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    Abdominal Pain

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    dhainey
    The document discusses abdominal pain, noting that pain arising from visceral organs produces deep, boring sensations that are poorly localized, often with accompanying nausea and vomiting. Pain from somatic nerves is sharp and well-localized. Understanding the innervation of abdominal organs helps determine the nature and pattern of a patient's pain. Severe acute abdominal pain can have life-threatening causes like leaking aneurysms or appendicitis, requiring urgent diagnosis and possible early surgery. A careful history and repeated exams over hours are important to identify the location, quality, and severity of symptoms.

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    Abdominal Pain

    Uploaded by

    dhainey
    908 views12 pages
    The document discusses abdominal pain, noting that pain arising from visceral organs produces deep, boring sensations that are poorly localized, often with accompanying nausea and vomiting. Pain from somatic nerves is sharp and well-localized. Understanding the innervation of abdominal organs helps determine the nature and pattern of a patient's pain. Severe acute abdominal pain can have life-threatening causes like leaking aneurysms or appendicitis, requiring urgent diagnosis and possible early surgery. A careful history and repeated exams over hours are important to identify the location, quality, and severity of symptoms.

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    The document discusses abdominal pain, noting that pain arising from visceral organs produces deep, boring sensations that are poorly localized, often with accompanying nausea and vomiting. Pain from somatic nerves is sharp and well-localized. Understanding the innervation of abdominal organs helps determine the nature and pattern of a patient's pain. Severe acute abdominal pain can have life-threatening causes like leaking aneurysms or appendicitis, requiring urgent diagnosis and possible early surgery. A careful history and repeated exams over hours are important to identify the location, quality, and severity of symptoms.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    908 views12 pages

    Abdominal Pain

    Uploaded by

    dhainey
    The document discusses abdominal pain, noting that pain arising from visceral organs produces deep, boring sensations that are poorly localized, often with accompanying nausea and vomiting. Pain from somatic nerves is sharp and well-localized. Understanding the innervation of abdominal organs helps determine the nature and pattern of a patient's pain. Severe acute abdominal pain can have life-threatening causes like leaking aneurysms or appendicitis, requiring urgent diagnosis and possible early surgery. A careful history and repeated exams over hours are important to identify the location, quality, and severity of symptoms.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 12

    Abdominal Pain

    Nadine Z. Villarin
    Acute Abdominal Pain

    It is important to understand the


    physiology of pain specific to each
    organ and site in the abdomen.
    For instance, distention of the bowel
    produces pain, whereas mechanical
    laceration does not.
    pain arising in the viscera

    vagal visceral afferent nerves


    and sympathetic afferent nerves

    sensations:
    • Deep
    • Boring
    • poorly localized
    – frequently accompanied by autonomic features
    such as nausea, vomiting, and diaphoresis.
    Pain transmitted via the spinal somatic
    afferent nerves

    innervating the body wall and peritoneum

    generally described as:


    • sharp
    • well localized to the anatomic site of the
    inflammation or injury.
    knowledge of the innervation of each
    abdominal organ will help the
    examiner understand the nature
    and pattern of the
    patient's pain history.
    Severe, acute abdominal pain can lead to a
    variety of disorders from the benign to the
    Immanently life-threatening.
    The specific diagnosis must be sought with
    a sense of urgency, because early surgical
    intervention may be lifesaving in some
    disorders:
    • leaking abdominal aortic aneurysm
    • appendicitis
    and contraindicated in others:
    • acute intermittent porphyria
    • sickle cell crisis.
    Some assistance is obtained from
    Imaging examinations, while laboratory tests
    are less important. A careful history and
    personally repeated examinations over a few
    hours are mandatory.
    Important in Examination:
    – Location of pain
    – Tenderness
    – Variations in quality
    – Severity of symptoms
    Fig. 9-19 Common Locations of Acute Abdominal Pain. In general, the painful
    spot is also tender, but not always. Note especially that the pain of acute appendicitis
    is in the epigastrium early and later in the right lower quadrant. Pain in the spleen
    commonly radiates to the top of the left shoulder. These pains are ordinarily constant,
    in contrast to the intermittent pain of colic.
    Chronic and Recurrent
    Abdominal Pain
    • Chronic pain is physiologically different
    from acute pain.
    • The pattern of pain and associated
    symptoms will help to make inferences
    about the possible pathophysiology, while
    the location of the pain suggests the
    organs involved.
    Pain that is vague in onset but steadily
    worsens over time suggests a progressive
    anatomically advancing obstructive lesion
    or mass effect.

    Intermittent pain separated by periods free


    of pain suggests painful smooth-muscle
    contraction or dynamic obstruction,
    recurrent inflammation or ulceration, and
    relapsing infection.
    Careful history is required to identify:

    • precipitating factors
    • Timing
    • previous surgeries
    • symptoms, or illnesses that could help
    explain the current problem
    It is important to recognize that
    nonspecific abdominal and pelvic pain is a
    common symptom in persons with
    histories of current or previous abuse.
    If the history and physical exam do not
    suggest specific leads for further
    investigation, a barrage of laboratory and
    imaging tests are extremely unlikely to be
    helpful.
    There is a tendency to project pain inward
    to intraabdominal structures when it
    actually arises from the abdominal wall.

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