UNDERSTANDING ABDOMINAL PAIN

Question 1

what causes visceral abdominal pain?

Answer 1

nerves running through the walls of an organ get stretched

Question 2

what are the key characteristics of visceral pain?

Answer 2

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

Question 3

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

Answer 3

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

Question 4

where does the foregut run from and to?

Answer 4

oesophagus to second part of duodenum

Question 5

where does the midgut run from and to?

Answer 5

second part of duodenum to splenic flexure

Question 6

where does the hindgut run from and to?

Answer 6

splenic flexure to rectum

Question 7

what causes parietal or somatic pain?

Answer 7

irritation to the parietal peritoneum

Question 8

what are thecharacteristic features of parietal/somatic pain?

Answer 8

localised to the organ beneath
pain is sharp
worse on movement

Question 9

what might RUQ pain be?

Answer 9

hepatitis
gallstones
acute cholecystitis
subdiaphragmatic abscess

Question 10

what might epigastric pain be?

Answer 10

GERD
gastritis
pancreatitis
peptic ulcer disease

Question 11

what might LUQ pain be?

Answer 11

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

Question 12

what might periumbilical pain be?

Answer 12

early appendicitis
small bowel obstruction
mesenteric ischaemia

Question 13

what might hypogastric pain be?

Answer 13

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

Question 14

what might RLQ pain be?

Answer 14

appendicitis, salpingitis, ectopic pregnancy, inguinal hernia

Question 15

what might LLQ pain be?

Answer 15

diverticulitis, salpingitis, ectopic pregnancy, inguinal hernia

Question 16

what is salpingitis?

Answer 16

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

Question 17

what are some differentials for diffuse abdominal pain?

Answer 17

infective gastroenteritis, coeliac disease, food poisoning, ruptured AAA

Question 18

what is melena?

Answer 18

black tarry stools that usually occurs due to upper GI bleeding

Question 19

what is Hematochezia?

Answer 19

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

Question 20

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

Answer 20

lipase and amylase

inflammation causes more to be released

Question 21

what are some GI associated symptoms for abdo pain?

Answer 21

nausea
vomiting
constipation
diarrhoea
stool changes

Question 22

what are some genitourinary associated symptoms for abdo pain?

Answer 22

dysuria
frequency
hematuria

Question 23

what are some constitutional associated symptoms for abdo pain?

Answer 23

fevers, chills, fatigue.weight loss, anorexia

Question 24

what are some cardiopulmonary associated symptoms for abdo pain?

Answer 24

cough, SOB, orthopnoea, exertional dyspnoea

Question 25

what is referred pain?

Answer 25

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

Question 26

where does splenic rupture pain radiate to?

Answer 26

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

Question 27

where does acute cholecystitis pain raidiate to?

Answer 27

right shoulder or scapula

Question 28

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

Answer 28

inflamamrion

Question 29

what is colicky pain?

Answer 29

pain that comes in waves

Question 30

what causes colicky pain?

Answer 30

hollow muscular structure is having exaggerated contractions to unblock itself

Question 31

what are some examples of colicky pain?

Answer 31

``` IBS appedicitis obstructions urinary retention labour ```

Question 32

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

Answer 32

inflammation e.g. cholecystitis

Question 33

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

Answer 33

galllbladdr obstruction with a stone = biliary colic | gallbladder becomes inflamed = acute cholecystitis

Question 34

what is a closed loop bowel obstruction?

Answer 34

two points along the course of a bowel are obstructed,

Question 35

what are the symptoms of a GI obstruction?

Answer 35

colicky abdo pain vomitiing absolute constipation abdo distention

Question 36

what can cause a GI obstruction?

Answer 36

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

Question 37

what is a stercoral ulcer?

Answer 37

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

Question 38

what are symptoms of GI inflammation?

Answer 38

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

Question 39

what is peritonitis?

Answer 39

inflammation of the peritoneum

Question 40

what are some symptoms of peritonitis?

Answer 40

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

Question 41

what causes peritonitis?

Answer 41

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

Question 42

what are some symptoms of cholecystitis?

Answer 42

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)

Question 43

what are symptoms of biliary colic?

Answer 43

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

Question 44

outline the difference between acute cholecystitis and biliary colic?

Answer 44

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

Question 45

what is cholangitis?

Answer 45

inflamamtion of the bile duct system

Question 46

what are symptoms of ruptured absominal aortic aneurysm?

Answer 46

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

Question 47

why may a rupture abdominal aortic aneurysm cause peritonitis?

Answer 47

the blood may irritate the peritoenum

Question 48

what are some symptoms of acute pancreatitis?

Answer 48

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

Question 49

what in a patients history may make you suspect pancreatitis?

Answer 49

gallstones, alcohol, trauma, hypertriglyceridemia, surgery, medication

Question 50

what are symptoms of renal colic?

Answer 50

colicky loin to groin pain nausea and vomiting cannot lie still

Question 51

what are symptoms of acute mesenteric ischaemia?

Answer 51

``` severe abdominal pain diarrhoea cardiovascular risk factors soft abdomen hypovolemia ```

Question 52

why is lactate raised in acute mesenteric ischaemia?

Answer 52

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

Question 53

what are symptoms of gastritis/peptic ulcers?

Answer 53

epigastric pain thats related to meals

Question 54

what are risk factors for gastritis?

Answer 54

NSAIDs, alcohol, spicy food

Question 55

what are symptoms of pyelonephritis?

Answer 55

fevers, rigors, loin pain, urinary frequency and dysuria

Question 56

what are symptoms of ectopic pregnancy?

Answer 56

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

Question 57

what are symptoms of an ovarian cyst rupture?

Answer 57

sudden unilateral pelvic pain light vaginal bleeding maybe fever and vomiting

Question 58

what are symptoms of pelvic inflammatory disease?

Answer 58

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