WEEK 1: Understanding Abdominal Pain Flashcards
Define the following terms.
- Abdomen
- Pain
- Tenderness
4.Acute - Surgery
- A Surgeon
Abdomen
The abdomen is the part of the body between the chest and the pelvis. It contains various organs, including the stomach, liver, intestines, and kidneys.
Pain
Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage.
Tenderness
Tenderness refers to a sensation of pain or discomfort when pressure is applied to a specific area of the body.
Acute
In medical terminology, “acute” refers to a condition or symptom that has a sudden onset and is of short duration.
Surgery
Surgery is a medical procedure that involves the manual or instrumental manipulation of body tissues to diagnose, treat, or prevent a disease or injury.
A Surgeon
*A surgeon is a medical professional who specializes in performing surgical procedures.
*A Surgeon is a physician who can operate when it is indicated and in the better interest of the patient.
Is Pain Always Bad, Undesirable?
Pain is not always bad or undesirable. While pain is often associated with negative experiences and discomfort, it serves an important purpose in our bodies. Here are some key points to consider:
- Pain is a protective mechanism that alerts us to potential harm or injury. It acts as a warning signal, signaling that something is wrong in our body and needs attention.
- Pain can help us identify and address underlying health issues. It can be an indicator of an injury, infection, or disease, prompting us to seek medical attention and treatment.
. - Pain can also be instrumental in our healing process. It can guide us to take necessary precautions and avoid further damage to the affected area.
ACUTE ABDOMEN ≠ PERITONITIS
Define the 2 terms.
- Acute Abdomen:
Any sudden non-traumatic disorder whose chief manifestation is in the abdominal area and for which urgent operation may be necessary.
The term “acute abdomen” refers to the sudden onset of severe abdominal symptoms that may necessitate surgical intervention or requiring urgent medical attention.
Patients with an acute abdomen often present with:
*Severe abdominal pain: This pain can be sudden in onset and may be localized or diffuse.
*Nausea and vomiting.
*Changes in bowel habits: These changes can include diarrhea or constipation/obstipation
- Peritonitis:
Peritonitis refers to inflammation of the inside lining of the abdomen (the peritoneum).
Symptoms of peritonitis include:
*Constant abdominal pain or pain that worsens upon gentle touch or pressure.
Acute abdomen is not the same as operative abdomen.
Define operative abdomen.
The term “operative abdomen” refers to the surgical exploration and intervention within the abdominal cavity.
It involves opening the abdomen (laparotomy) to access and visualize the abdominal organs for diagnostic or therapeutic purposes.
Abdominal surgery can be performed for various reasons, such as removing diseased organs or tissues, repairing injuries, treating abdominal infections, or addressing other conditions affecting the abdominal cavity.
Define Acute and chronic.
ACUTE
The term “acute” refers to a condition or symptom that has a sudden onset and is of short duration. It typically describes a condition that occurs suddenly and is severe in nature.
Acute conditions often require immediate attention or intervention.
CHRONIC
On the other hand, the term “chronic” refers to a condition or disease that persists or recurs over a long period of time.
Chronic conditions develop gradually and may worsen over time. They are characterized by their long-lasting nature and often require long-term medical care.
When it comes to describing pain, there are different terms used to characterize its qualities. Two of these terms are “sharp pain” and “dull pain.”
Describe the 2 types of pain.
Sharp pain: Sharp pain is often described as a sudden, intense, and piercing sensation.
It can be felt as a stabbing or cutting pain. Sharp pain is typically associated with acute conditions or injuries, such as a muscle strain, a cut, or a broken bone.
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Dull pain: Dull pain is usually a bearable but long-term pain. It is often described as a steady, aching pain.
Dull pain can be persistent and may last for an extended period of time. It is commonly associated with chronic conditions, such as arthritis or muscle tension.
Define surgery according to Mark M. Ravitch.
Surgery = Hand + Work
Surgery is not an act or a room.
Surgery is an art, a science, a system of thought, a tradition.
We are physicians who think, not “just” technicians who perform manual tasks and procedures
Define medicine according to Sir William Osler, 1849-1919.
“Medicine is a science of uncertainty and an art of probability.”
YOU SEE WHAT YOU LOOK FOR, YOU DIAGNOSE WHAT YOU KNOW- Ronald Belsey
When preparing for entry to the operating theater, there are several important components to consider.
State them.
- History: Prior Operations, Medications, Co-morbidities, Performance-status, etc.
- Physical Examination
- Investigations
-Lab
-Imaging
Outline items to consider when having acute abdomen prior to surgery.
Other Items to Consider:
History: Weight Loss
Medications
Prior colonoscopy or EGD PMI: ? HIV, IBD
Physical: BMI/Weight SpO2
Investigations:
Hgb SS
HCG
INR
Any items specific to the concerns or diff dx at hand.
Confinement = last delivery
Diagnosis precedes treatment. Explain.
Diagnosis involves the process of identifying a disease or condition based on signs, symptoms, medical history, and various diagnostic tests. It is through the diagnostic process that healthcare professionals can determine the underlying cause of a patient’s symptoms and establish a specific diagnosis.
Once a diagnosis is made, treatment decisions can be based on the identified condition. Treatment plans are tailored to address the specific disease or condition, taking into account factors such as the severity of the condition, the patient’s overall health, and any potential risks or contraindications.
What is visceral peritoneum?
Discuss innervation of viscera and pain.
The visceral peritoneum is a layer of the peritoneum, a serous membrane that lines the abdominal cavity and covers the abdominal organs.
It is the inner layer of the peritoneum that directly covers the organs, providing them with a protective covering.
The visceral peritoneum is not innervated, meaning it lacks sensory nerve fibers. However, the sub-mesothelial tissue beneath the visceral peritoneum is innervated by the autonomic nervous system.
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- Autonomic Innervation:
The autonomic nervous system (ANS) is responsible for regulating involuntary bodily functions, including those of the internal organs.
The autonomic innervation of the abdominal and pelvic viscera involves both the sympathetic and parasympathetic branches of the ANS.
The sympathetic nerves arise from the thoracic and lumbar regions of the spinal cord, while the parasympathetic nerves originate from the cranial nerves and the sacral region of the spinal cord.
These autonomic nerves provide motor innervation to the abdominal and pelvic organs and also carry sensory information from these organs back to the central nervous system.
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2. C Fibers:
C fibers are a type of unmyelinated nerve fibers that transmit sensory information related to pain and temperature.
They are part of the general visceral afferent (GVA) fibers, which conduct sensory impulses from the internal organs, glands, and blood vessels to the central nervous system.
C fibers are involved in the transmission of slow, dull, and poorly localized pain sensations. In the context of visceral pain, C fibers play a role in the perception of diffuse and poorly defined pain that is often felt in the midline of the body
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3. Midline:
In the context of visceral pain, the term “midline” refers to the central region of the body.
Visceral pain is often perceived as a diffuse, dull pain that is not well localized and is frequently referred to the midline region of the abdomen or upper sternum.
This means that the pain is felt in the central area of the body, rather than in a specific location.
Discuss parietal peritoneum.
The parietal peritoneum is the outer layer of the peritoneum, a serous membrane that lines the abdominal cavity and covers the abdominal organs.
Unlike the visceral peritoneum, which covers the organs, the parietal peritoneum lines the internal surface of the abdominal and pelvic walls.
It is innervated by both somatic and visceral afferent nerves.
Sensitive branches from the lower intercostal nerves and upper lumbar nerves provide innervation to the parietal peritoneum.
Microscopically, a dense network of unmyelinated and myelinated nerve fibers can be found throughout the parietal peritoneum
- Somatic Innervation:
Somatic innervation refers to the innervation of structures related to the body wall, including the parietal peritoneum.
The parietal peritoneum receives somatic innervation from spinal nerves T10 through L1. This somatic innervation allows for the sensation of pain, pressure, touch, and temperature, which can be localized. Pain from the parietal peritoneum is well-localized and can be perceived as sharp.
- C and A Delta Fibers:
C fibers and A delta fibers are types of nerve fibers involved in transmitting sensory information related to pain.
C fibers are unmyelinated and transmit slow, dull, and poorly localized pain sensations.
Delta fibers are myelinated and transmit sharp, well-localized pain sensations.
Both C fibers and A delta fibers are involved in the perception of pain from the parietal peritoneum. Noxious stimuli to the parietal peritoneum are perceived as localized, sharp pain.
- Focal:
In the context of the provided search results, the term “focal” is not directly related to the parietal peritoneum or its innervation.
However, it is important to note that pain from the parietal peritoneum is typically well-localized, meaning it is felt in a specific area rather than being diffuse or generalized
Compare Visceral pain and Somatic pain (parietal).
- Visceral pain
-Dull, aching and vague
-Poorly localized
-Non-lateralizing
-Assoc with nausea, emesis, sweating and pallor - Somatic pain (parietal)
-Sharp, lancing, more intense
-Precisely localized
-Lateralizes
Visceral afferent nerves (autonomics) accompany major arteries and are stimulated by distension, stretching and ischemia yielding midline symptoms.
Describe the innervation and the type of pain in the following parts.
Foregut celiac plexus epigastric
Midgut SMA afferents periumbilical
Hindgut IMA/lumbar hypogastric
- Foregut:
The celiac plexus, which is a network of nerves located around the celiac artery, provides autonomic innervation to the organs derived from the foregut.
These include the distal esophagus, stomach, proximal duodenum, pancreas, liver, biliary system, spleen, and adrenal glands.
Stimulation of the visceral afferent nerves in this region can yield symptoms in the epigastric area
- Midgut:
The superior mesenteric artery (SMA) afferents provide autonomic innervation to the organs derived from the midgut.
These include the distal duodenum, jejunum, ileum, cecum, appendix, ascending colon, and proximal transverse colon.
Stimulation of the visceral afferent nerves in this region can yield symptoms in the periumbilical area.
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- Hindgut:
The inferior mesenteric artery (IMA) and lumbar afferents provide autonomic innervation to the organs derived from the hindgut.
These include the distal transverse colon, descending colon, sigmoid colon, rectum, upper anal canal, bladder, external genitalia, and gonads.
Stimulation of the visceral afferent nerves in this region can yield symptoms in the hypogastric (lower abdominal) region.
Discuss Somatic/Parietal Pain.
An inflammatory process stimulates the afferent pain receptors of the parietal peritoneum.
Somatic peripheral nerves correspond to dermatomes.
Describe referred pain.
State where the pain originating from the following will bw felt at.
C4
T6-8
T10
Pain felt in 2 entirely separate and anatomically distinct areas that share a common embryological origin and therefore a common afferent innervation.
C4 diaphragm shoulder
T6-8 liver, biliary tree subscapular
T10 kidney, ureter flank, groin
An “acute abdomen” is not necessarily an emergent or urgent surgical condition.
Name ten diseases than can mimic an operative abdomen?
“Diseases which may simulate the acute abdomen”, Ch 21. Cope’s
Diabetes Herpes zoster
Typhoid Fever Renal Disease
Malaria Periarteritis nodosa
Tuberculosis Retroperitoneal Dz.
Pleurisy/Pneumonia (AAA, dissections, etc.)
Acute cardiac disease Pelvic Infections/Inflm.
Osteomyelitis spine Hgb SS—Sickle Crisis
Tabes Dorsalis