Abdomen Trans part 1 Flashcards
Solid viscera
Liver Spleen Kidneys Pancreas Ovaries Uterus
The principal mechanical signal to which visceral nocireceptors are sensitive
Stretch
Example of mechanoreceptors stimulation
From rapid distention of hallow viscus
Intestinal obstruction
Example of mechanoreceptors stimulation
Forceful muscular contraction
Biliary or renal colic
Example of mechanoreceptors stimulation
Rapid stretching of solid organs serosa or capsule
Hepatic congestion
Example of mechanoreceptors stimulation
Torsion of mesentery
Cecal volvolus
Example of mechanoreceptors stimulation
Tension from traction on the messentery or mesenteric vessels
Retroperitoneal or pancreatic tumor
Chemical receptor are directly activated by substance
H+ K+ Histamine Serotonin Substance P Bradykinin Vasoactive amines Calcitonin Related peptides Prostaglandin Leukotrines
Classification of abdominal pain
Visceral pain
Somatoparietal pain
Referred pain
Not localized pain
Visceral pain
Because most viscera is multi segmental and low nerve endings
Visceral pain is generally described as
Cramping
Burning
Gnawing
Aching
Visceral pain
Secondary autonomic effects such as
Sweating Restlessness Nausea Vomiting Perspiration Pallor
Visceral pain
To relieve the pain
Patient move about in an effort
More intense and more precisely localized
Somatoparietal pain
Somatoparietal pain
Dermatomes corresponds
T6 to L1 region
Somatoparietal pain
Usually aggravated by
Movement and coughing
Somatoparietal pain
Palpation over the area is
Extremely painful
Patient lies as still as possible
Somatoparietal pain
Overlying abdominal muscles contraction
Rebound tenderness
Felt in areas remote to the diseased organ
Referred pain
Referred pain
Result of convergence of what neurons
Visceral afferent neurons with
Somatic afferent neurons on
2nd order neurons in the spinal cord
Referred pain
Maybe felt in skin or deeper tissues but is usually
Well localized
Referred pain
Appears as the noxious visceral stimulus becomes
More intense
Most important part of evaluation of a patient with abdominal pain
History
Temporal considerations in the evaluation of a patient with acute abdominal pain include the rapidity of onset and the progression and duration of symptoms
Chronology
Measure its significance
Pain that is sudden in onset, severe and well localized.
Rapidity of onset of pain
Rapidity of onset of pain
Likely to be the result of an intra abdominal catastrophic events such as
Perforated viscus
Mesenteric infarction
Ruptured aneurysm
Example of self limited pain
Gastroenteritis
Example of progressive
Appendicitis
Colicky pain has crescendo-decrescendo patterns that may be diagnostic as in
Renal colic
Patient who seek evaluation of abdominal pain that has been present for an extended period are less likely to have an acutely threatening illness than those who do so within hours to days
Duration
Pain of less than 24 hours
Not always mandate surgical intervention
Acute abdominal pain
Pain present for at least 6 months
Divided into diagnosable and undiagnosable
Chronic abdominal pain
Changes in location may represent
Progression from visceral to parietal irritation as in
Appendicitis
Changes in location may represent
Represent the development of diffuse peritoneal irritation, as with
Perforated viscus
The point of reference varies among individuals depends on
Setting in which pain is occuring
Past experienced with various types of pain
Personality
Culture
Intensity and character
Severity of pain is loosely related to the magnitude of the
Noxious stimuli
Fatty food development of
Biliary colic
Pain with duodenal ulcer is alleviated by
Meals
Patients with gastric ulcer or chronic mesenteric may report exacerbation of pain with
Eating
History considered
Associated symptoms and review of symptoms
Information regarding changes in digestive functions
Vomitus clear suggest
Gastric outlet obstruction
Vomitus feculent suggest
More distal small bowel or colonic obstruction
Patients with a history of these are likely to have recurrences
Partial small bowel obstruction
Renal calculi
PID
Systemic illnesses such as ________________ often have abdominal pain as manifestation of their illness
Scleroderma Lupus Nephritic syndrome Porphyria Sickle cell disease
Social and family history
Familial disease Substance abuse Occupation Travel to other place Contact to animals or ill people
Location of the pain suggest
Organ involved
Pain that is vagued in onset but steadily worsened overtime suggest a
Progressive advancing obstructive lesion or mass effect
Intermittent pain with period of free pain suggest
Painful smooth muscle contraction
Dynamic obstruction
Recurrent inflammation
Relapsing infection
Patient with an organic cause for abdominal pain is
Generally not hungry
Ask patient to finger point the pain
Kapag direct na tinuro significant
The farther from the navel the pain, the more likely it will be organic in origin
Apley rule
Patients with non specific abdominal pain keep their
Eyes closed during palpation
Patient with organic disease usually keep their
Eyes open
Sensation of sticking or obstruction of passage of food through the mouth, pharynx or esophagus
Dysphagia
Complete esophageal obstruction which is usually due to bolus impaction and represents a medical emergency
Aphagia
Painful swallowing
Odynophagia
Is the sensation of a lump lodged in the throat
Globus pharyngeus
Fear of swallowing
Phagophobia
Sensation of food being hindered in its passage
Food sticks, hang up or that food just won’t go down
Dysphagia
Normally orophanyngeal swallowing, peristalsis of esophagus to stomach occurs within
10 seconds