腹痛英文课件

ABDOMINALPAIN

Abdominalpainisaverycommonclinicalsymptom,whichinvolvesthepatients’subjectivereactiontothestimulus.Theapproachtothepatientwithabdominalpainisoneofaphysiciangreatestchallenges.Generally,therearetwokindsofabdominalpain,acuteabdominalpainandchronicabdominalpain.ABDOMINALPAIN1Cause:

1.acuteabdominalpain

1)peritonitis2)theacuteinflammationofabdominalorgans3)theswellingandobstructionofcavum4)thetorsionandruptureofabdominalorgans5)thoracicillnesses6)bellydiseases7)whole-lengthdiseasesCause:21)peritonitis:Theperforationofstomachorduodenumisthemostcommonreasonsofperitonitis.2)theacuteinflammationofabdominalorgans:

forinstant:acutegastritisacuteenteritisacutepancreatitisacutecholecystitis,andsoonIfthepatienthasahistoryofeatingsomeuncleanortoocoldfoods,andaccompaniedwithvomiting,diarrheaandacuteabdominalpain,it’shighlysuggestiveofacutegastroenteritis.1)peritonitis:3Acutepancreatitis:thepancreasisnecrosedandpartiallyliquefied.Acutepancreatitis:thepancre4

3)thedilationandobstructionofcavum

forinstant:cholelithiasisileus

4)thetorsionandruptureofabdominalorgans:forinstant:thetorsionofintestineorovarytheruptureofliverorspleencausedbytrauma.5)thoracicillness:forinstant:pneumoniamiocardialinfarction

5

Ifyoumeetsomeoldpeoplewhofeelepigastricpain,youshouldpayattentiontotakeaElectirocardiogram(ECG).It’sagoodwaytodistinguishabdominaldiseasesfrommiocardialinfarction.6)bellydiseases:forinstant:contusionofbelly7)whole-lengthdiseases:forinstant:uraemiaIfyoumeetsomeold6Cause:

1.acuteabdominalpain

1)peritonitis2)theacuteinflammationofabdominalorgans3)theswellingandobstructionofcavum4)thetorsionandruptureofabdominalorgans5)thoracicillnesses6)bellydiseases7)whole-lengthdiseasesCause:72.

chronicabdominalpain:1)Chronicinflammationofabdominalorgans

forinstant:

chronicgastritis,chroniccholecystitis,chronicpancreatitis

2)gastricorduodenalpepticulcer(mostimportant)3)thetorsionandobstructionofstomachorintestineforinstant:

chronictorsionofstomachorintestine4)increasedtensionofenvelopeforinstant:livercancer,liverabscess,hepaticgore5)toxicosisandmetabolicdisfunction:uremia6)encroachmentandoppressionoftumor

2.chronicabdominalpain:8

Bariummealexaminationshowinganulcercraterwithradiatingmucosalfoldsreachingtoitsrimandstronglysuggeststhattheulcerisbenign.ULCERBariummealexaminati92.chronicabdominalpain:1)Chronicinflammationofabdominalorgans

forinstant:

chronicgastritis,chroniccholecystitis,chronicpancreatitis

2)gastricorduodenalpepticulcer(mostimportant)3)thetorsionandobstructionofstomachorintestineforinstant:

chronictorsionofstomachorintestine4)increasedtensionofenvelopeforinstant:livercancer,liverabscess,hepaticgore5)toxicosisandmetabolicdisfunction:uremia6)encroachmentandoppressionoftumor2.chronicabdominalpain:10

Thedilationofmaterialorgans(suchasliver)canresultintheincreasedtensionoforgan’senvelope,sothepatientsfeelabdominalpainandotherdiscomfort.Thedilationofmateria112.chronicabdominalpain:1)Chronicinflammationofabdominalorgans

forinstant:

chronicgastritis,chroniccholecystitis,chronicpancreatitis

2)gastricorduodenalpepticulcer(mostimportant)3)thetorsionandobstructionofstomachorintestineforinstant:

chronictorsionofstomachandintestine4)increasedtensionofenvelopeforinstant:livercancer,liverabscess,hepaticgore5)toxicosisandmetabolicdisfunction:uremia6)encroachmentandoppressionoftumor2.chronicabdominalpain:12Cause:

2.chronicabdominalpain:1)Chronicinflammationofabdominalorgans

2)gastricorduodenalpepticulcer(mostimportant)3)thetorsionandobstructionofstomachorintestine4)increasedtensionofenvelope5)toxicosisandmetabolicdisfunction:6)encroachmentandoppressionoftumorCause:13Pathogenesis:Abdominalpainmaybeclassifiedasvisceralpain,somaticpain,andreferredpain1.

visceralpain:Visceralpainoriginatesfrominternalorgans.Mostvisceralfibershaveslowconduction,andtheabdominalvisceralakethedensenetworkofsomaticafferentfibers.a.dullb.nodistinctlocationc.accompaniedsymptom:nausea,vomiting,sweatingsuchas:

Painderivedfromstomach,duodenum,liver,biliarysystemorpancreasmostoftenpresentswithmidlinepainintheepigastrium.Pathogenesis:Abdominalpain142.somatic

pain:Somaticpainoriginatesfromtheabdominalwallandparietalperitoneum.Somaticafferentneverfibersallowmorepreciselocationofstimulation,andthedensityofneverfibersintheparietalperitoneumissignificantlygreaterthaninabdominalviscera.Thisallowsbetteridentificationofthelocation.a.It’ssharp,severeandcontinuousb.Distinctlocationc.Coughingandthechangeofbodyposturecanaggravatethepain.Suchas:peritonitis2.somaticpain:153.referredpain:

Itisatermthatdescribesaspainlocalizedtoasitedistantfromtheabdominalorganfromwhichthepainoriginates.Referredpainoriginatesfromtheinternalorgans.Itoccursbecauseofthecommonsiteofentryintothespinalcordofcutaneousandsensorynervesandabdominalvisceralafferents.Cutaneousandvisceralafferentsterminateonthesamesecondaryneuronwithinthedorsalhornofthespinalcord,resultinginmisinterpretationbythebrainofthecorrectoriginofthestimulations.Soithasdistinctlocation.Suchas:rightuppershoulderpainmayresultfromcholecystitis.

3.referredpain:16summary

visceralpainsomatic

painreferredpain

dullsharp,severecontinuousnodistinctlocationdistinctlocationdistinctlocationinternalorgansperitonitis

cholecystitis

summaryvisceralpains17Clinicalfeatures:1)location:

Painsiteoftenindicatestheorganresponsiblefortheproblem.A.Rightupperquadrantpainismoretypicalofcholecystitis.B.TendernessoverMcBurney’spointshouldbeconsideredstrongevidenceof

appendicitis.

C.Paincausedbycolondiseasesmostoftenpresentsinthemidlinelowerabdomen.D.Painarisingfromthesmallintestineiscommonlylocalizedtothesurroundingregionofumbilicus.Clinicalfeatures:182)characterandintensity:A.Extremelyintensepainofsuddenonsetcausedbytheperforationofgastriculcerisoftendescribedas“burning”or“cutting”.B.Biliaryorrenalcalculusisoftendescribedas“cramy”constricting.C.Persisting,wide-rangingseverepainaccompaniedwithhighintensityofabdominalmusclesishighlysuggestiveofacuteperitonitis.D.Intestinalobstructionisoftendescribedas“gripping”.2)characterandintensity:19E.Thepainofpepticulcerisusuallydescribedasadull,gnawingsensationofmildtomoderateseverity.It’sahungrypainandnocturnalpain.

Periodicepigastricpainoccuring1/2houraftereatingisatypicalsymptomofgastricpepticulcerandpatientswithaduodenalpepticulcerhavepain2-3hoursaftereatingorbeforethenextmeal.Sofoodtendstolessenthepainofduodenalpepticulcer.E.Thepainofpepticulceris203)timecourse:Suddenonset:(oversecondstominutes)

ruptureofliverorspleenperforationofpepticulcerrapidlyprogressive:(over1-2hours)pancreatitis,cholecystitisbowelobstructionrenalorbiliarycolic

gradual

onset:

(overseveralhours)typicalpepticulcer,chronicappendicitis

3)timecourse:214)aggravatingoralleviatingfactors:A.Painworsenedbymovementsuggestsperitonitis.B.Patientswitharetroperitonealprocess(suchaspancreatitis)commonlyfindpartialreliefbyleaningforward,andaggravationbylyingsupine.5)inducement:a.heavyandfattyfood-------cholecystitisb.heavyfoodanddrinking-------acutepancreatitisc.Trauma------ruptureofliverorspleen.腹痛英文课件22Clinicalfeatures:location:2)

characterandintensity:3)

timecourse:4)

aggravatingoralleviatingfactors:5)

inducement:Clinicalfeatures:23Accompaniedsymptoms:1.fever,chill:thesignofinflammationForinstant:acutecholangitis2.jaundice:biliarysystemandpancreasdiseases.3.theshockorhypotension:acuteinternalorgansbleeding4.bloodurine:Bloodurineishighlysuggestiveofthecalculusofurogenitalsystemdiseases.Accompaniedsymptoms:24SummaryLocation:rightupperquadranttendernessoverMcBurney’spointsurroundingregionofumbilicusmidlinelowerabdomenCharacter:pepticulcer:peritonitisintestinalobstructionbiliaryorrenalcalculusdull,gnawing,nocturnal,hungrysharp,burning,cuttinggrippingcramy

cholecystitisappendicitissmallintestinediseases

colonicdiseasesSummarydull,gnawing,nocturna25Inquirepoints:1.onsetoftheabdominalpain

Didthepainstartsuddenly?2.severityandcharacter

Canyoudescribethepain?Isitsharp?burning?cramy?Isthepaincontinuous?Hastherebeenanychangeintheseverityornatureofthepainsinceitbegan?Whatmakesitworse?Whatmakesitbetter?Inquirepoints:263.siteWhereisthepain?

Hasthepainchangeditslocationsinceitstarted?Doyoufeelthepaininanyotherpartofyourbody?4.timecourseHowlonghaveyouhadthepain?5.accompaniedsymptomsIsthepainassociatedwithnausea?vomiting?sweating?diarrhea?bloodstools?fever?chills?3.site27

SHORTSUMMARYWecansum-upinquirepointsin“PQRST”P:provocative-palliativefactors(aggravating-alleviatedfactors)Q:qualityR:regionS:severityT:temporalcharacteristicSHORTSUMMARY28ABDOMINALPAIN

Abdominalpainisaverycommonclinicalsymptom,whichinvolvesthepatients’subjectivereactiontothestimulus.Theapproachtothepatientwithabdominalpainisoneofaphysiciangreatestchallenges.Generally,therearetwokindsofabdominalpain,acuteabdominalpainandchronicabdominalpain.ABDOMINALPAIN29Cause:

1.acuteabdominalpain

1)peritonitis2)theacuteinflammationofabdominalorgans3)theswellingandobstructionofcavum4)thetorsionandruptureofabdominalorgans5)thoracicillnesses6)bellydiseases7)whole-lengthdiseasesCause:301)peritonitis:Theperforationofstomachorduodenumisthemostcommonreasonsofperitonitis.2)theacuteinflammationofabdominalorgans:

forinstant:acutegastritisacuteenteritisacutepancreatitisacutecholecystitis,andsoonIfthepatienthasahistoryofeatingsomeuncleanortoocoldfoods,andaccompaniedwithvomiting,diarrheaandacuteabdominalpain,it’shighlysuggestiveofacutegastroenteritis.1)peritonitis:31Acutepancreatitis:thepancreasisnecrosedandpartiallyliquefied.Acutepancreatitis:thepancre32

3)thedilationandobstructionofcavum

forinstant:cholelithiasisileus

4)thetorsionandruptureofabdominalorgans:forinstant:thetorsionofintestineorovarytheruptureofliverorspleencausedbytrauma.5)thoracicillness:forinstant:pneumoniamiocardialinfarction

33

Ifyoumeetsomeoldpeoplewhofeelepigastricpain,youshouldpayattentiontotakeaElectirocardiogram(ECG).It’sagoodwaytodistinguishabdominaldiseasesfrommiocardialinfarction.6)bellydiseases:forinstant:contusionofbelly7)whole-lengthdiseases:forinstant:uraemiaIfyoumeetsomeold34Cause:

1.acuteabdominalpain

1)peritonitis2)theacuteinflammationofabdominalorgans3)theswellingandobstructionofcavum4)thetorsionandruptureofabdominalorgans5)thoracicillnesses6)bellydiseases7)whole-lengthdiseasesCause:352.

chronicabdominalpain:1)Chronicinflammationofabdominalorgans

forinstant:

chronicgastritis,chroniccholecystitis,chronicpancreatitis

2)gastricorduodenalpepticulcer(mostimportant)3)thetorsionandobstructionofstomachorintestineforinstant:

chronictorsionofstomachorintestine4)increasedtensionofenvelopeforinstant:livercancer,liverabscess,hepaticgore5)toxicosisandmetabolicdisfunction:uremia6)encroachmentandoppressionoftumor

2.chronicabdominalpain:36

Bariummealexaminationshowinganulcercraterwithradiatingmucosalfoldsreachingtoitsrimandstronglysuggeststhattheulcerisbenign.ULCERBariummealexaminati372.chronicabdominalpain:1)Chronicinflammationofabdominalorgans

forinstant:

chronicgastritis,chroniccholecystitis,chronicpancreatitis

2)gastricorduodenalpepticulcer(mostimportant)3)thetorsionandobstructionofstomachorintestineforinstant:

chronictorsionofstomachorintestine4)increasedtensionofenvelopeforinstant:livercancer,liverabscess,hepaticgore5)toxicosisandmetabolicdisfunction:uremia6)encroachmentandoppressionoftumor2.chronicabdominalpain:38

Thedilationofmaterialorgans(suchasliver)canresultintheincreasedtensionoforgan’senvelope,sothepatientsfeelabdominalpainandotherdiscomfort.Thedilationofmateria392.chronicabdominalpain:1)Chronicinflammationofabdominalorgans

forinstant:

chronicgastritis,chroniccholecystitis,chronicpancreatitis

2)gastricorduodenalpepticulcer(mostimportant)3)thetorsionandobstructionofstomachorintestineforinstant:

chronictorsionofstomachandintestine4)increasedtensionofenvelopeforinstant:livercancer,liverabscess,hepaticgore5)toxicosisandmetabolicdisfunction:uremia6)encroachmentandoppressionoftumor2.chronicabdominalpain:40Cause:

2.chronicabdominalpain:1)Chronicinflammationofabdominalorgans

2)gastricorduodenalpepticulcer(mostimportant)3)thetorsionandobstructionofstomachorintestine4)increasedtensionofenvelope5)toxicosisandmetabolicdisfunction:6)encroachmentandoppressionoftumorCause:41Pathogenesis:Abdominalpainmaybeclassifiedasvisceralpain,somaticpain,andreferredpain1.

visceralpain:Visceralpainoriginatesfrominternalorgans.Mostvisceralfibershaveslowconduction,andtheabdominalvisceralakethedensenetworkofsomaticafferentfibers.a.dullb.nodistinctlocationc.accompaniedsymptom:nausea,vomiting,sweatingsuchas:

Painderivedfromstomach,duodenum,liver,biliarysystemorpancreasmostoftenpresentswithmidlinepainintheepigastrium.Pathogenesis:Abdominalpain422.somatic

pain:Somaticpainoriginatesfromtheabdominalwallandparietalperitoneum.Somaticafferentneverfibersallowmorepreciselocationofstimulation,andthedensityofneverfibersintheparietalperitoneumissignificantlygreaterthaninabdominalviscera.Thisallowsbetteridentificationofthelocation.a.It’ssharp,severeandcontinuousb.Distinctlocationc.Coughingandthechangeofbodyposturecanaggravatethepain.Suchas:peritonitis2.somaticpain:433.referredpain:

Itisatermthatdescribesaspainlocalizedtoasitedistantfromtheabdominalorganfromwhichthepainoriginates.Referredpainoriginatesfromtheinternalorgans.Itoccursbecauseofthecommonsiteofentryintothespinalcordofcutaneousandsensorynervesandabdominalvisceralafferents.Cutaneousandvisceralafferentsterminateonthesamesecondaryneuronwithinthedorsalhornofthespinalcord,resultinginmisinterpretationbythebrainofthecorrectoriginofthestimulations.Soithasdistinctlocation.Suchas:rightuppershoulderpainmayresultfromcholecystitis.

3.referredpain:44summary

visceralpainsomatic

painreferredpain

dullsharp,severecontinuousnodistinctlocationdistinctlocationdistinctlocationinternalorgansperitonitis

cholecystitis

summaryvisceralpains45Clinicalfeatures:1)location:

Painsiteoftenindicatestheorganresponsiblefortheproblem.A.Rightupperquadrantpainismoretypicalofcholecystitis.B.TendernessoverMcBurney’spointshouldbeconsideredstrongevidenceof

appendicitis.

C.Paincausedbycolondiseasesmostoftenpresentsinthemidlinelowerabdomen.D.Painarisingfromthesmallintestineiscommonlylocalizedtothesurroundingregionofumbilicus.Clinicalfeatures:462)characterandintensity:A.Extremelyintensepainofsuddenonsetcausedbytheperforationofgastriculcerisoftendescribedas“burning”or“cutting”.B.Biliaryorrenalcalculusisoftendescribedas“cramy”constricting.C.Persisting,wide-rangingseverepainaccompaniedwithhighintensityofabdominalmusclesishighlysuggestiveofacuteperitonitis.D.Intestinalobstructionisoftendescribedas“gripping”.2)characterandintensity:47E.Thepainofpepticulcerisusuallydescribedasadull,gnawingsensationofmildtomoderateseverity.It’sahungrypainandnocturnalpain.

Periodicepigastricpainoccuring1/2houraftereatingisatypicalsymptomofgastricpepticulcerandpatientswithaduodenalpepticulcerhavepain2-3hoursaftereatingorbeforethenextmeal.Sofoodtendstolessenthepainofduodenalpepticulcer.E.Thepainofpepticulceris483)timecourse:Suddenonset:(oversecondstominutes)

ruptureofliverorspleenperforationofpepticulcerrapidlyprogressive:(over1-2hours)pancreatitis,cholecystitisbowelobstructionrenalorbiliarycolic

gradual

onset:

(overseveralhours)typicalpepticulcer,chronicappendicitis

3)timecourse:494)aggravatingoralleviatingfactors:A.