Abdominal Pain

Group ix

Scenario
A 17 year-old girl, came to the clinic department
complaining of right lower quadrant
abdominal pain that woke her from sleep last
night. This chief complaint is associated with
nausea and episode of vomiting. The patient
also reports that she has chills.

Keywords

17 yo girl
Right lower quadrant pain
Nausea & vomiting
chills

Questions
1. Explain the basic science of the digestive system?
2. Whats the pathomechanism & types of abdominal
pain?
3. Whats the causes of abdominal pain?
4. Whats the relationship between chills & abdominal
pain?
5. Whats the relationship between nausea, vomiting &
abdominal pain?
6. Whats the additional anamnesis?
7. Differential Diagnosis?

1. Basic Science of Digestive System

Anatomy

Histology of the Digestive System

Basic Histological Layers
1. Mucosa
a. Epithelium
b. Lamina Propria
c. Muscularis Mucosae
2. Submucosa
a. Submucosal plexus
Plexus of Meissner
3. Muscularis
a. Myenteric plexus
Plexus of Auerbach
4. Serosa

Mucosa
Epithelial

Lamina
Propria

Surfaces

Organ

Epithelium

Folds of Epithellium

Mouth

Non Keratinized
Stratified
Squamous

Pharynx

Non Keratinized
Stratified
Squamous

Esophagus

Non Keratinized
Stratified
Squamous

Stomach

Simple Collumnar

Rugae

Gastric Pits

Small Intestines

Small Collumnar

Plicae Circularis
Vili

Crypts of
Lieberkhun,
Microvili

Large Intestines

Small Collumnar

Haustra

Intestinal Glands

Anus

Non Keratinized
Stratified
Squamous

Submuco Muscular
sa
is

Serosa

Specialized
structure

Smooth Muscle
Layer

Serose

Submucosal
Mucous Gland

2 (circular &
longitudinal)

Adventitia

3 (circular,
longitudinal,
oblique)

Visceral
Peritoneum

Brunners Gland
(duodenum)
Peyers patches
(ileum)

2 (circular,
longitudinal)

Visceral
Peritoneum

2 (circular &
longitiudinal )

Visceral
Peritoneum

Biochemistry

Physiology

2. Whats the pathomechanism &

types of abdominal pain?

3. Whats the causes of abdominal

pain?

4. Whats the relationship between

chills & abdominal pain?

5. Whats the relationship between

nausea, vomiting & abdominal pain?
Trigger

Serotonergic & Adrenergic

stimulation

Dilataion / constriction of
Cerebral & Scalp blood vessels
Stimulation of 5th Cranial
nerves (Trigeminal)
Stimulation of 5th Cranial
nerves (Trigeminal)

Thalamus

Cortex

Abdominal Pain

Stimulation of 5th Cranial

nerves (Trigeminal)

Chemoreceptor
Stimulation of 5th Cranial
nerves (Trigeminal)

6. Whats the additional anamnesis?

7. DD

Appendicitis

PID
Background: infectious & inflammatory
disorder of the upper female reproductive
tract (uterus, fallopian tubes, and adjacent
pelvic structure)

 Pathophysiology:
Stage I vaginal or cervical infection
Stage II direct ascent of microorganisms
from the vagina or cervix to the upper genital
tract.

 Etiology
Infecting organisms:
Neiseeria gonorrhoeae
Chlamydia trachomatis

Risk factors:

Mesntruating woman younger than 25

Multiple sexual partners
Dont use contraception
History of STIs
History of sexual abuse
Frequent vaginal douching

 Epidemiology
Age range: 15-49 yo
10-20 per 1000 women of reproductive age.

Prognosis
Chronic pelvic pain
Impaired fertility
Tubo-ovarian abscess (TOA) pelvic peritonitis &
Fitz Hugh Curtis syndrome (perihepatitis)

 Clinical Presentation
Sign & symptoms:
Depend on severity of the infection (fever, nausea, vomiting,
severe pelvic & abdominal pain)
Lower abdominal pain

Dull, aching, crampy

Bilateral
Constant
Begins a few days after the onset of the last menstrual period
Worsening by motion, exercise, coitus.
Last less than 7 days. No more than 3 weeks

Abnormal vaginal discharge

Vaginal bleeding often postcoital (40%)

 Workup
Lab studies
USG
Laparoscopy
CT
MRI
Culdocentesis
Endometrial Biopsy

 Treatment & Management

Antibiotic regiments
Surgical care
Detterence & Prevention

Medication
Antibiotics