Transcript abdominal pain

ABDOMINAL PAIN
Abdominal Pain
• Abdominal pain is pain that you feel anywhere
between your chest and groin. This is often
referred to as the stomach region or belly.
• Abdominal pain comes from organs within the
abdomen or organs adjacent to the abdomen.
• Acute and severe abdominal pain, however, is
almost always a symptom of intra-abdominal
disease.
ABDOMINAL PAIN
Abdominal 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
chronic 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
Cause
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5) thoracic illnesses
6) belly diseases
7)disease of abdominal wall
8) whole-length diseases
1) peritonitis:
The perforation of stomach or duodenum is the
most common reasons of peritonitis .
2) the acute inflammation of abdominal organs:
for instant: acute gastritis
acute enteritis
acute pancreatitis
acute cholecystitis ,and so on
If the patient has a history of eating some
unclean or too cold foods, and accompanied with
vomiting, diarrhea and acute abdominal pain, it’s
highly suggestive of acute gastroenteritis.
The perforation of stomach or
duodenum
Acute pancreatitis: the pancreas is necrosed
and partially liquefied.
3) the dilation and obstruction of cavum
for instant: cholelithiasis
ileus
4) the torsion and rupture of abdominal organs:
for instant: the torsion of intestine or ovary
the 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). It’s a good way to
distinguish abdominal diseases from miocardial
infarction.
6) belly diseases:
for instant : contusion of belly
7) disease of abdominal wall
for instant :contusion of abdominal wall
herpes zoster
herpes zoster
• 8) whole-length diseases:
• for instant:uraemia
abdominal allergic purpura
Diabetic acidosis
abdominal allergic purpura
blutene chloaide
2. chronic abdominal pain:
1) Chronic inflammation of abdominal organs
for instant : chronic gastritis, chronic cholecystitis ,chronic
pancreatitis
2) gastric or duodenal peptic ulcer (most important )
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
ULCER
Barium meal examination showing an ulcer
crater with radiating mucosal folds reaching to
its rim and strongly suggests that the ulcer is
benign.
Ulcer
The dilation of material organs (such as liver)
can result in the increased tension of organ’s
envelope , so the patients feel abdominal pain and
other discomfort.
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 somatic afferent fibers.
a. dull
b. no distinct location
c. 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 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. It’s sharp, severe and continuous
b. 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 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 correct origin of
the stimulations. So it has distinct location.
•Such as: right upper shoulder pain may result from
cholecystitis.
summary
• visceral pain

dull
no distinct location
• internal organs
somatic pain
referred pain
sharp, severe
continuous
distinct location
distinct location
peritonitis
cholecystitis
 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 presents 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. 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 usually described as a
dull, gnawing sensation of mild to moderate severity.
 It’s 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 the 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 spleen
perforation of peptic ulcer
rapidly progressive: (over 1-2 hours)
pancreatitis ,cholecystitis
bowel obstruction
renal or biliary colic
gradual onset: (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 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:
1) location:
2) character and intensity :
3) time course:
4) aggravating or alleviating factors:
5) inducement :
 Accompanied symptoms:
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 organs
bleeding
4. blood urine:
Blood urine is highly suggestive of the calculus
of urogenital system diseases.
Summary
Location:
right upper quadrant
cholecystitis
tenderness over McBurney ’s point
appendicitis
surrounding region of umbilicus
small intestine diseases
midline lower abdomen
colonic diseases
Character:
peptic ulcer:
dull, gnawing, nocturnal, hungry
peritonitis
sharp, burning, cutting
intestinal obstruction
gripping
biliary or renal calculus
cramp
Character and severity
• Gastroduodenitis or ulcer:Dull pain or
burning pain
• gastric-intestinal perforation:Knife-like
pain (Piercing pain)
• acute pancreatitis:Bursting pain or Dull
pain
Character and severity
• Cholecystalgia or renal colic :
Colicky (griping,cramp)pain
• Peritonitis:Severe and diffuse pain
• Biliary ascariasis:Cramp pain
Inquire points :
1. onset of the abdominal pain
Did 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 makes 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 course
How long have you had the pain ?
5. accompanied symptoms
Is the pain associated with nausea? vomiting ?
sweating? diarrhea? blood stools? fever? chills?
SHORT SUMMARY
We can sum-up inquire points in
“ PQRST”
P: provocative - palliative factors
(aggravating -alleviated factors )
Q: quality
R: region
S: severity
T: temporal characteristic
Thank you for
you attention