L2: Understanding abdominal pain:

Question 1

3 types of abdominal pain

Answer 1

visceral
parietal
referred

Question 2

what is visceral pain

Answer 2

sensory fibres from the bowel/ organs/ mesentery conveying pain to the brain with mechanical/ chemical or thermal stimuli

Question 3

what pattern does visceral pain follow

Answer 3

embryological distribution of organs

Question 4

description of visceral pain (5)

Answer 4

• non specific
• poorly localised
• ache or dull pain
• gradual onset
• usually midline

Question 5

foregut=

Answer 5

oesophagus to second part of duodenum

Question 6

midgut=

Answer 6

second part of duodenum to splenic flexure

Question 7

hindgut=

Answer 7

splenic flexture to rectum

Question 8

parietal pain=

Answer 8

sensory nerve fibres in the parietal peritoneum

Question 9

what does parietal pain localise

Answer 9

the organ underneath

Question 10

what pattern does parietal pain follow

Answer 10

dermatological

Question 11

describe parietal pain

Answer 11

• localising pain
• sharp pain
• peritonitic
• worse by movement

Question 12

what pattern does radiation of pain take

Answer 12

from visceral innervation to parietal innervation

Question 13

epigastrium–>

Answer 13

foregut

Question 14

periumbilical –>

Answer 14

midgut

Question 15

hypogastrium–>

Answer 15

hindgut

Question 16

foregut -> RUQ=

Answer 16

cholecystitis

Question 17

foregut ->back=

Answer 17

pancreatitis

Question 18

midgut -> RIF =

Answer 18

appendicitis

Question 19

midgut -> lower=

Answer 19

meckels diverticulitis

Question 20

forgut -> lower right

Answer 20

perforated duodenal ulcer

Question 21

what is referred pain

Answer 21

pain originated from one source felt at another site

Question 22

where is irritation to the diaphragm (e.g by gallbladder) felt

Answer 22

scapular/ shoulder tip area (C3,C4,C5 keeps the diaphragm alive)

Question 23

acute of sudden causes of pain (5)

Answer 23

torsion 
perforation 
ruptured AAA
ischaemia 
obstruction

Question 24

few days onset of pain (2)

Answer 24

• inflammation (cholecystitis, appendicitis, diverticulitis)
• obstruction

Question 25

2 causes of chronic relapses of pain

Answer 25

- exacerbation of Crohn's disease | - recurrent small bowel obstruction

Question 26

colicky pain=

Answer 26

obstruction

Question 27

description of colicky pain

Answer 27

comes and goes in waves, gripping pain and then eases and come again

Question 28

what structure causes the colicky pain

Answer 28

hollow muscular structure trying to unblock itself with exaggerated contractions

Question 29

bowel colic time=

Answer 29

every 15 mins

Question 30

biliary colic time=

Answer 30

2-6 hours

Question 31

which obstruction may not have colicky pain

Answer 31

late bowel obstruction

Question 32

non-colicky pain/ persistent =

Answer 32

inflammation/ itis

Question 33

description of persistent pain

Answer 33

pain for few days which doesn't go away unless with pain killers

Question 34

causes of inflammation persistent pain= (6)

Answer 34

- acute cholecystitis - appendicitis - gastritis - pancreatitis - diverticulitis - colitis

Question 35

gastro tract pathology symptoms=

Answer 35

``` vomiting bleeding bowel changes weight loss fever ```

Question 36

gynae pathology symptoms

Answer 36

PV bleeding | dysmenorrhoea

Question 37

urology pathology symptoms

Answer 37

fever frequency UTI bleeding

Question 38

vascular pathology symptoms

Answer 38

dizziness sweaty palpitations

Question 39

what can a hiatus hernia present as

Answer 39

chest pain

Question 40

liver signs in inspection (4)

Answer 40

ascities spider naevi clubbing jaundice

Question 41

murphy's sign=

Answer 41

tenderness in gallbladder

Question 42

rebound tenderness=

Answer 42

peritoneum is so painful patient jumps

Question 43

tympanic percussion=

Answer 43

gaseous

Question 44

dull percussion=

Answer 44

solid/ fluid

Question 45

2 reasons for increased bowel movement

Answer 45

gastroenteritis | bowel obstruction

Question 46

5 common pathology's of acute abdomen

Answer 46

``` obstruction inflammation perforation biliary vascular ```

Question 47

4 symptoms of obstruction=

Answer 47

- colicky abdo pain - vomiting - absolute constipation - abdominal distension

Question 48

4 signs of obstruction

Answer 48

abdo distension tympanic visible peristalsis increased bowel sounds

Question 49

2 types of obstruction

Answer 49

closed loop | open loop

Question 50

symptoms of inflammation (4)

Answer 50

- persistent abdo pain - feels unwell - maybe fever - localised pain

Question 51

sign of inflammation

Answer 51

abdominal tenderness

Question 52

symptoms of perforation/ peritonitis

Answer 52

persistent colicky pain initially later localising pain progressing to generalised abdo pain

Question 53

signs of perforation/ peritonitis (4)

Answer 53

- tender abdomen - unable to tolerate deep palpation - rigid abdomen - rebound tenderness

Question 54

cholecystitis signs

Answer 54

- tender URQ - murphy's sign positive - pyrexia and tachycardia

Question 55

biliary colic signs

Answer 55

no localising pain | jaundice

Question 56

what is acute cholecystitis

Answer 56

gallstones inflaming gallbladder wall

Question 57

what is biliary stones

Answer 57

gallstones impacted in neck of the gallbladder obstructing gallbladder

Question 58

symptoms of appendicitis

Answer 58

- periumbilical pain radiating to RIF - anorexia - nausea

Question 59

signs of appendicitis

Answer 59

tender at Mcburney's +ve rovsing sign +ve Psoas sign

Question 60

where is Mcburney's point

Answer 60

1/3 between Anterior superior iliac spine to umbilicus

Question 61

symptoms of vascular emergencies

Answer 61

sudden onset of acute pain light headed dizzy loss of concentration

Question 62

signs of vascular emergencies (7)

Answer 62

- tender abdomen (no specific distribution) - peritonitis - pale - tachycardia - sweaty - hypotension - collapsing

Question 63

differential diagnosis for vascular emergencies

Answer 63

ruptured abdominal aneurysm ruptured spleen other aneurysm

Question 64

symptoms of an embolic event

Answer 64

- sudden acute abdominal pain | - restless with severe pain

Question 65

signs of embolic event

Answer 65

- too painful to examine - bowel sounds absent - AF