duodenum (e.g. via fistula or anatomically) and blocks caecal valve *air in the billary tree would be seen on the x ray
  • adhesions, hernias, tumours
25
Q

What can you see on that x ray?

A
26
Q

Causes of blocked colon

A
  • volvulus
  • tumour
  • diverticular disease -> but diverticulitis (when the pouches will get inflamed recurrently - strictures may form)
  • adhesions
27
Q

Pancreas anatomical location

A

epigastric, behind the stomach

28
Q

causes of pancreatitis

A
29
Q

Where is the pain of pancreatitis?

A. Initially

B. where does it spread

A

Pancreatitis pain

A. initial - epigastric

B. spread - posterior/back (in chronic forms); anterior peritonitis/ abdo pan (in acute - due to enzymatic digestion and necrotic tissue)

30
Q

Diverticulitis

  • where does the pain localise?
A

L lower iliac fossa

* in Japanese people - also R sided pain is possible due to diverticulitis n the caecum

Y3 Lecture week IV (18 decks)

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