Causes of Abdo pain

Question 2

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

A. one organ

B. Two organs

Answer 2

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

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

Question 3

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

A. Visceral peritoneum

B. Parietal peritoneum

Answer 3

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

Question 4

Small bowel pain

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

Answer 4

Gut pain

Nerve: splanchnic nerve (SNS)

Dermatome: T7 - T9

Location: above the umbilicus

*earlier pain - epigastric pain

Question 5

Colon pain

• dermatome

Answer 5

Colon pain

• T12 suprapubic pain

Question 6

Potential causes of duodenal ulcer

Answer 6

• H pylori
• NSAIDs

Question 7

Location of duodenal ulcer

Answer 7

1st or 2nd part of duodenum

Question 8

• When the pain would usually start with a duodenal ulcer?
• character/description
• What makes it worse?

Answer 8

• Epigastric/central -> may radiate into the back
• burning pain
• pain is less when eaten food with duodenal ulcer

Question 9

What structures may duodenal ulcer erode into?

a. posterior
b. anterior

Answer 9

posterior ulcer - gastro-duodenal a.

anterior ulcer - superior pancreaticoduodenal a.

Question 10

Potential complication of duodenal ulcer?

Answer 10

May penetrate and hit the artery

• Upper GI bleed
• haematemesis/ Malena
• peritonitis

Question 11

Signs and symptoms of peritonitis

*what’s seen on the chest x-ray?

Answer 11

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

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

Question 12

Causes of appendicitis

Answer 12

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

Question 13

Appendicitis

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

Answer 13

Appendicitis

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

Question 14

What does it mean?

• ileus
• guarding
• rebound

Answer 14

• 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)

Question 15

Vitamin B12

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

Answer 15

diet (meat and milk)

absorption:

• by the intrinsic factor (from parietal cells )
• ileal absorption

Question 16

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?

Answer 16

1. No B12 -> impaired cell division -> megaloblastic anaemia
2. no intrinsic factor -> pernicious anaemia
3. no ileum, no B12 - Crohn’s disease

Question 17

When do we get the colic?

Answer 17

When the muscular tube is blocked

Question 18

Examples of causes of the blockage causing colic

• intrinsic
• mural
• extrinsic

Answer 18

Intrinsic - stones/ bolus

Mural - scars/ tumour

Extrinsic - mass/adhesion

Question 19

What are the other symptoms associated with colic causing:

A. Proximal blockage

B. Distal blockage

Answer 19

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)

Question 20

What symptoms does the patient get with blocked bile duct?

Location of pain

A. initially

B. Later

Answer 20

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

Pain:
A. initially: epigastric

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

Question 21

Common causes of duodenal blockage

A. babies

B. adults

Answer 21

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

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

Question 22

Symptoms of blocked duodenum

Answer 22

• early satiety (fullness)
• vomiting after meals
• some pain

Question 23

Features on the X ray of blocked ileum

Answer 23

Question 24

Causes of ileal blockage

Answer 24

• 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

Question 25

What can you see on that x ray?

Answer 25

Question 26

Causes of blocked colon

Answer 26

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

Question 27

Pancreas anatomical location

Answer 27

epigastric, behind the stomach

Question 28

causes of pancreatitis

Answer 28

Question 29

Where is the pain of pancreatitis?

A. Initially

B. where does it spread

Answer 29

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)

Question 30

Diverticulitis

• where does the pain localise?

Answer 30

L lower iliac fossa

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

Question 31

What organs does the… contain:

A. Foregut

B. Midgut

C. Hindgut

Answer 31

A. Foregut -> stomach, duodenum

B. Midgut -> small intestine

C. Hindgut -> large bowel (colon)