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brs (phase 1b) > (gastro) abdominal pain > Flashcards

(gastro) abdominal pain Flashcards

1
Q

how do most intra-abdominal diseases present?

A

present with pain alone mostly

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2
Q

what are the two most significant properties of pain and why are they important?

A

site and character

= good chance of making a correct diagnosis

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3
Q

what is SOCRATES?

A 
S = site 
O = onset 
C = character 
R = radiation 
A = associated symptoms 
T = time course 
E = exacerbating and alleviating factors 
S = severity scale
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4
Q

how would you ask about the site of pain?

A

‘where is the pain?’

‘can you point to where you feel the pain?’

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5
Q

how would you ask about the onset of pain?

A

‘did the pain come on suddenly or gradually?’

‘when did the pain first start?’

‘how long does it last?’

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6
Q

how would you ask about the character of pain?

A

‘how would you describe the pain?’

‘what kind of pain is it?”

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7
Q

how would you ask about the radiation of pain?

A

‘does the pain go anywhere?’

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8
Q

how would you ask about the associated symptoms of the pain?

A

‘are there any other symptoms that seem associated with the pain?’

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9
Q

how would you ask about the timing of pain?

A

‘how has the pain changed over time?’

‘how long have you had this pain for?’

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10
Q

how would you ask about the exacerbating and relieving factors of the pain?

A

‘does anything make the pain worse?’

‘does anything make the pain better?’

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11
Q

how would you ask about the severity of pain?

A

‘on a scale of 0-10, how severe is the pain, if 0 is no pain and 10 is the worst pain you’ve ever experienced?’

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12
Q

what are the two ways the abdomen can be divided?

A

abdominopelvic regions

abdominopelvic quadrants

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13
Q

what are the abdominopelvic regions?

A

right and left hypochondriac regions

right and left lumbar regions

right and left iliac regions/fossae

epigastric region

umbilical region

hypogastric/suprapubic region

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14
Q

what are the abdominopelvic quadrants?

A

right upper quadrant
right lower quadrant
left upper quadrant
left lower quadrant

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15
Q

which surface lines form the nine abdominopelvic regions?

A

vertical = right and left midclavicular line

horizontal = transpyloric plane and interspinous plane

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16
Q

which surface lines form the four abdominopelvic quadrants?

A

vertical and horizontal line through the umbilicus

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17
Q

what is the hypogastric region also called?

A

suprapubic region

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18
Q

name the following planes

A

transpyloric plane
subcostal plane
supracristal plane
intertubercular plane
interspinous plane

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19
Q

what is the vertebral level of the transpyloric plane?

A

L1

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20
Q

what does the transpyloric plane go through?

A

pylorus of stomach

neck of pancreas

fundus of gallbladder

renal hilum

duodenojejunal flexure

end of spinal cord (adult)

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21
Q

how and why are the kidneys not aligned?

A

the right kidney is lower than the left due to the liver pushing down on the right

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22
Q

what is the vertebral level of the subcostal plane?

A

L3

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23
Q

what does the subcostal plane go through?

A

origin of the inferior mesenteric artery

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24
Q

what is the vertebral level of the supracristal plane?

A

L4

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25
Q

what does the supracristal plane go through?

A

bifurcation of the aorta

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26
Q

what is the vertebral level of the intertubercular plane?

A

L4-L5

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27
Q

what does the intertubercular plane go through?

A

passes through the iliac tubercules

(i.e. transtubercular OR intertubercular OR interspinous)

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28
Q

what is the vertebral level of the interspinous plane?

A

L5

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29
Q

what does the interspinous plane go through?

A

passes through the anterior superior iliac spines on the right and the left

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30
Q

which organ/structure(s) most commonly causes problems in the right hypochondriac region?

A

gallbladder

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31
Q

which organ/structure(s) most commonly causes problems in the right lumbar region?

A

right kidney

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32
Q

which organ/structure(s) most commonly causes problems in the right iliac region?

A

appendix & caecum

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33
Q

which organ/structure(s) most commonly causes problems in the epigastrium region?

A

stomach, duodenum, pancreas

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34
Q

which organ/structure(s) most commonly causes problems in the umbilical region?

A

small bowel, caecum, retroperitoneal structures

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35
Q

which organ/structure(s) most commonly causes problems in the hypogastric/suprapubic region?

A

transverse colon, bladder, uterus & adnexae (appendages)

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36
Q

which organ/structure(s) most commonly causes problems in the left hypochondriac region?

A

pancreas

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37
Q

which organ/structure(s) most commonly causes problems in the left lumbar region?

A

left kidney

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38
Q

which organ/structure(s) most commonly causes problems in the left iliac region?

A

sigmoid colon

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39
Q

what are the retroperitoneal structures?

A

kidneys, adrenal glands, pancreas, nerve roots, lymph nodes, abdominal aorta, and inferior vena cava

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40
Q

what is the adnexa and why are they important?

A

adnexa = fallopian tubes, ovaries and surrounding connective tissue

masses or fluid-filled cysts can develop in these regions and be termed: adnexal masses

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41
Q

summarise the abdominopelvic regions and their corresponding organs

A
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42
Q

what are the three divisions of the gut?

A

foregut = distal oesophagus to proximal half of second part of the duodenum

midgut = distal half of second part of the duodenum to the proximal 2/3 of the transverse colon

hindgut = distal 1/3 of the transverse colon to the rectum

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43
Q

what is the foregut?

A

distal oesophagus to proximal half of second part of the duodenum

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44
Q

what is the midgut?

A

distal half of second part of the duodenum to the proximal 2/3 of the transverse colon

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45
Q

what is the hindgut?

A

distal 1/3 of the transverse colon to the rectum

46
Q

what supplies the foregut?

A

coeliac trunk

47
Q

what supplies the midgut?

A

superior mesenteric artery

48
Q

what supplies the hindgut?

A

inferior mesenteric artery

49
Q

what is the abdominal peritoneum?

A

tissue that lines your abdominal wall and covers most of the organs in your abdomen

(lubricated by peritoneal fluid)

50
Q

what are the types of the abdominal peritoneum?

A

one continuous sheet, made up of two types of peritoneum:

  • parietal
  • visceral
51
Q

what is the parietal peritoneum?

A

outer segment of the peritoneum

lines the abdominal and pelvic cavities

52
Q

what is the visceral peritoneum?

A

inner segment of the peritoneum

covers the external surfaces of most of the intraperitoneal organs, including the GI tract

53
Q

differentiate between the visceral and parietal peritoneum

A

while the outer parietal peritoneum covers the abdominal and pelvic cavities/walls, the inner visceral peritoneum covers the surface of the intraperitoneal organs and GI tract

54
Q

what innervates the visceral peritoneum?

A

autonomic nervous system (sympathetic & parasympathetic)

  • parasympathetic from vagus nerve
55
Q

what innervates the parietal peritoneum?

A

somatic and visceral afferents

(phrenic nerve to diaphragm)

56
Q

how is visceral pain localised?

A

embryological origin = foregut, midgut, hindgut

(vague, non-localised)

57
Q

how is parietal pain localised?

A

well-localised, well-defined

58
Q

what is the character of visceral pain?

A

dull ache, crampy, burning

59
Q

what is the character of parietal pain?

A

sharp, severe

60
Q

what innervates the foregut?

A

T5-T9

61
Q

what innervates the midgut?

A

T10-T11

62
Q

what innervates the hindgut?

A

L1-L2

63
Q

where does pain in the foregut usually radiate to?

A

epigastric region

64
Q

where does pain in the midgut usually radiate to?

A

umbilical region

65
Q

where does pain in the hindgut usually radiate to?

A

suprapubic/hypogastric region

66
Q

what triggers parietal pain?

A

irritation/inflammation of the parietal peritoneal wall

67
Q

what triggers visceral pain?

A

when there is damage or disruption to internal organs = nerves running through organ wall get stretched

(bilateral innervation so often midline pain that cannot be localised)

68
Q

explain why parietal pain is well-localised

A

parietal peritoneum innervated unilaterally by the spinal nerves that supply abdominal wall

= unilateral innervation allows parietal pain to localise in a specific region/quadrant

69
Q

why is parietal pain well-localised while visceral pain in vague?

A

parietal peritoneum
= unilateral innervation so pain can be localised in a specific region

visceral organs/glands
= bilateral innervation so often midline pain that cannot be localised

70
Q

why is parietal pain well-localised while visceral pain in vague?

A

parietal peritoneum
= unilateral innervation so pain can be localised in a specific region

visceral organs/glands
= bilateral innervation so often midline pain that cannot be localised

71
Q

differentiate between visceral and parietal pain

A
72
Q

what are the two main causes of abdominal pain?

A

inflamation

obstruction of a muscular tube

(prolonged obstruction of a hollow viscus causes distention)

73
Q

what type of pain occurs in inflammation?

A

constant pain = ‘aching’

persistent pain until inflammation subsides

74
Q

what exacerbates inflammatory pain?

A

made worse on movement

75
Q

what type of pain occurs in obstruction?

A

colicky pain = ‘gripping’

fluctuates in severity

76
Q

what relieves obstruction pain?

A

move to try and get comfortable

77
Q

what type of pain occurs with a prolonged obstruction of a hollow viscus?

A

constant, stretching pain

78
Q

what can prolonged obstruction of a hollow viscus cause?

A

distention

= constant, stretching pain

79
Q

what can prolonged obstruction of a hollow viscus cause and what can this lead to?

A

distention

= constant, stretching pain

(can lead to ischaemia)

80
Q

how does a prolonged obstruction pain compare to that of inflammation and obstruction?

A

inflammation = constant, aching pain

obstruction = colicky, gripping pain

prolonged obstruction = constant, stretching pain w distention
(can lead to ischaemia)

81
Q

what kind of pain (character) would ureteric stones present with?

A

colicky = obstruction of the muscular ureter

82
Q

what kind of pain would liver abscesses and hepatitis present with?

A

constant = inflammation of the liver

83
Q

what kind of pain would gallstones present with?

A

colicky = obstruction of the common bile duct (e.g. bilary colic)

BUT cholecystitis = constant pain as gallbladder inflammation + colicky pain due to obstruction of cystic duct

84
Q

what kind of pain would splenic abscesses and ruptures present with?

A

constant = inflammation of the spleen

85
Q

what kind of pain would pyelonephritis present with?

A

constant = inflammation of the kidney

86
Q

what kind of pain would large bowel obstructions present with?

A

colicky = obstruction of the muscular bowel tube

87
Q

compare the pain intensity of ureteric colic, biliary colic and intestinal colic

A

ureteric = intermittent, very painful at peak

biliary = very painful, fairly constant

intestinal = comparatively less painful, intermittent

88
Q

what is the biggest concern when colicky pain become constant?

A

something is becoming ischaemic = medical emergency (!)

89
Q

where does the pain from the upper abdominopelvic regions radiate to?

A
90
Q

why is pancreatic pain relieved by sitting forward?

A

sit up and lean forwards makes pain better = take pressure off the back of the abdomen

91
Q

where does the pain from the lower abdominopelvic regions radiate to?

A

lower abdominal pain rarely radiates

92
Q

how does kidney pain radiate and why?

A

kidney = classic loin to groin pain (following path of ureter to bladder)

93
Q

what does the radiation of pain signify?

A

the involvement of other structures

94
Q

where is colicky pain referred to?

A

visceral sensation SO referred to the centre

95
Q

where is pain from parietal inflammation felt?

A

somatic sensation SO felt over the inflamed ares

96
Q

what does the following history suggest?

A) appendicitis
B) ruptured abdominal aortic aneurysm (AAA)
C) ureteric colic
D) biliary colic
E) pancreatitis
F) bowel obstruction

A

appendicitis

(can give you pain anywhere in the abdomen; might not specifically get any pain in the right iliac fossa)

97
Q

what does the following history suggest?

A) appendicitis
B) ruptured abdominal aortic aneurysm (AAA)
C) ureteric colic
D) biliary colic
E) pancreatitis
F) bowel obstruction

A

bowel obstruction

(bowels not opened, colicky pain)

98
Q

what does the following history suggest?

A) appendicitis
B) ruptured abdominal aortic aneurysm (AAA)
C) ureteric colic
D) biliary colic
E) pancreatitis
F) bowel obstruction

A

ureteric colic

(from loin to groin is characteristic of kidney/ureteric pain)

99
Q

what does the following history suggest?

A) appendicitis
B) ruptured abdominal aortic aneurysm (AAA)
C) ureteric colic
D) biliary colic
E) pancreatitis
F) bowel obstruction

A

biliary colic

(RUQ, colicky, after eating)

100
Q

what are adhesions and what do they cause?

A

scarring on the inside of the abdomen

= forms bands of fibre that constrict and obstruct free movement through the bowel due to twisting

= can risk ischaemia and necrosis which might require bowel resections

(pic = closed loop adheson)

101
Q

what are the possible causes of pain in the right hypochondriac region?

A

gallstones
cholangitis
hepatitis
liver abscess

102
Q

what are the possible causes of pain in the epigastric region?

A

oesophagitis
peptic ulcer
perforated ulcer
pancreatitis
biliary tract disease

103
Q

what are the possible causes of pain in the left hypochondriac region?

A

splenic abscess
acute splenomegaly
splenic rupture

104
Q

what are the possible causes of pain in the right lumbar region?

A

renal colic
pyelonephritis
ovarian cyst
ovarian mass
ovarian torsion

105
Q

what are the possible causes of pain in the umbilical region?

A

appendicitis (early)
mesenteric adenitis
Meckel’s diverticulitis

106
Q

what are the possible causes of pain in the left lumbar region?

A

renal colic
pyelonephritis
ovarian cyst
ovarian mass
ovarian torsion

107
Q

what are the possible causes of pain in the right iliac region?

A

appendicits (late)
Crohn’s disease
ovarian cyst/mass/torsion
ectopic pregnancy
hernias
renal colic

108
Q

what are the possible causes of pain in the suprapubic region?

A

urinary retention
cystitis
uterine fibroids
endometriosis

109
Q

what are the possible causes of pain in the left iliac region?

A

diverticulitis
ulcerative colitis
constipation
ovarian cyst/torsion
PID (pelvic inflammatory disease)
ectopic pregnancy
hernias
renal colic

110
Q

what are non-abdominal causes of abdominal pain?

A

cardiac causes
lung causes

111
Q

summarise the causes of pain in each abdominopelvic regions

A

brs (phase 1b) (71 decks)

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