Andreas M Andreas M KluftingerKluftingerMD FRCSC Simplified in ThirdsSimplified in Thirds EmbryologicStructuresNervesArteriesPain Location ForegutEsophagus stomach34 duodliver gb panc Thoracic sp ID: 945708
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Acute Abdomen Andreas M Andreas M KluftingerKluftingerMD FRCSC Simplified in ThirdsSimplified in Thirds Emb
ryologicStructuresNervesArteriesPain Location ForegutEsophagus, stomach,3/4 duod,liver, gb panc Thoracic sp
lanchnics, vagusCoeliacEpigastrium panc Midgut¼ duodto splenicflexureThoracic splanchnics, vagusSMAPeriumbi
licalHindgutLeft colon, rectum, GU tractPelvic splanchnics, lesser thoracic splanchnicsIMAHypogastrium Poss
ible Causes of Pain by Location Location of PainAssociated DiseasesRight upper quadrant(liver, kidney, gall
bladder)Acute cholecystitis, biliarycolic, acute hepatitis, duodenal ulcer, right lower lobe pneumoniaRight
lower quadrant(ascending colon, appendix, ovary, fallopian tube)Appendicitis, cecaldiverticulitis, ectopic
pregnancy, tubo-ovarian abcess, ruptured ovarian cyst, ovarian torsionLeft upper quadrant(pancreas, spleen
, kidney)Gastritis, acute pancreatitis, splenicpathology, left lower lobe pneumonia Left lower quadrant(si
gmoid and descending colon, ovary, fallopian tube)Diverticulitis, ectopic pregnancy, tubo-ovarian abcess, r
uptured ovarian cyst, ovarian torsionMidline or periumbilicalAppendicitis (early), gastroenteritis, mesente
ric lymphadenitis, myocardial ischemia or infarction, pacreatitisFlankAbdominal aortic aneurysm, renal coli
c, pyelonephritisFront to backAcute pancreatitis, ruptured abdominal aortic aneurysm, retrocecalappendiciti
s, posterior duodenal ulcerSuprapubic or lower abdominalEctopic pregnancy, mittelschmerz, ruptured ovarian
cyst, pelvic inflammatory disease, endometriosis, urinary tract infection SignFindingAssociation Cullen's s
ignGrey TurnerÂ’s signBluish periumbilicaldiscolorationBluish flank discolorationRetroperitoneal hemorrhagep
ancreatitis, abdominal aortic aneurysm rupture)Kehr'ssignSevere left shoulder painSplenicruptureEctopic pre
gnancy McBurney'ssignTenderness located 2/3 distance fromASIS to umbilicus on right sideAppendicitis Murphy
's signAbrupt interruption of inspiration onpalpation of right upper quadrantAcute cholecystitisIliopsoas s
ign Hyperextension of right hipcausing abdominal painAppendicitisObturator's signInternal rotation of flexe
d right hip causing abdominal painAppendicitisChandelier signManipulation of cervix causes patient to lift
buttocks off tablePelvic inflammatory diseaseRovsing'ssign Right lower quadrant pain with palpation of th
e left lower quadrant Appendicitis Referred Pain Structure IrritatedLocation of Referred PainDiaphragmati
cSupraclavicular area (Kehr's sign)UreteralHypogastrium, groin, inner thighCardiac painEpigastrum, jaw, sho
ulder Appendix Periumbilical via T10 nerve Appendix Periumbilical via T10 nerve DuodenumUmbilical region vi
a greater thoracic splanchnicnerveHiatal herniaEpigastrumvia T7 and T8 nervesPancreas or gallbladderEpigast
rumGallbladder and bile ductEpigastricpain that wraps around to the scapula Imaging for AppendicitisImaging