• Date:23.3.

1387
Year: 2008
‫بسم الرحمن الرحیم‬
 Short Anatomy of Abdominal Cavity

• Super border thoracic diaphragm

• Inferior border pelvic inlet or superior
pelvic aperture (is not clear )
• It continuous up to 4th intercostals space
• Thoracic cage protects liver spleen & part
of stomach
• Greater pelvis protects part of ileum
cecum & sigmoid colon
• The space surrounded by the multilayered
abdominal walls
• The location of most digestive organs ,the
spleen, kidneys and most of ureters
• Contains peritoneum
 Nine origin of the abdominal
cavity

• Tow horizontal (sub costal and trans

tubercular plane)

• Tow vertical (midclavicolar plane)

Developmental anatomy and
blood supply
• Forgut: Pharynx esophagus stomach and
proximal three part of duodenum
• Midget: Fourth part of duodenum .all
jejuneum.ascending colon.midpart of transverse
colon .blood supply superior mesenteric
artery
• hindgut: Remain of transverse colon
descending and sigmoid colon. rectum. blood
supply inferior mesenteric artery
 Innervations
• Abdominal wall
• Parietal peritoneum
• Liver. spleen. center part of diaphragm {pherinic
Nerve C3-C5}
• Peripheral
diaphragm.stomach.pancreas.gallbladder .small
intestine {celiac plexus +greater splanchinic Nerve
T6-T9}
• Appendix .colons .pelvic viscera {Mesenteric
plexus T10-T11}
• Sigmoid colon .rectum. kidneys .ureters .testes
{lower splanchinic Nerve T11-L1}
 Abdominal pain

• Pain means distress or unpleasant feel.

• Definition : is pain that is felt in abdomen.

• The term abdominal pain is used to describe pain

originating from abdominal organs (stomach, small
intestine, colon, liver, gall bladder, and pancreases.
 Kinds of abdominal pain
• Visceral: dull, poorly localized, mostly felt
in epigastric, periumblical or suprapubic
region, .

• Parietal: acute, sharp, well localized

• Referred pain: pain originates from extra

abdominal organs but is felt in abdomen
 Causes of abdominal pain

A : Inflammation
• Distention
• Hemorrhage
• Perforation (peritoneum, reaction, diffuse peritonitis)
• Acute intestinal obstruction
• Torsion of pedicle
• colics
 Extra abdominal causes
• Parietal conditions

• Thoracic conditions

• Retroperitoneal conditions
Diseases of the spine
• General diseases (malaria, typhoid )
 PUD perforation
• Peritonism

• Reaction

• Diffuse peritonitis
 Intestinal obstruction
• Intestinal colic
• Vomiting
• Distention
• Absolute constipation
• dehydration
 colics
• Sever griping pain

• Nausea , vomiting, retching

• Varying degree of collapse
• No presens of muscle guarding
How is the Causes of abdominal
pain diagnosed

• Characteristics of the pain

• Physical examination
• Laboratory, radio logic &
endoscopic tests
• surgery
 1.Characteristics of the pain

• the way the pain begins

location of the pain
the pattern of the pain
colicky pain
shifting pain
spreading pain
sharp superficial constant pain
agonizing pain
throbbing pain
deny pain
the duration of the pain
what makes the pain worse
what relives the pain
associated signs and symptoms
gynecologic history
post history
drug history
travel history
 2.Physical examination
• General survey
• Appearance
• ability to communicate
• attitude

• vital signs
temperature, respiration, pulse, heart
 Inspection

Hernia orifice

Contour of abdomen
Respiratory movement
Skin
Distension
Cullen's sign
 Coughing to elicit pain

• Auscultation

• Percussion

• palpation
Hyperesthesia
Tenderness
Spreading tenderness
rebound tenderness
Guarding or rigidity
 3. tests
• Laboratory exams

• Blood exam
• Urine exam
• Stool exam
• Liver enzymes
• Pancreatic enzymes
 Imaging studies
• Plain chest X – ray
• Plain abdominal x – ray (KUB)
• Barium x – ray
• Ultrasonography
• C.T scan
• M.R.I
• Capsule enteroscopy
• Endoscopic procedures
Plain chest X-Ray shown lobar
pneumonia and free air under
diaphragm
Plain abdominal X-Ray shown
gaseous distension
 Differential diagnosis
• Appendicitis

• Medical diseases

• 1/3 cases are none specific &

can't be diagnosed until surgery.
 When to seek medical care
• Abdominal pain which continuous more
then 6 hours
• Abd .pain accompanied with vomiting
more then 3 or 4 times.
• Pain worsen by movement
• Pain that starts all over, but settles into
one area especially the right lower abd
• Pain that wakes the patient up at night
• Pain with vaginal bleeding and pregnancy
•
• Pain accompanied by fever over 101F

• Pain along with inability to urinate, move

• the bowels or pass gas
 treatment

• Self care at home

• Medical treatment
• Surgery
Who should be treated surgically
• If the patients pain comes from an infected
organ such as the appendix or gallbladder

• Sometimes bowl obstruction

• If the patients pain comes from ruptured or

perforated organ
• Positive radio logic signs for peptic
perforation

• Localized tenderness getting worse

• Abdominal pain accompanied whit sepsis

• Intestinal ischemia
‫تشکر‬