Lec 9 Abdominal Pain Flashcards
Which type of abdominal pain is easy to localize?
somatic
Which type of abdominal pain is hard to localize?
visceral
What are characteristics of visceral afferents:
- how many
- bilateral or unilateral
- how do they localize
few in number, bilateral
diverge up and down several segments making it hard to localize
What are some stimuli for visceral afferents?
- distension
- traction
- pressure
- smooth muscle contraction
- ischemia
What are characteristics of somatic afferents:
- how many
- bilateral or unilateral
- how do they localize
high in number, unilateral and segmented traveling w/in dermatomal nerves; minimally diverge and easy to localize with pinpoint
What structures cause epigastric [T5-T8] pain?
- stomach
- proximal duodenum
- pancreas
- gallbladder
- common bile duct [CBD]
- liver
What structures cause periumbilical pain [T9-10]?
- distal duodenum
- small bowel
- appendix
What structures cause hypogastric pain [T11-T12]?
- colon
- bladder
- rectum
- ureters
- uterus
Diaphragmatic irritation causes referred pain to where?
to ipsilateral shoulder
Where is referred pain from pancreas felt?
midback
Where is referred pain from rectum felt?
low back
Where is referred pain from gallbladder felt?
scapular area
Where is referred pain from liver felt?
right shoulder
What is the visceral pain reflex phenomena? examples?
viscera send signals to spinal cord and reflex back to feed skeletal muscle, skin, and sweat glands at same level
examples:
- decreased bowel motility
- reflex contraction of skeletal muscle = involuntary guarding
- changes in local blood flow and sweating
What is the pathophysiology of appendicitis?
- luminal obstruction, maybe due to fecalith
- causes increased intraluminal pressure –> increases wall tension/distension and visceral pain –> venous pressure exceded –> venous collapse –> ischemia of appedix –> viscious cycle
What is clinical presentation of appendicitis?
vague diffuse ab discomfort, nausea, mild fever
over 6-12 hrs evoles to localized sharp RLQ pain with more nausea and fever
What are some examples of people that present with atypical appendicitis?
- pregnant women: RUQ b/c pregnancy pushes everything up
- situs inverus: LLQ
- retrocecal appendix: back pain
What are some complications of appendicitis?
- risk of perforation –> peritonitis
- abscess
What is pathophysiology of diverticular disease?
- see in low fiber western diet –> leads to slow colonic transit and increased intraluminal pressures
leads have muscular hypertrophy, increased intraluminal pressure in colon –> mucosa and submucosa herniates at points of weakness
Who gets diverticulosis?
usually over age 60
What are symptoms of diverticulosis?
crampy ab pain
usually LLQ b/c diverticula usually in sigmoid colon
constipation
What is diverticulitis?
diverticula become infected
What are signs of diverticulitis?
- pain
- fever
- leucocytosis
What is pathophysiology of diverticular bleeding?
erosion of arteriole at mouth of diverticulum
have pianless bright red blood in stool
