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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
Why is pain not constant in renal colic?
Mediated by nerves which are quick and doesn't take longer to wear off
26
How is pain described for bowel obstruction? Why?
Squeezing pain then stops | Actin myosin stop interlocking
27
Where is pain located for harm in the upper abdomen
Epigastrium
28
Organs blood supplied by the celiac axis cause pain where?
Epigastrium
29
Organs blood supplied by the super mesenteric artery cause pain where?
periumbilical
30
Organs blood supplied by the inferior mesenteric artery cause pain where?
super pubic
31
What is located in the right upper right quadrant of the abdomen?
``` Liver Gallbladder Duodenum Pancreas Lung a little bit ```
32
What is most common disease to be found in the right upper quadrant
Gallbladder disease
33
What can biliary colic lead to? Why?
Acute cholecystitis | Biliary tube keeps pushing at gallstone starts becoming inflamed and infected
34
What signs lead to Acute cholecystitis?
Tenderness in RUQ Fever tachycardia other signs of sepsis
35
What are causes of peptic ulcers?
``` Drink too much Smoke too much Underlying conditions- Helicobacter pylori Non-steriod anti-inflamatorities Physiological stress ```
36
What causes pancreatitis?
Gallstones Ethanol Trauma Steroids Mumps Autoimmune pancreatitis Scorpion sting Hyperlipidemia, hypothermia, hyperparathyroidism Endoscopic retrograde cholangiopancreatography Drugs(commonly azathioprine, valproic acid, liraglutide)
37
Ho does pancreatitis present in a patient?
Right upper quadrant pain Epigastric pain Radiating to the back Associated vomiting
38
What is located in the epigastrium of the abdomen?
Oesophagus Stomach Parts of liver / galllbladder Small intestine
39
What is AAA stand for?
abdominal aortic aneurysm
40
What is a patient AAA presented with?
Pain in upper abdomen | associated with hemodynamic instability
41
When is pancreatitis more likely to causing pain in thee left upper quadrant
When it happens in the tail of the pancreas
42
What is located in the left upper right quadrant of the abdomen?
Stomach Pancreas (tail) Spleen
43
What is located in the central quadrant of the abdomen?
Bowels | Apeendix
44
Who is at risk of having mesenteric ischaemia
People who already have underlying cardiovascular disease, atherosclerotic disease Atrial fibrillation
45
What is hemodynamic instability
Low blood pressure | High pulse rate
46
What signs are associated with IBS?
Colicky pain small bowel gut distension central abdominal pain
47
What symptoms does appendicitis cause?
``` 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
What is murphy's triad
lower right abdominal pain along with nausea, vomiting, and fever.
49
What is mesenteric adenitis
swelling of the lymph nodes in the mesentery supplying the terminal ileum
50
What is Meckel's diverticulum
outpouching of the small bowel which was embryological remnant can get perforation and inflammation from that
51
What if you examine the appendix and cant find appendicitus
Walk through small bowel to check for Meckel's diverticulum
52
What if a women presents herself with right iliac fossa pain? Why?
Make sure she has a negative pregnancy test | Ectopic pregnancy cause life-threatening bleeding and hemoperitonium
53
What is Crohn's disease
Irritable bowel disease
54
How does pain radiate for renal colitis?
pain and inflammation which starts in the rectum and works proximally
55
What is PID?
Pelvic inflammatory disease
56
What diseases are part of pelvic inflammatory diseases
Hydrosalpinx endometritis pyosalpinx
57
What is Hydrosalpinx
Fluid built up in fallopian tubes
58
How is pain presented in renal ureteric colic?
Pain radiating from the flank down to the groin or to the towards the bladder
59
Where does diverticulitis pain normally occur? Why on the other side?
In the Left iliac fossa Sigmoid colon flipped over to right because colon is very mobile or rarily cecum or ascending colon inflamed
60
Where does diverticulitis normally occur?
In the sigmoid colon
61
What is the difference between diverticulitis and Meckel's diverticulum
``` Meckel= congenital Doverticulitis= acquired ```
62
What is urinary retention
Not able to pass urine
63
What symptoms are associated with diverticulitus
``` Pain Fever Tachycardia Vomiting Haematochezia ```
64
Can you see gallstones on a CT or X-ray?
No
65
Can you see kidney stones on a CT or X-ray?
Yes
66
How is biliary duct mediated?
Hormonally by cholecystokinin
67
What secretes cholecystokinin
Stomach
68
What advice is given to people with gallstones? Why?
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
What is cholecystitis initially doing and what can it lead to?
Inflammation into infection
70
Can gallstones be asymptomatic?
Yes
71
What is the management of asymptomatic gallstones
No management needed unless bcomes symptomatoc
72
What happens if you have a stone that then blocks the outlet of the gallbladder?
Empyema
73
What is an empyema
Bag of pus
74
What can happen if there is an empyema in the gallbladder
it can make the wall of the gallbladder inflamed and weakened swelling of the gallbladder Gallbladder can perforate
75
What happens if gallbladder traps bile nothing leaves?(Mucus)
Mucus builds up because of mucosa secreting mucin causing a mucocoele
76
What is a mucocoele
A bag of mucin
77
What happens if the gallstone lodges in the bile duct?
Jaundice because bile cant be drained?
78
What if bile stays too long in the bile duct?
Infection- cholangitis
79
What is the difference between cholangitis and cholecystitis
Inflammation of the gallbladder- cholecystitis | Inflammation/ Infection of the bile duct- cholangitis
80
What are the main symptoms of cholangitis
Fever Right upper quadrant pain Jaundice
81
What happens if gallstones go into pancreatic duct
backwash of pancreatic enzymes irritates the pancreas causing pancreatitis
82
What are ways that gallstones can affect the body?
Blocking gallbladder Blocking bile duct Blocking pancreas Eroding gallbladder wall and going in the duodenum
83
What happens if gallstones erode into duodenum?
Cholecystoduodenal fistula
84
What is Cholecystoduodenal fistula
It stops at the terminal ileum causing gallstone obstruction
85
What disease can cholecystitis lead to?
Generalised peritonitis
86
What disease is caused by perforated gallbladdr?
Generalised biliary peritonitis
87
What can happen in vessels because of gallstone diseases?
Thrombosis of the blood supply to the gallbladder get a dead gallbladder or ischemic or necrotic gallbladder
88
What are common causes of pancreatitis
Gallstones Ethanol (Alcohol abuse) Trauma or after endoscopic retrograde cholangiopancreatography
89
How is pancreatitis graded?
Modified Glasgow Score APACHE-II CT seventy grading
90
What does the Modified Glasgow Score record?
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
What are the main investigations for pancreatitis
Amylase vs lipase (serum vs urine) | Looking at CRP for inflamation
92
What scans are done for gallstones
USS
93
When are CT scans used for pancreatitis
Uncertain still | one of the complications at a later stage
94
What complications can arise from pancreatitis?
``` Pancreatic necrosis Acute fluid collections +/- infection Pseudoaneurysm/ bleeding ARDS +/- multi-organ failure Duodenal ileus Chronic pancreatitis Pseudo-cyst ```
95
What can happen to peptic uncomplicated ulcers?
EITHER Bleed or Perforate
96
What is mostly likely to be affected by ulcerations from the duodenum posterly?
Gastroduodenal artery Duodenal D1 | Causing bleeding from there
97
What is mostly likely to be affected by ulcerations from the duodenum anteriorly?
Peritoneal cavity | Localised peritonitis
98
What investigations can be done for peptic ulcer disease?
Endoscopy Consider H pylori- do biopses CT if concern about perforation CT angiogram if bleeding not arrested endoscopically
99
Why is perforation best seen on a CT Scan
best way of seeing free intraperitoneal air
100
What kind of fever does appendicitis have? Why?
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
What are signs of appendicitis?
``` 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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