1、ABDOMINAL PAINAbdominal pain is a very common clinical symptom , which involves the patients subjective reaction to the stimulus. The approach to the patient with abdominal pain is one of a physician greatest challenges.Generally, there are two kinds of abdominal pain, acute abdominal pain and chron
2、ic abdominal pain.,Cause: 1.acute abdominal pain 1) peritonitis 2) the acute inflammation of abdominal organs 3) the swelling and obstruction of cavum 4) the torsion and rupture of abdominal organs 5) thoracic illnesses 6) belly diseases 7) whole-length diseases,1) peritonitis:The perforation of sto
3、mach or duodenum is the most common reasons of peritonitis . 2) the acute inflammation of abdominal organs:for instant: acute gastritis acute enteritis acute pancreatitisacute cholecystitis ,and so on If the patient has a history of eating some unclean or too cold foods, and accompanied with vomitin
4、g, diarrhea and acute abdominal pain, its highly suggestive of acute gastroenteritis.,Acute pancreatitis: the pancreas is necrosed and partially liquefied.,3) the dilation and obstruction of cavumfor instant: cholelithiasis ileus4) the torsion and rupture of abdominal organs: for instant: the torsio
5、n of intestine or ovarythe rupture of liver or spleen caused by trauma. 5) thoracic illness: for instant: pneumonia miocardial infarction,If you meet some old people who feel epigastric pain, you should pay attention to take a Electirocardiogram (ECG). Its a good way to distinguish abdominal disease
6、s from miocardial infarction. 6) belly diseases: for instant: contusion of belly 7) whole-length diseases: for instant: uraemia,Cause: 1.acute abdominal pain 1) peritonitis 2) the acute inflammation of abdominal organs 3) the swelling and obstruction of cavum 4) the torsion and rupture of abdominal
7、organs 5) thoracic illnesses 6) belly diseases 7) whole-length diseases,2. chronic abdominal pain: 1) Chronic inflammation of abdominal organs for instant : chronic gastritis, chronic cholecystitis ,chronicpancreatitis 2) gastric or duodenal peptic ulcer (most important ) 3) the torsion and obstruct
8、ion of stomach or intestine for instant: chronic torsion of stomach or intestine 4) increased tension of envelope for instant :liver cancer, liver abscess, hepatic gore 5) toxicosis and metabolic disfunction: uremia 6) encroachment and oppression of tumor,Barium meal examination showing an ulcer cra
9、ter with radiating mucosal folds reaching to its rim and strongly suggests that the ulcer is benign.,ULCER,2.chronic abdominal pain: 1) Chronic inflammation of abdominal organs for instant : chronic gastritis, chronic cholecystitis ,chronicpancreatitis 2) gastric or duodenal peptic ulcer (most impor
10、tant ) 3) the torsion and obstruction of stomach or intestine for instant: chronic torsion of stomach or intestine 4) increased tension of envelope for instant :liver cancer , liver abscess, hepatic gore 5) toxicosis and metabolic disfunction: uremia 6) encroachment and oppression of tumor,The dilat
11、ion of material organs (such as liver) can result in the increased tension of organs envelope , so the patients feel abdominal pain and other discomfort.,2.chronic abdominal pain: 1) Chronic inflammation of abdominal organs for instant : chronic gastritis, chronic cholecystitis ,chronicpancreatitis
12、2) gastric or duodenal peptic ulcer (most important ) 3) the torsion and obstruction of stomach or intestine for instant: chronic torsion of stomach and intestine 4) increased tension of envelope for instant :liver cancer , liver abscess, hepatic gore 5) toxicosis and metabolic disfunction: uremia 6
13、) encroachment and oppression of tumor,Cause: 2.chronic abdominal pain: 1) Chronic inflammation of abdominal organs 2) gastric or duodenal peptic ulcer (most important ) 3) the torsion and obstruction of stomach or intestine 4) increased tension of envelope 5) toxicosis and metabolic disfunction: 6)
14、 encroachment and oppression of tumor,Pathogenesis: Abdominal pain may be classified as visceral pain , somatic pain , and referred pain 1. visceral pain:Visceral pain originates from internal organs. Most visceral fibers have slow conduction, and the abdominal viscera lake the dense network of soma
15、tic afferent fibers.a. dullb. no distinct locationc. accompanied symptom: nausea,vomiting, sweating such as: Pain derived from stomach, duodenum, liver, biliary system or pancreas most often presents with midline pain in the epigastrium.,2.somatic pain:Somatic pain originates from the abdominal wall
16、 and parietal peritoneum. Somatic afferent never fibers allow more precise location of stimulation, and the density of never fibers in the parietal peritoneum is significantly greater than in abdominal viscera. This allows better identification of the location . a. Its sharp, severe and continuous b
17、. Distinct location c. Coughing and the change of body posture can aggravate the pain. Such as: peritonitis,3. referred pain : It is a term that describes as pain localized to a site distant from the abdominal organ from which the pain originates.Referred pain originates from the internal organs. It
18、 occurs because of the common site of entry into the spinal cord of cutaneous and sensory nerves and abdominal visceral afferents. Cutaneous and visceral afferents terminate on the same secondary neuron within the dorsal horn of the spinal cord, resulting in misinterpretation by the brain of the cor
19、rect origin of the stimulations. So it has distinct location. Such as: right upper shoulder pain may result fromcholecystitis.,summary,visceral pain somatic pain referred pain dull sharp, severe continuousno distinct location distinct location distinct location internal organs peritonitis cholecysti
20、tis,Clinical features: 1) location:Pain site often indicates the organ responsible for the problem. A. Right upper quadrant pain is more typical of cholecystitis. B. Tenderness over McBurney s point should be considered strong evidence of appendicitis. C.Pain caused by colon diseases most often pres
21、ents in the midline lower abdomen. D. Pain arising from the small intestine is commonly localized to the surrounding region of umbilicus .,2) character and intensity : A. Extremely intense pain of sudden onset caused by the perforation of gastric ulcer is often described as “burning” or “cutting”. B
22、. Biliary or renal calculus is often described as “cramy” constricting. C. Persisting, wide-ranging severe pain accompanied with high intensity of abdominal muscles is highly suggestive of acute peritonitis. D. Intestinal obstruction is often described as “gripping”.,E. The pain of peptic ulcer is u
23、sually described as a dull, gnawing sensation of mild to moderate severity.Its a hungry pain and nocturnal pain. Periodic epigastric pain occuring 1/2 hour after eating is a typical symptom of gastric peptic ulcer and patients with a duodenal peptic ulcer have pain 2-3 hours after eating or before t
24、he next meal. So food tends to lessen the pain of duodenal peptic ulcer .,3) time course: Sudden onset: (over seconds to minutes )rupture of liver or spleenperforation of peptic ulcer rapidly progressive: (over 1-2 hours) pancreatitis ,cholecystitisbowel obstructionrenal or biliary colic gradual ons
25、et: (over several hours )typical peptic ulcer , chronic appendicitis,4) aggravating or alleviating factors: A. Pain worsened by movement suggests peritonitis . B. Patients with a retroperitoneal process (such as pancreatitis) commonly find partial relief by leaning forward ,and aggravation by lying
26、supine. 5) inducement : a. heavy and fatty food - cholecystitis b. heavy food and drinking - acute pancreatitis c. Trauma - rupture of liver or spleen.,Clinical features: location: 2) character and intensity : 3) time course: 4) aggravating or alleviating factors: 5) inducement :,Accompanied symptom
27、s: 1. fever, chill: the sign of inflammation For instant: acute cholangitis 2. jaundice: biliary system and pancreas diseases. 3. the shock or hypotension: acute internal organsbleeding 4. blood urine:Blood urine is highly suggestive of the calculus of urogenital system diseases.,Summary Location: r
28、ight upper quadrant tenderness over McBurney s point surrounding region of umbilicus midline lower abdomen Character: peptic ulcer: peritonitis intestinal obstruction biliary or renal calculus,dull, gnawing, nocturnal, hungry,sharp, burning, cutting,gripping,cramy,cholecystitis,appendicitis,small in
29、testine diseases,colonic diseases,Inquire points : 1. onset of the abdominal painDid the pain start suddenly? 2. severity and character Can you describe the pain ? Is it sharp? burning? cramy?Is the pain continuous?Has there been any change in the severity or nature of the pain since it began?What m
30、akes it worse?What makes it better?,3. site Where is the pain? Has the pain changed its location since it started?Do you feel the pain in any other part of your body? 4. time courseHow long have you had the pain ? 5. accompanied symptomsIs the pain associated with nausea? vomiting ? sweating? diarrhea? blood stools? fever? chills?,SHORT SUMMARYWe can sum-up inquire points in “ PQRST” P: provocative - palliative factors(aggravating -alleviated factors ) Q: quality R: region S: severity T: temporal characteristic,
