OnlineMedEd: Surgery: General - "Abdominal Pain"

Question 1

List the three types of pain.

Answer 1

• Somatic: damage to external tissues that is correctly identified by nerves
• Neuropathic: damage to nerves that presents as tingling/burning to healthy tissues
• Visceral: stretching of internal organs

Question 2

Obstructive abdominal pain is ___________ in nature.

Answer 2

colicky

This happens because pain occurs when the peristaltic wave squeezes the obstruction. The pain disappears when the wave passes.

Question 3

Purely obstructive disorders present how?

Answer 3

• Colicky abdominal pain that is not positiional
• Absence of fever
• Absence of leukocytosis

Think of cholelithiasis and nephrolithiasis.

Question 4

Inflammatory abdominal disorders present how?

Answer 4

• Constant abdominal pain
• Fever
• Leukocytosis

Think of cholecystitis and pyelonephritis.

Question 5

_____________ presents like an inflammatory disorder but they will be extremely sick and have peritoneal signs.

Answer 5

Perforation

Question 6

Describe the presentation of bowel ischemia.

Answer 6

The main sign is pain out of proportion to the exam: think of the person writhing in agony with a relatively normal abdominal exam.

Question 7

Go through the angry robot diagram.

Answer 7

RUQ:

• Lungs
• Diaphragm
• Liver
• Gallbladder

Epigastric area:

• Stomach
• Heart
• Esophagus
• Aorta
• Pancreas

LUQ:

• Lungs
• Diaphragm
• Spleen

RLQ:

• Colon
• Kidneys / ureters
• Testes / ovaries
• Colon (appendix)

LLQ:

• Colon (diverticula)
• Kidneys / ureters
• Testes / ovaries

Diffuse:

• DKA
• Mesenteric ischemia
• Constipation

Suprapubic:

• Bladder
• Uterus

Question 8

List the correct imaging modality for each area.

Answer 8

• RUQ: US
• All others: CT

Though KUBs for obstruction and US for appy… this is debatable.