UNDERSTANDING ABDOMINAL PAIN Flashcards
what causes visceral abdominal pain?
nerves running through the walls of an organ get stretched
what are the key characteristics of visceral pain?
it follows the embryological distribution of organs non-specific poorly localised aching or dull pain gradual onset
outline what you mean by ‘visceral pain follows embryological distribution’?
pain in te upper abdomen = foregut affected
pain in middle abdomen = midgut affected
pain in lower abdomen = hindgut affected
where does the foregut run from and to?
oesophagus to second part of duodenum
where does the midgut run from and to?
second part of duodenum to splenic flexure
where does the hindgut run from and to?
splenic flexure to rectum
what causes parietal or somatic pain?
irritation to the parietal peritoneum
what are thecharacteristic features of parietal/somatic pain?
localised to the organ beneath
pain is sharp
worse on movement
what might RUQ pain be?
hepatitis
gallstones
acute cholecystitis
subdiaphragmatic abscess
what might epigastric pain be?
GERD
gastritis
pancreatitis
peptic ulcer disease
what might LUQ pain be?
pancreatitis, splenic abscess, splenic infarct, gastritis, gastroc ulcer
what might periumbilical pain be?
early appendicitis
small bowel obstruction
mesenteric ischaemia
what might hypogastric pain be?
diverticlitis, IBD, colorectal cancer, cystitic, pyelonephritis, ovarian torsion, eptopic pregnancy
what might RLQ pain be?
appendicitis, salpingitis, ectopic pregnancy, inguinal hernia
what might LLQ pain be?
diverticulitis, salpingitis, ectopic pregnancy, inguinal hernia
what is salpingitis?
inflammation of the fallopian tubes, caused by bacterial infection. usually caused by STD bacteria
what are some differentials for diffuse abdominal pain?
infective gastroenteritis, coeliac disease, food poisoning, ruptured AAA
what is melena?
black tarry stools that usually occurs due to upper GI bleeding
what is Hematochezia?
the passage of fresh blood through the anus usually in or with stools
which enzymes will be 3x higher than normal in pancreatitis? why?
lipase and amylase
inflammation causes more to be released
what are some GI associated symptoms for abdo pain?
nausea vomiting constipation diarrhoea stool changes
what are some genitourinary associated symptoms for abdo pain?
dysuria
frequency
hematuria
what are some constitutional associated symptoms for abdo pain?
fevers, chills, fatigue.weight loss, anorexia
what are some cardiopulmonary associated symptoms for abdo pain?
cough, SOB, orthopnoea, exertional dyspnoea
what is referred pain?
pain originated from one source but felt at another site caused by sharing nerve innervation
where does splenic rupture pain radiate to?
left shoulder (bleeding from the spleen by irritate the phrenic nerve)
where does acute cholecystitis pain raidiate to?
right shoulder or scapula
if abdominal pain has an onset of a few days, whats the likely pathology?
inflamamrion
what is colicky pain?
pain that comes in waves
what causes colicky pain?
hollow muscular structure is having exaggerated contractions to unblock itself
what are some examples of colicky pain?
IBS appedicitis obstructions urinary retention labour
what is usually the cause of non-colicky abdominal pain?
inflammation e.g. cholecystitis
give an example of when abdominal pain can change from colicky to non-colicky?
galllbladdr obstruction with a stone = biliary colic
gallbladder becomes inflamed = acute cholecystitis
what is a closed loop bowel obstruction?
two points along the course of a bowel are obstructed,
what are the symptoms of a GI obstruction?
colicky abdo pain
vomitiing
absolute constipation
abdo distention
what can cause a GI obstruction?
food bolus, foriegn body, strictures, pyloric stenosis, ashesions, hernia, IBD, stercoral ulcer
what is a stercoral ulcer?
an ulcer of the colon due to pressure and irritation resulting from severe, prolonged constipation
what are symptoms of GI inflammation?
persistent abdo pain, malaise, fever, pain may be localised
what is peritonitis?
inflammation of the peritoneum
what are some symptoms of peritonitis?
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
what causes peritonitis?
perforation of the bowel wall e.g. sharp foreign body, ulcer, inflamed diverticulitis
what are some symptoms of cholecystitis?
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)
what are symptoms of biliary colic?
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
outline the difference between acute cholecystitis and biliary colic?
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
what is cholangitis?
inflamamtion of the bile duct system
what are symptoms of ruptured absominal aortic aneurysm?
sudden onset of acute pain,
pan may radiate to the back
light headed, dizzy, loss of concentration, tender abdomen, sweaty, collapsing, hypotension
why may a rupture abdominal aortic aneurysm cause peritonitis?
the blood may irritate the peritoenum
what are some symptoms of acute pancreatitis?
severe epigastric pin that raidiates to the back and can be relieved by sitting forward
vomiting
what in a patients history may make you suspect pancreatitis?
gallstones, alcohol, trauma, hypertriglyceridemia, surgery, medication
what are symptoms of renal colic?
colicky loin to groin pain
nausea and vomiting
cannot lie still
what are symptoms of acute mesenteric ischaemia?
severe abdominal pain diarrhoea cardiovascular risk factors soft abdomen hypovolemia
why is lactate raised in acute mesenteric ischaemia?
Acute mesenteric ischemia results in overgrowth of the resident bacterial flora which release D-lactate into the portal and systemic circulation
what are symptoms of gastritis/peptic ulcers?
epigastric pain thats related to meals
what are risk factors for gastritis?
NSAIDs, alcohol, spicy food
what are symptoms of pyelonephritis?
fevers, rigors, loin pain, urinary frequency and dysuria
what are symptoms of ectopic pregnancy?
severe unilatera; pelvic pain
6-8 weeks after pregnancy discovered/missed period/contracetion not used
shoulder tip pain
may have spotting
what are symptoms of an ovarian cyst rupture?
sudden unilateral pelvic pain
light vaginal bleeding maybe
fever and vomiting
what are symptoms of pelvic inflammatory disease?
bilateral pelvic pain vaginal dischage dyspareunia dysmenorrhoea intermenstrual and post-coital bleeding
