2. Definition
• Designate symptoms and signs of intra-
abdominal disease of short duration usually
treated best by surgical operation.
• Condition with a rapidly worsening prognosis
in the absence of surgical intervention.
3. • Two syndromes that constitute urgent surgical
referrals are obstruction and peritonitis.
• A particularly high level of suspicion should be
maintained for severe pathology in
immunosuppressed patients.
4. • Abdominal pain may be visceral, parietal, or
referred.
Visceral:
• It is usually the result of distention of a hollow
viscus.
• The gastrointestinal tract is divided
embryologically into the foregut, midgut and
hindgut.
5. • Foregut : Oesophagus
Stomach
Duodenum – first and second parts
Pancreas
Liver
Gall bladder
• Midgut : Duodenum – third and fourth parts
Jejunum
Ileum
Right colon
Transverse colon
Appendix
• Hindgut: Left colon
Sigmoid colon
Rectum
7. • The viscera and visceral peritoneum is innervated
by the ANS with pain travelling back to the spinal
cord along sympathetic fibres.
• Sensory afferents involved with intraperitoneal
abdominal pain transmit dull, sickening, poorly
localized pain of more gradual onset and
protracted duration.
• This pain is therefore deep, poorly localised and
usually associated with sympathetic symptoms
such as sweating and nausea.
8. Parietal pain:
• The parietal peritoneum is innervated by the
relevant somatic nerves through spinal nerves
in the distribution of the overlying
dermatomes: the xiphisternum at the level of
T4, the umbilicus at T8 and the inguinal
ligament at T12.
• Pain is sharply localised to the point of
inflammation of the parietal peritoneum.
9. Referred pain:
• It is perceived at a site distant from the
source of stimulus.
• The phrenic nerve and afferent fibers in C3,
C4, and C5 dermatomes innervate the
diaphragmatic musculature and the
peritoneum on its undersurface. Stimuli to the
diaphragm therefore cause referred shoulder
pain.
11. • Introduction of bacteria/ irritating chemicals →
increased blood flow, increased permeability, and
the formation of a fibrinous exudate on its
surface.
• The bowel also develops local or generalized
paralysis.
• Abscess may produce sharply localized pain with
normal bowel sounds and gastrointestinal
function, whereas a diffuse process produces
generalized abdominal pain with a quiet
abdomen.
Peritoneum:
Editor's Notes
DkA, poryphyria, pain from the heart or lungs
The latter encompasses most severe abdominal pathology since intraperitoneal hemorrhage or viscus perforation typically present with common features of peritonitis
each arising with its own blood and nerve supply.
Of course, most causes of abdominal pain will incorporate both visceral and parietal pain, producing a picture that changes as the inflammation increases and spreads. This evolving picture may be picked up within the history-taking process or subse-quently by regular and repeated review of the patient.
The fibrinous surface and decreased intestinal movement cause adherence between the bowel and omentum
