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xB15W1 > UNDERSTANDING ABDOMINAL PAIN > Flashcards

UNDERSTANDING ABDOMINAL PAIN Flashcards

1
Q

what causes visceral abdominal pain?

A

nerves running through the walls of an organ get stretched

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2
Q

what are the key characteristics of visceral pain?

A 
it follows the embryological distribution of organs
non-specific
poorly localised
aching or dull pain
gradual onset
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3
Q

outline what you mean by ‘visceral pain follows embryological distribution’?

A

pain in te upper abdomen = foregut affected
pain in middle abdomen = midgut affected
pain in lower abdomen = hindgut affected

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4
Q

where does the foregut run from and to?

A

oesophagus to second part of duodenum

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5
Q

where does the midgut run from and to?

A

second part of duodenum to splenic flexure

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6
Q

where does the hindgut run from and to?

A

splenic flexure to rectum

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7
Q

what causes parietal or somatic pain?

A

irritation to the parietal peritoneum

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8
Q

what are thecharacteristic features of parietal/somatic pain?

A

localised to the organ beneath
pain is sharp
worse on movement

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9
Q

what might RUQ pain be?

A

hepatitis
gallstones
acute cholecystitis
subdiaphragmatic abscess

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10
Q

what might epigastric pain be?

A

GERD
gastritis
pancreatitis
peptic ulcer disease

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11
Q

what might LUQ pain be?

A

pancreatitis, splenic abscess, splenic infarct, gastritis, gastroc ulcer

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12
Q

what might periumbilical pain be?

A

early appendicitis
small bowel obstruction
mesenteric ischaemia

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13
Q

what might hypogastric pain be?

A

diverticlitis, IBD, colorectal cancer, cystitic, pyelonephritis, ovarian torsion, eptopic pregnancy

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14
Q

what might RLQ pain be?

A

appendicitis, salpingitis, ectopic pregnancy, inguinal hernia

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15
Q

what might LLQ pain be?

A

diverticulitis, salpingitis, ectopic pregnancy, inguinal hernia

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16
Q

what is salpingitis?

A

inflammation of the fallopian tubes, caused by bacterial infection. usually caused by STD bacteria

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17
Q

what are some differentials for diffuse abdominal pain?

A

infective gastroenteritis, coeliac disease, food poisoning, ruptured AAA

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18
Q

what is melena?

A

black tarry stools that usually occurs due to upper GI bleeding

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19
Q

what is Hematochezia?

A

the passage of fresh blood through the anus usually in or with stools

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20
Q

which enzymes will be 3x higher than normal in pancreatitis? why?

A

lipase and amylase

inflammation causes more to be released

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21
Q

what are some GI associated symptoms for abdo pain?

A 
nausea
vomiting
constipation
diarrhoea
stool changes
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22
Q

what are some genitourinary associated symptoms for abdo pain?

A

dysuria
frequency
hematuria

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23
Q

what are some constitutional associated symptoms for abdo pain?

A

fevers, chills, fatigue.weight loss, anorexia

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24
Q

what are some cardiopulmonary associated symptoms for abdo pain?

A

cough, SOB, orthopnoea, exertional dyspnoea

25
Q

what is referred pain?

A

pain originated from one source but felt at another site caused by sharing nerve innervation

26
Q

where does splenic rupture pain radiate to?

A

left shoulder (bleeding from the spleen by irritate the phrenic nerve)

27
Q

where does acute cholecystitis pain raidiate to?

A

right shoulder or scapula

28
Q

if abdominal pain has an onset of a few days, whats the likely pathology?

A

inflamamrion

29
Q

what is colicky pain?

A

pain that comes in waves

30
Q

what causes colicky pain?

A

hollow muscular structure is having exaggerated contractions to unblock itself

31
Q

what are some examples of colicky pain?

A 
IBS
appedicitis
obstructions
urinary retention
labour
32
Q

what is usually the cause of non-colicky abdominal pain?

A

inflammation e.g. cholecystitis

33
Q

give an example of when abdominal pain can change from colicky to non-colicky?

A

galllbladdr obstruction with a stone = biliary colic

gallbladder becomes inflamed = acute cholecystitis

34
Q

what is a closed loop bowel obstruction?

A

two points along the course of a bowel are obstructed,

35
Q

what are the symptoms of a GI obstruction?

A

colicky abdo pain
vomitiing
absolute constipation
abdo distention

36
Q

what can cause a GI obstruction?

A

food bolus, foriegn body, strictures, pyloric stenosis, ashesions, hernia, IBD, stercoral ulcer

37
Q

what is a stercoral ulcer?

A

an ulcer of the colon due to pressure and irritation resulting from severe, prolonged constipation

38
Q

what are symptoms of GI inflammation?

A

persistent abdo pain, malaise, fever, pain may be localised

39
Q

what is peritonitis?

A

inflammation of the peritoneum

40
Q

what are some symptoms of peritonitis?

A

starts with peristant or colicky pain but later it will localise to severe pain progresing to generalised abdo pain
pain on movement
unable to tolerate light palpation

41
Q

what causes peritonitis?

A

perforation of the bowel wall e.g. sharp foreign body, ulcer, inflamed diverticulitis

42
Q

what are some symptoms of cholecystitis?

A

perisstant epigastric and RUQ pain with radiation to right shoulder blade
fever
feels unwell
murphy’s sign positive (asking the patient to take in and hold a deep breath while palpating the right subcostal area)

43
Q

what are symptoms of biliary colic?

A

colicky pain in epigastrium - pain may come on worse with fatty foods (pain typically lasts <3 hours unlike cholecystitis)
nausea and vomiting
may present with jaundice pale stools and dark urine

44
Q

outline the difference between acute cholecystitis and biliary colic?

A

biliary colic - the gallbladder neck becomes impacted by a gallstone. no inflammatory response, yet the contraction of the gallbladder against the occluded neck will result in pain.

acute cholecystitis - inflamamtion of the gallbladder, usuually precipitated by gallstones

45
Q

what is cholangitis?

A

inflamamtion of the bile duct system

46
Q

what are symptoms of ruptured absominal aortic aneurysm?

A

sudden onset of acute pain,
pan may radiate to the back
light headed, dizzy, loss of concentration, tender abdomen, sweaty, collapsing, hypotension

47
Q

why may a rupture abdominal aortic aneurysm cause peritonitis?

A

the blood may irritate the peritoenum

48
Q

what are some symptoms of acute pancreatitis?

A

severe epigastric pin that raidiates to the back and can be relieved by sitting forward
vomiting

49
Q

what in a patients history may make you suspect pancreatitis?

A

gallstones, alcohol, trauma, hypertriglyceridemia, surgery, medication

50
Q

what are symptoms of renal colic?

A

colicky loin to groin pain
nausea and vomiting
cannot lie still

51
Q

what are symptoms of acute mesenteric ischaemia?

A 
severe abdominal pain
diarrhoea
cardiovascular risk factors
soft abdomen
hypovolemia
52
Q

why is lactate raised in acute mesenteric ischaemia?

A

Acute mesenteric ischemia results in overgrowth of the resident bacterial flora which release D-lactate into the portal and systemic circulation

53
Q

what are symptoms of gastritis/peptic ulcers?

A

epigastric pain thats related to meals

54
Q

what are risk factors for gastritis?

A

NSAIDs, alcohol, spicy food

55
Q

what are symptoms of pyelonephritis?

A

fevers, rigors, loin pain, urinary frequency and dysuria

56
Q

what are symptoms of ectopic pregnancy?

A

severe unilatera; pelvic pain
6-8 weeks after pregnancy discovered/missed period/contracetion not used
shoulder tip pain
may have spotting

57
Q

what are symptoms of an ovarian cyst rupture?

A

sudden unilateral pelvic pain
light vaginal bleeding maybe
fever and vomiting

58
Q

what are symptoms of pelvic inflammatory disease?

A 
bilateral pelvic pain
vaginal dischage
dyspareunia
dysmenorrhoea
intermenstrual and post-coital bleeding

xB15W1 (9 decks)

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