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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.
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