(gastro) abdominal pain Flashcards
1
Q
how do most intra-abdominal diseases present?
A
present with pain alone mostly
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
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
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?’
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?’
6
Q
how would you ask about the character of pain?
A
‘how would you describe the pain?’
‘what kind of pain is it?”
7
Q
how would you ask about the radiation of pain?
A
‘does the pain go anywhere?’
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?’
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?’
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?’
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?’
12
Q
what are the two ways the abdomen can be divided?
A
abdominopelvic regions
abdominopelvic quadrants
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
14
Q
what are the abdominopelvic quadrants?
A
right upper quadrant
right lower quadrant
left upper quadrant
left lower quadrant
15
Q
which surface lines form the nine abdominopelvic regions?
A
vertical = right and left midclavicular line
horizontal = transpyloric plane and interspinous plane
16
Q
which surface lines form the four abdominopelvic quadrants?
A
vertical and horizontal line through the umbilicus
17
Q
what is the hypogastric region also called?
A
suprapubic region
18
Q
name the following planes
A
transpyloric plane
subcostal plane
supracristal plane
intertubercular plane
interspinous plane
19
Q
what is the vertebral level of the transpyloric plane?
A
L1
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)
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
22
Q
what is the vertebral level of the subcostal plane?
A
L3
23
Q
what does the subcostal plane go through?
A
origin of the inferior mesenteric artery
24
Q
what is the vertebral level of the supracristal plane?
A
L4
25
what does the supracristal plane go through?
bifurcation of the aorta
26
what is the vertebral level of the intertubercular plane?
L4-L5
27
what does the intertubercular plane go through?
passes through the iliac tubercules
(i.e. transtubercular OR intertubercular OR interspinous)
28
what is the vertebral level of the interspinous plane?
L5
29
what does the interspinous plane go through?
passes through the anterior superior iliac spines on the right and the left
30
which organ/structure(s) most commonly causes problems in the right hypochondriac region?
gallbladder
31
which organ/structure(s) most commonly causes problems in the right lumbar region?
right kidney
32
which organ/structure(s) most commonly causes problems in the right iliac region?
appendix & caecum
33
which organ/structure(s) most commonly causes problems in the epigastrium region?
stomach, duodenum, pancreas
34
which organ/structure(s) most commonly causes problems in the umbilical region?
small bowel, caecum, retroperitoneal structures
35
which organ/structure(s) most commonly causes problems in the hypogastric/suprapubic region?
transverse colon, bladder, uterus & adnexae (appendages)
36
which organ/structure(s) most commonly causes problems in the left hypochondriac region?
pancreas
37
which organ/structure(s) most commonly causes problems in the left lumbar region?
left kidney
38
which organ/structure(s) most commonly causes problems in the left iliac region?
sigmoid colon
39
what are the retroperitoneal structures?
kidneys, adrenal glands, pancreas, nerve roots, lymph nodes, abdominal aorta, and inferior vena cava
40
what is the adnexa and why are they important?
adnexa = fallopian tubes, ovaries and surrounding connective tissue
masses or fluid-filled cysts can develop in these regions and be termed: adnexal masses
41
summarise the abdominopelvic regions and their corresponding organs
42
what are the three divisions of the gut?
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
43
what is the foregut?
distal oesophagus to proximal half of second part of the duodenum
44
what is the midgut?
distal half of second part of the duodenum to the proximal 2/3 of the transverse colon
45
what is the hindgut?
distal 1/3 of the transverse colon to the rectum
46
what supplies the foregut?
coeliac trunk
47
what supplies the midgut?
superior mesenteric artery
48
what supplies the hindgut?
inferior mesenteric artery
49
what is the abdominal peritoneum?
tissue that lines your abdominal wall and covers most of the organs in your abdomen
(lubricated by peritoneal fluid)
50
what are the types of the abdominal peritoneum?
one continuous sheet, made up of two types of peritoneum:
- parietal
- visceral
51
what is the parietal peritoneum?
outer segment of the peritoneum
lines the abdominal and pelvic cavities
52
what is the visceral peritoneum?
inner segment of the peritoneum
covers the external surfaces of most of the intraperitoneal organs, including the GI tract
53
differentiate between the visceral and parietal peritoneum
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
what innervates the visceral peritoneum?
autonomic nervous system (sympathetic & parasympathetic)
- parasympathetic from vagus nerve
55
what innervates the parietal peritoneum?
somatic and visceral afferents
(phrenic nerve to diaphragm)
56
how is visceral pain localised?
embryological origin = foregut, midgut, hindgut
(vague, non-localised)
57
how is parietal pain localised?
well-localised, well-defined
58
what is the character of visceral pain?
dull ache, crampy, burning
59
what is the character of parietal pain?
sharp, severe
60
what innervates the foregut?
T5-T9
61
what innervates the midgut?
T10-T11
62
what innervates the hindgut?
L1-L2
63
where does pain in the foregut usually radiate to?
epigastric region
64
where does pain in the midgut usually radiate to?
umbilical region
65
where does pain in the hindgut usually radiate to?
suprapubic/hypogastric region
66
what triggers parietal pain?
irritation/inflammation of the parietal peritoneal wall
67
what triggers visceral pain?
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
explain why parietal pain is well-localised
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
why is parietal pain well-localised while visceral pain in vague?
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
why is parietal pain well-localised while visceral pain in vague?
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
differentiate between visceral and parietal pain
72
what are the two main causes of abdominal pain?
inflamation
obstruction of a muscular tube
(prolonged obstruction of a hollow viscus causes distention)
73
what type of pain occurs in inflammation?
constant pain = 'aching'
persistent pain until inflammation subsides
74
what exacerbates inflammatory pain?
made worse on movement
75
what type of pain occurs in obstruction?
colicky pain = 'gripping'
fluctuates in severity
76
what relieves obstruction pain?
move to try and get comfortable
77
what type of pain occurs with a prolonged obstruction of a hollow viscus?
constant, stretching pain
78
what can prolonged obstruction of a hollow viscus cause?
distention
= constant, stretching pain
79
what can prolonged obstruction of a hollow viscus cause and what can this lead to?
distention
= constant, stretching pain
(can lead to ischaemia)
80
how does a prolonged obstruction pain compare to that of inflammation and obstruction?
inflammation = constant, aching pain
obstruction = colicky, gripping pain
prolonged obstruction = constant, stretching pain w distention
(can lead to ischaemia)
81
what kind of pain (character) would ureteric stones present with?
colicky = obstruction of the muscular ureter
82
what kind of pain would liver abscesses and hepatitis present with?
constant = inflammation of the liver
83
what kind of pain would gallstones present with?
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
what kind of pain would splenic abscesses and ruptures present with?
constant = inflammation of the spleen
85
what kind of pain would pyelonephritis present with?
constant = inflammation of the kidney
86
what kind of pain would large bowel obstructions present with?
colicky = obstruction of the muscular bowel tube
87
compare the pain intensity of ureteric colic, biliary colic and intestinal colic
ureteric = intermittent, very painful at peak
biliary = very painful, fairly constant
intestinal = comparatively less painful, intermittent
88
what is the biggest concern when colicky pain become constant?
something is becoming ischaemic = medical emergency (!)
89
where does the pain from the upper abdominopelvic regions radiate to?
90
why is pancreatic pain relieved by sitting forward?
sit up and lean forwards makes pain better = take pressure off the back of the abdomen
91
where does the pain from the lower abdominopelvic regions radiate to?
lower abdominal pain rarely radiates
92
how does kidney pain radiate and why?
kidney = classic loin to groin pain (following path of ureter to bladder)
93
what does the radiation of pain signify?
the involvement of other structures
94
where is colicky pain referred to?
visceral sensation SO referred to the centre
95
where is pain from parietal inflammation felt?
somatic sensation SO felt over the inflamed ares
96
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
appendicitis
(can give you pain anywhere in the abdomen; might not specifically get any pain in the right iliac fossa)
97
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
bowel obstruction
(bowels not opened, colicky pain)
98
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
ureteric colic
(from loin to groin is characteristic of kidney/ureteric pain)
99
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
biliary colic
(RUQ, colicky, after eating)
100
what are adhesions and what do they cause?
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
what are the possible causes of pain in the right hypochondriac region?
gallstones
cholangitis
hepatitis
liver abscess
102
what are the possible causes of pain in the epigastric region?
oesophagitis
peptic ulcer
perforated ulcer
pancreatitis
biliary tract disease
103
what are the possible causes of pain in the left hypochondriac region?
splenic abscess
acute splenomegaly
splenic rupture
104
what are the possible causes of pain in the right lumbar region?
renal colic
pyelonephritis
ovarian cyst
ovarian mass
ovarian torsion
105
what are the possible causes of pain in the umbilical region?
appendicitis (early)
mesenteric adenitis
Meckel's diverticulitis
106
what are the possible causes of pain in the left lumbar region?
renal colic
pyelonephritis
ovarian cyst
ovarian mass
ovarian torsion
107
what are the possible causes of pain in the right iliac region?
appendicits (late)
Crohn's disease
ovarian cyst/mass/torsion
ectopic pregnancy
hernias
renal colic
108
what are the possible causes of pain in the suprapubic region?
urinary retention
cystitis
uterine fibroids
endometriosis
109
what are the possible causes of pain in the left iliac region?
diverticulitis
ulcerative colitis
constipation
ovarian cyst/torsion
PID (pelvic inflammatory disease)
ectopic pregnancy
hernias
renal colic
110
what are non-abdominal causes of abdominal pain?
cardiac causes
lung causes
111
summarise the causes of pain in each abdominopelvic regions
