Causes of Abdo pain Flashcards
Abdo pain: Where is the pain felt usually (location)?
A. one organ
B. Two organs
A. one organ -> central pain (e.g. gut, stomach, colon pain)
B. Two organs -> lateral pain (e.g. kidney stone groin/ leg/ testicle)
Abdo pain: Where is the pain felt usually (location)?
A. Visceral peritoneum
B. Parietal peritoneum
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
Small bowel pain
- what nerve?
- which dermatomes?
- around which anatomical landmark?
Gut pain
Nerve: splanchnic nerve (SNS)
Dermatome: T7 - T9
Location: above the umbilicus
*earlier pain - epigastric pain
Colon pain
- dermatome
Colon pain
- T12 suprapubic pain
Potential causes of duodenal ulcer
- H pylori
- NSAIDs
Location of duodenal ulcer
1st or 2nd part of duodenum
- When the pain would usually start with a duodenal ulcer?
- character/description
- What makes it worse?
- Epigastric/central -> may radiate into the back
- burning pain
- pain is less when eaten food with duodenal ulcer
What structures may duodenal ulcer erode into?
a. posterior
b. anterior
posterior ulcer - gastro-duodenal a.
anterior ulcer - superior pancreaticoduodenal a.
Potential complication of duodenal ulcer?
May penetrate and hit the artery
- Upper GI bleed
- haematemesis/ Malena
- peritonitis
Signs and symptoms of peritonitis
*what’s seen on the chest x-ray?
- severe pain
- ileus (bowel movements stop/ blockage)
* on chest x ray - errect -> free air under diaphragm (pneumoperitoneum)
Causes of appendicitis
- infection
- faecolith - hardened stool blocks the outlet of the appendix -> stasis mucous in -> potential infection
Appendicitis
- where does the pain usually start?
- where does the pain progress? name of the location
Appendicitis
- early central/umbilical pain T10
- later progresses into right iliac fossa (McBurney’s point)
What does it mean?
- ileus
- guarding
- rebound
- 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)
Vitamin B12
- Where do we get it from?
- what’s needed for its absorption?
- is it absorbed?
diet (meat and milk)
absorption:
- by the intrinsic factor (from parietal cells )
- ileal absorption
- B12 deficiency
- what condition for it leads to - No intrinsic factor
- what condition does it lead to? - what other condition may impact B12 absorption as it leads to # ileum?
- No B12 -> impaired cell division -> megaloblastic anaemia
- no intrinsic factor -> pernicious anaemia
- no ileum, no B12 - Crohn’s disease
When do we get the colic?
When the muscular tube is blocked
Examples of causes of the blockage causing colic
- intrinsic
- mural
- extrinsic
Intrinsic - stones/ bolus
Mural - scars/ tumour
Extrinsic - mass/adhesion
What are the other symptoms associated with colic causing:
A. Proximal blockage
B. Distal blockage
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)
What symptoms does the patient get with blocked bile duct?
Location of pain
A. initially
B. Later
- pain - slow and colic
- jaundice (dark urine, pale stool)
Pain:
A. initially: epigastric
B. later: spreads to the right (but not always)
Common causes of duodenal blockage
A. babies
B. adults
A. pyloric stenosis (projectile vomit in first few weeks of life)
B. old duodenal ulcers, neurological problems (e.g. pylorus does not relax)
Symptoms of blocked duodenum
- early satiety (fullness)
- vomiting after meals
- some pain
Features on the X ray of blocked ileum
Causes of ileal blockage
- 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
What can you see on that x ray?
Causes of blocked colon
- volvulus
- tumour
- diverticular disease -> but diverticulitis (when the pouches will get inflamed recurrently - strictures may form)
- adhesions
Pancreas anatomical location
epigastric, behind the stomach
causes of pancreatitis
Where is the pain of pancreatitis?
A. Initially
B. where does it spread
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)
Diverticulitis
- where does the pain localise?
L lower iliac fossa
* in Japanese people - also R sided pain is possible due to diverticulitis n the caecum
What organs does the… contain:
A. Foregut
B. Midgut
C. Hindgut
A. Foregut -> stomach, duodenum
B. Midgut -> small intestine
C. Hindgut -> large bowel (colon)
