Site of pain

Typical pain sites of abdominal pain (general guidelines only) are presented in Figures 30.4 and 30.5 . Epigastric pain usually arises from disorders of the embryologie foregut such as the oesophagus, stomach and duodenum, hepatobiliary structures, pancreas and spleen. However, as some disorders progress the pain tends to shift from the midline to the right (gall bladder and liver) or left (spleen). Periumbilical pain usually arises from disorders of structures of the embryologic midgut, while structures from the hindgut tend to refer pain to the lower abdomen or suprapubic region.

Organs

Right hypochonUnuni

ú¿t¡ bladder biliary tract liver

Conditions biliary colic efioiecystitis BSCeMÏihQ cholangitis

Feriumt)illGai(centraii fttfanum/tJeum srrraft bowel oísfructitor; appendix appendicitis {eanyj Jtfrrí rUptU/WÍ ¿AA

rrcesertterj'c arieiy ocdusion

appendix appendicitis caecum/ilsum Crohn's disease

Meckel's dfYçrtfçuWtfs torsiïvi of testis check tent/a! orifices mtftSBC

biliary colic efioiecystitis BSCeMÏihQ cholangitis

Meckel's dfYçrtfçuWtfs torsiïvi of testis check tent/a! orifices mtftSBC

Organs

Epigastric oesophagus stomach duodenum gaü bladder liver pancreas

Fig. 30.4 Typical sites of various causes of acute abdominal pain

Organs

Epigastric oesophagus stomach duodenum gaü bladder liver pancreas

Conditions perforated ¿^cer cholecystitis pancreatitis myocardial infarction

{referred) lower lobe pneumonia {referred)

L hy pochcridrium and loin ktdney renal colic spleen urinary fnfecHon splenic infarct

LOwer abdomen targe bo-fret targe bo-irel oifsirLiCtiVjji

descending colon diverticulitis sigmoid

Suprapubic (hypogastric) ovaries ruptured ectopic fallopian rL'Li-ss scute PID bladder ruptured ovarian cyst to.rsfor? of ovary

NB lower abdominal and suprapubic pa m overlap

Fig. 30.4 Typical sites of various causes of acute abdominal pain

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