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Abdominal symptoms > Pain > Flashcards

Pain Flashcards

1
Q

What is referred pain?

A

Pain felt in a part of the body that is not the source of the pain.

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2
Q

What is the mechanism of referred pain

A

Uncertain — many theories
Afferent pain fibres in thorax/abdomen follow sympathetic back to spinal cord
These neurones have cell bodies co-located with dermatomal cell bodies
They share second order neuron synapses

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3
Q

What are examples of referred pain?

A 
Brain freeze (vagus/ trigeminal), 
MI,
Biliary colic, 
Pancreatitis, 
phantom limb pain
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4
Q

What colicky pain?

A

Pain characterised by either intermittent nature or variable/cyclical intensity

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5
Q

What are examples of colicky pain?

A

Biliary colic
Bowel obstruction
Renal colic

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6
Q

What is peritonitis pain?

A

Abdominal pain due to inflammation of the peritoneum

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7
Q

How is peritonitis pain evolved

A

First visceral

then somatic

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8
Q

How is visceral peritonitis pain characterised?

A

Vague, poorly localised
Dull ache
Embryological origin

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9
Q

How is somatic peritonitis pain characterised?

A

Sharp

Localised

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10
Q

What diseases are likely diagnosed for pain in the right upper quadrant abdomen

A 
Biliary Colic 
Acute Cholecystitis 
Peptic ulcer  (+/- perforation)
Abscess
Pancreatitis 
Pneumonia
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11
Q

What diseases are likely diagnosed for pain in the epigastrium

A 
Peptic ulcer 
Reflux oesophagitis
Gastritis
AAA(+/- rupture)
Pancreatitis 
Biliary colic 
Acute cholecystitis 
Myocardial infarction
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12
Q

What diseases are likely diagnosed for pain in the left upper quadrant abdomen

A 
Peptic ulcer
Pancreatitis 
Splenic rupture (or cyst rupture)
Abscess
Pneumonia
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13
Q

What diseases are likely diagnosed for pain in the central abdomen

A 
Small bowel obstruction 
Appendicitis 
Mesenteric ischaemia
AAA +/- rupture
IBS
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14
Q

What diseases are likely diagnosed for pain in the right iliac fossa

A 
Appendicitis 
Mesenteric adenitis
Meckel's diverticulum
TubaI/ovarian pathology (including ectopic)
IBD
PID
Renal/ureteric colic
Diverticulitis
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15
Q

What diseases are likely diagnosed for pain in the Low (suprapubic)

A 
Diverticulitis 
IBD
Large bowel obstruction
PID
Ectopic pregnancy
Retention of urine
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16
Q

What diseases are likely diagnosed for pain in the left iliac fossa

A 
Diverticulitis 
IBD
Tubal/ ovarian pathology (including ectopic)
PID
Renal/ureteric colic
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17
Q

types of gallstones

A

Mixed
Pigment
Cholesterol

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18
Q

What is the biliary colic

A

Distension and contraction of a gall bladder against an obstructed cystic duct

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19
Q

How is pain described in peptic ulcers?

A

“Deep gnawing pain”, “burning pain”
Often worse at night -duodenal ulcer
More immediate- gastric ulcer

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20
Q

What is colicky pain indicate?

A

Viscera
Related to hollow viscus
Obstruction somewhere to do with peristalsis

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21
Q

How is colicky pain described?

A

Squeezing pain then stops then repeats

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22
Q

How is pain described for biliary colic?

A

Squeezing pain that never stops constant

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23
Q

How is pain described for renal colic?

A

Squeezing pain then stops then repeats

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24
Q

Why is pain constant in biliary colic?

A

Mediated by hormones wwhich are slow and take longer to wear off

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25
Q

Why is pain not constant in renal colic?

A

Mediated by nerves which are quick and doesn’t take longer to wear off

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26
Q

How is pain described for bowel obstruction? Why?

A

Squeezing pain then stops

Actin myosin stop interlocking

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27
Q

Where is pain located for harm in the upper abdomen

A

Epigastrium

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28
Q

Organs blood supplied by the celiac axis cause pain where?

A

Epigastrium

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29
Q

Organs blood supplied by the super mesenteric artery cause pain where?

A

periumbilical

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30
Q

Organs blood supplied by the inferior mesenteric artery cause pain where?

A

super pubic

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31
Q

What is located in the right upper right quadrant of the abdomen?

A 
Liver
Gallbladder
Duodenum
Pancreas
Lung a little bit
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32
Q

What is most common disease to be found in the right upper quadrant

A

Gallbladder disease

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33
Q

What can biliary colic lead to? Why?

A

Acute cholecystitis

Biliary tube keeps pushing at gallstone starts becoming inflamed and infected

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34
Q

What signs lead to Acute cholecystitis?

A

Tenderness in RUQ
Fever
tachycardia
other signs of sepsis

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35
Q

What are causes of peptic ulcers?

A 
Drink too much
Smoke too much
Underlying conditions- Helicobacter pylori
Non-steriod anti-inflamatorities
Physiological stress
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36
Q

What causes pancreatitis?

A

Gallstones
Ethanol
Trauma
Steroids
Mumps
Autoimmune pancreatitis
Scorpion sting
Hyperlipidemia, hypothermia, hyperparathyroidism
Endoscopic retrograde cholangiopancreatography
Drugs(commonly azathioprine, valproic acid, liraglutide)

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37
Q

Ho does pancreatitis present in a patient?

A

Right upper quadrant pain
Epigastric pain
Radiating to the back
Associated vomiting

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38
Q

What is located in the epigastrium of the abdomen?

A

Oesophagus
Stomach
Parts of liver / galllbladder
Small intestine

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39
Q

What is AAA stand for?

A

abdominal aortic aneurysm

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40
Q

What is a patient AAA presented with?

A

Pain in upper abdomen

associated with hemodynamic instability

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41
Q

When is pancreatitis more likely to causing pain in thee left upper quadrant

A

When it happens in the tail of the pancreas

42
Q

What is located in the left upper right quadrant of the abdomen?

A

Stomach
Pancreas (tail)
Spleen

43
Q

What is located in the central quadrant of the abdomen?

A

Bowels

Apeendix

44
Q

Who is at risk of having mesenteric ischaemia

A

People who already have underlying cardiovascular disease, atherosclerotic disease
Atrial fibrillation

45
Q

What is hemodynamic instability

A

Low blood pressure

High pulse rate

46
Q

What signs are associated with IBS?

A

Colicky pain
small bowel gut distension
central abdominal pain

47
Q

What symptoms does appendicitis cause?

A 
Periumbilical pain which moves to the right iliac fossa over short duration (<24hrs)
Murphys triad
 Localised peritonism in the RIF
Dyspareunia (for women)
Rebound tenderness
48
Q

What is murphy’s triad

A

lower right abdominal pain along with nausea, vomiting, and fever.

49
Q

What is mesenteric adenitis

A

swelling of the lymph nodes in the mesentery supplying the terminal ileum

50
Q

What is Meckel’s diverticulum

A

outpouching of the small bowel which was embryological remnant
can get perforation and inflammation from that

51
Q

What if you examine the appendix and cant find appendicitus

A

Walk through small bowel to check for Meckel’s diverticulum

52
Q

What if a women presents herself with right iliac fossa pain? Why?

A

Make sure she has a negative pregnancy test

Ectopic pregnancy cause life-threatening bleeding and hemoperitonium

53
Q

What is Crohn’s disease

A

Irritable bowel disease

54
Q

How does pain radiate for renal colitis?

A

pain and inflammation which starts in the rectum and works proximally

55
Q

What is PID?

A

Pelvic inflammatory disease

56
Q

What diseases are part of pelvic inflammatory diseases

A

Hydrosalpinx
endometritis
pyosalpinx

57
Q

What is Hydrosalpinx

A

Fluid built up in fallopian tubes

58
Q

How is pain presented in renal ureteric colic?

A

Pain radiating from the flank down to the groin or to the towards the bladder

59
Q

Where does diverticulitis pain normally occur? Why on the other side?

A

In the Left iliac fossa
Sigmoid colon flipped over to right because colon is very mobile or
rarily cecum or ascending colon inflamed

60
Q

Where does diverticulitis normally occur?

A

In the sigmoid colon

61
Q

What is the difference between diverticulitis and Meckel’s diverticulum

A 
Meckel= congenital
Doverticulitis= acquired
62
Q

What is urinary retention

A

Not able to pass urine

63
Q

What symptoms are associated with diverticulitus

A 
Pain 
Fever
Tachycardia
Vomiting
Haematochezia
64
Q

Can you see gallstones on a CT or X-ray?

A

No

65
Q

Can you see kidney stones on a CT or X-ray?

A

Yes

66
Q

How is biliary duct mediated?

A

Hormonally by cholecystokinin

67
Q

What secretes cholecystokinin

A

Stomach

68
Q

What advice is given to people with gallstones? Why?

A

Eat less fatty foods
When fatty foods arrive in stomach More bile is trying to be forced out past gallstones so more pain is made as bile is used to emulsify fats

69
Q

What is cholecystitis initially doing and what can it lead to?

A

Inflammation into infection

70
Q

Can gallstones be asymptomatic?

A

Yes

71
Q

What is the management of asymptomatic gallstones

A

No management needed unless bcomes symptomatoc

72
Q

What happens if you have a stone that then blocks the outlet of the gallbladder?

A

Empyema

73
Q

What is an empyema

A

Bag of pus

74
Q

What can happen if there is an empyema in the gallbladder

A

it can make the wall of the gallbladder inflamed and weakened
swelling of the gallbladder
Gallbladder can perforate

75
Q

What happens if gallbladder traps bile nothing leaves?(Mucus)

A

Mucus builds up because of mucosa secreting mucin causing a mucocoele

76
Q

What is a mucocoele

A

A bag of mucin

77
Q

What happens if the gallstone lodges in the bile duct?

A

Jaundice because bile cant be drained?

78
Q

What if bile stays too long in the bile duct?

A

Infection- cholangitis

79
Q

What is the difference between cholangitis and cholecystitis

A

Inflammation of the gallbladder- cholecystitis

Inflammation/ Infection of the bile duct- cholangitis

80
Q

What are the main symptoms of cholangitis

A

Fever
Right upper quadrant pain
Jaundice

81
Q

What happens if gallstones go into pancreatic duct

A

backwash of pancreatic enzymes irritates the pancreas causing pancreatitis

82
Q

What are ways that gallstones can affect the body?

A

Blocking gallbladder
Blocking bile duct
Blocking pancreas
Eroding gallbladder wall and going in the duodenum

83
Q

What happens if gallstones erode into duodenum?

A

Cholecystoduodenal fistula

84
Q

What is Cholecystoduodenal fistula

A

It stops at the terminal ileum causing gallstone obstruction

85
Q

What disease can cholecystitis lead to?

A

Generalised peritonitis

86
Q

What disease is caused by perforated gallbladdr?

A

Generalised biliary peritonitis

87
Q

What can happen in vessels because of gallstone diseases?

A

Thrombosis of the blood supply to the gallbladder get a dead gallbladder or ischemic or necrotic gallbladder

88
Q

What are common causes of pancreatitis

A

Gallstones
Ethanol (Alcohol abuse)
Trauma or after endoscopic retrograde cholangiopancreatography

89
Q

How is pancreatitis graded?

A

Modified Glasgow Score
APACHE-II
CT seventy grading

90
Q

What does the Modified Glasgow Score record?

A

various factors of the systemic inflammatory response whether they need to be managed on a ward or
high dependency care for invasive blood pressure monitoring or medications to support the blood pressure

91
Q

What are the main investigations for pancreatitis

A

Amylase vs lipase (serum vs urine)

Looking at CRP for inflamation

92
Q

What scans are done for gallstones

A

USS

93
Q

When are CT scans used for pancreatitis

A

Uncertain still

one of the complications at a later stage

94
Q

What complications can arise from pancreatitis?

A 
Pancreatic necrosis
Acute fluid collections +/- infection
Pseudoaneurysm/ bleeding
ARDS +/- multi-organ failure
Duodenal ileus
Chronic pancreatitis
Pseudo-cyst
95
Q

What can happen to peptic uncomplicated ulcers?

A

EITHER
Bleed or
Perforate

96
Q

What is mostly likely to be affected by ulcerations from the duodenum posterly?

A

Gastroduodenal artery Duodenal D1

Causing bleeding from there

97
Q

What is mostly likely to be affected by ulcerations from the duodenum anteriorly?

A

Peritoneal cavity

Localised peritonitis

98
Q

What investigations can be done for peptic ulcer disease?

A

Endoscopy
Consider H pylori- do biopses
CT if concern about perforation
CT angiogram if bleeding not arrested endoscopically

99
Q

Why is perforation best seen on a CT Scan

A

best way of seeing free intraperitoneal air

100
Q

What kind of fever does appendicitis have? Why?

A

Low grade fever
Pyrogens from the appendix go into the portal venous system and go into the liver
Kupffer cells take out a lot of pyrogens before the blood then continues around the systemic circulation and goes to the pyrogenic centers within the brain.

101
Q

What are signs of appendicitis?

A 
McBurney's sign- rebound tenderness
Rovsing sign - palpating the left highlight fossa causes pain on the right due to the peritoneum
Psoas stretch- particularly in children
Obturator sign
"Cervical excitation" or Chandelier sign

Abdominal symptoms (7 decks)

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