🍔Gastro🍔 - Abdominal Pain Flashcards
What are the most significant properties of (abdominal)
Site and character
What are the abdominopelvic regions?
What are the abdominopelvic quadrants?
What are the 5 main planes of the abdomen?
What is the level of the transpyloric plane?
L1
What lies on the transpyloric plane?
Pylorus of the stomach
Neck of the pancreas
Fundus of the gallbladder
Renal hilum
Duodenojejunal flexure
End of spinal cord (adult)
What is the level of the subcostal plane?
L3
What lies on the subcostal plane?
Origin of the inferior mesenteric artery
What is the level of the supracristal plane?
L4
What occurs on the supracristal plane?
Bifurcation of the aorta
What common sites of abdominal pain are located in the right hypochondriac region?
Gallbladder
What common sites of abdominal pain are located in the epigastric region?
Stomach
Duodenum
Pancreas
What common sites of abdominal pain are located in the left hypochondriac region?
Pancreas
What common sites of abdominal pain are located in the right lumbar region?
Kidney
What common sites of abdominal pain are located in the umbilical region?
Small bowel
Caecum
Retroperitoneal structures
What common sites of abdominal pain are located in the left lumbar region?
Kidney
What common sites of abdominal pain are located in the right iliac region?
Appendix
Caecum
What common sites of abdominal pain are located in the hypogastric region?
Terminal colon
Bladder
Uterus
Andexae - the ovaries, fallopian tubes and ligaments that secure the female reproductive organs
What common sites of abdominal pain are located in the left iliac region?
Sigmoid colon
What are the 3 anatomical regions of the GI tract?
Foregut
Midgut
Hindgut
What section of the GI tract is labelled as the foregut?
Distal oesophagus to the proximal half of the 2nd part of the duodenum
What section of the GI tract is labelled as the midgut?
Distal half of the 2nd part of the duodenum to the proximal 2/3 of the transverse colon
What section of the GI tract is labelled as the hindgut?
Distal 1/3 of the transverse colon to the rectum
What are the visceral and parietal peritoneum?
What are innervations of the visceral vs parietal peritoneum?
What are the sites of pain in the visceral vs parietal peritoneum?
Visceral has pain of embryological origin
Parietal has well-localised site of pain
What is the difference in the character of pain experience by the visceral and parietal peritoneum?
Visceral has a dull, crampy, burning pain
Parietal has sharp pain, or an ache
What is the innervation for sensation in the foregut?
T5-T9
What is the innervation for sensation in the midgut?
T10-T11
What is the innervation for sensation in the hindgut?
L1-L2
What are the sites of pain in each of the areas of the gut?
Foregut - epigastrium
Midgut - Umbilical
Hindgut - Hypogastrium
What categories do the most painful abdominal conditions fall into?
Inflammation
Obstruction of a muscular tube
What is experienced with inflammation in the abdomen?
Constant pain (“aching”)
Made worse by movement
Persists until inflammation subsides
What is experience with obstruction of a muscular tube in the abdomen?
Colicky pain (“gripping”)
Fluctuates in severity
Move to try and get comfortable
What can prolonged obstruction of a hollow viscus lead to?
Constant stretching pain
Distention
What should be queried if there is an abdominal pain that is different from the ache of inflammation and is not colicky?
Ischaemia
What character of pain is experienced by the urinary tract?
Colicky
What character of pain is experience by the liver?
Constant
What character of pain is experienced by the biliary tree?
Colicky
What character of pain is experienced by the spleen?
Constant
What character of pain is experienced by the kidney?
Constant
What character of pain is experienced by the intestinal tract?
Colicky
Compare the pains of ureteric, intestinal and biliary colic
What could a transition from colicky to constant pain indicate?
Ischaemia
Where does gallbladder pain radiate to?
Through to the back and right
Where does stomach, duodenal or pancreatic (in the epigastric region) pain radiate to?
Straight through to the back
Where does pancreatic pain in the left hypochondriac region radiate to?
Through to the back and left
Where does kidney pain radiate to?
The loin and radiates to the groin (on the respective side)
Where does small bowel, caecum or retroperitoneal structure pain radiate to?
Doesn’t normally radiate
Where does lower abdominal pain radiate to?
Rarely radiates
Pain from structures deep in the pelvis referred to lower back/perineum
Where does colicky abdominal pain generally radiate to?
Referred to the centre (visceral sensation)
Where does pain from parietal inflammation generally radiate to?
Felt over the inflamed area (somatic sensation)
What are the causes of pain in the right upper quadrant?
Gallstones
Cholangitis
Hepatitis
Liver abscess
What are the causes of pain the the epigastric region?
Oesophagitis
Peptic ulcer
Perforated ulcer
Pancreatitis
Biliary tract disease
What are the causes of pain in the left upper quadrant?
Splenic abscess
Acute splenomegaly
Splenic rupture
What are the causes of pain in the lumbar regions?
Renal colic
Pyelonephritis
Ovarian cyst
Ovarian mass
Ovarian torsion
What are the causes of pain in the right lower quadrant?
Appendicitis
Crohn’s
Ovarian cyst/torsion
Ectopic pregnancy
Hernias
Renal colic
What are the causes of pain in the left lower quadrant?
Diverticulitis
UC
Constipation
Ovarian cyst/torsion
PID
Ectopic pregnancy
Hernias
Renal colic
What are the causes of pain in the pelvic/lower abdominal region?
Urinary retention
Cystitis
Uterine fibroid
Endometriosis
What is the typical SOCRATES of appendicitis?
How will someone with appendicitis present?
Central pain, visceral stimulation
As progresses, starts to irritate the parietal peritoneum
Gradual onset
Recoiling from the idea of food
Non-classical presentation possible (as appendix can be in a number of places)
What is the typical SOCRATES of bowel obstruction?
How does someone with bowel obstruction present?
Can be small or large bowel
Farting relieves pain
Most common cause is adhesions (scar tissue) e.g. post op
Called adhesions because they ‘adhere’ to the bowel
What is a typical SOCRATES for ureteric colic?
How does someone with ureteric colic present?
Very painful - stones through the ureter
Usually a fairly easy diagnosis
What is a typical SOCRATES for biliary colic?
