Wednesday, November 2, 2011

ABDOMINAL PAIN-causes, symptoms, management

Abdominal Pain

Description
  • Parietal pain:
    • Irritating material causing peritoneal inflammation
    • Pain transmitted by somatic nerves
    • Exacerbated by changes in tension of the peritoneum
    • Pain characteristics:
      • Sharp
      • Well localized
      • Abdominal tenderness
      • Involuntary guarding
      • Rebound tenderness
      • Exacerbated by movement and coughing
  • Visceral pain:
    • Distention of a viscous or organ capsule or spasm of intestinal muscularis fibers:
      • Pain is generally poorly localized.
      • Colicky with intestinal distention
      • Constant with a distended gallbladder or kidney
    • Inflammation:
      • Initially, the pain is poorly localized.
      • Focal tenderness develops as the inflammation extends to the peritoneum or localizers.
    • Ischemia from vascular disturbances:
      • Pain is severe and diffuse with catastrophic vascular emergencies
      • Pain is disproportional to the abdominal examination
  • Referred pain:
    • Felt at distant location from diseased organ
    • Due to an overlapping supply by the affected neurosegment to the perceived location of pain
  • Abdominal wall pain:
    • Constant
    • Aching
    • Muscle spasm
    • Involvement of other muscle groups
Etiology
  • Peritoneal irritants:
    • Gastric juice
    • Fecal material
    • Pus
    • Blood
    • Bile
    • Pancreatic enzymes
  • Visceral obstruction:
    • Small intestines
    • Large intestines
    • Gallbladder
    • Ureters and kidneys
    • Visceral ischemia
    • Intestinal
    • Renal
    • Splenic
  • Visceral inflammation:
    • Appendicitis
    • Inflammatory bowel disorders
    • Cholecystitis
    • Hepatitis
    • Peptic ulcer disease
    • Pancreatitis
    • Pelvic inflammatory disease
    • Pyelonephritis
  • Abdominal wall pain
  • Referred pain:
    • The possibility of intrathoracic disease must be considered in every patient with abdominal pain.
Diagnosis
Signs and Symptoms
  • General:
    • Anorexia
    • Malaise
    • Tachycardia
    • Hypotension
    • Fever
    • Nausea
    • Vomiting:
      • Etiology requiring surgical intervention is less likely when vomiting precedes the onset of pain
  • Abdominal:
    • Diarrhea
    • Constipation
    • Distended abdomen
    • Abnormal bowel sounds:
      • High-pitched rushes with bowel obstruction
      • Absence of sound with ileus or peritonitis
      • Often unreliable
    • Pulsatile abdominal mass
    • Rovsing sign:
Related Posts Plugin for WordPress, Blogger...