clinical approach to apatient with abdominal pain
TRANSCRIPT
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Clinical approach to a patient with abdominal pain
byprof/ GOUDA ELLABBAN
prof of surgery , hepatobiliary and laparoscopy scu hospital/ Egypt
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ABDOMINAL PAIN
VISCERAL PAIN
NOCICEPTORSSTRETCHCHEMICAL
SOMATIC PAIN
From ABDOMINAL WALL & PARIETAL PERITONEUM
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SITE AND RADIATION
ORGAN SITE OF PAIN RADIATION
STOMACH EPIGASTRIUM Rt HYPO, LUMBAR,Rt ILIAC,Lt CHEST,VERTEBRAL COLUMN
LIVER-Rt LOBE Rt HYPOCHONDRIUM
SHOULDER,SUPRACLAVICULAR & SCAPULAR REGION ON Rt
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LIVER-Lt LOBE EPIGASTRIUM PRECORDIUM, Lt SCAPULAR, Lt CLAVICLE
GALL BLADDER EPIGASTRIUM or Rt HYPOCHONDRIUM
CHEST,Rt SCAPULA,Rt CLAVICLE,SHOULDER,BACKMay resemble ANGINAL pain
SPLEEN(pain unusual)
Dragging sensation &fullness-Lt HYPO & LUMBAR
Local inflamn of peritoneum-Catching pain respiration
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PANCREAS EPIGASTRIUM OR BACK
Acute-symps of shockChronic-vague in nature & location
KIDNEYS LOINS or LUMBAR REGION
Obstructive lesions-Penis or Labia + urgency for urination
URINARY BLADDER
HYPOGASTRIUM PERINEUM & URETHRA
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SMALL INTESTINE
UMBILICUS
LARGE INTESTINE
ILIAC or LUMBAR
APPENDIXCAECUM
Rt ILIAC FOSSA Rt LUMBAR, UMBILICAL
RECTUM Lt ILIAC FOSSA or HYPOGASTRIUM
Assoc. with tenesmus
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UTERUS
DYSMENORRHOEA
HYPOGASTRIUM & UMBILICUS
LOWER ABDOMEN
LOW BACK & FLANKS
OVARY ILIAC FOSSA EXTERNAL GENITALIA
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PERITONITIS
LOCALISED
Eg. Rt iliac fossa in appendicitis
GENERALISED
DIFFUSE affecting the whole abdomen
GUARDING AND RIGIDITY ON PALPATION
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REFERRED PAIN
Pain arising from lesions outside abdomenREFERRED to abdomenEg. MI radiate to epigastriumGirdle pain B/L dorsal nerve root
compression
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Psycogenic Pain
Not due to any organic causeMore common at night
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NATURE OF PAIN
SOLID ORGANS:DULL & CONSTANT aggravated by pressure.Organ enlarged,palpable,tender.
HOLLOW VISCERA:COLICKY PAIN reach max. in secs or mins & passes off.
Exception biliary tract & pancreas
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DURATION OF PAIN
ACUTE
Intense pain with dramatic onset
Reach maximum in hrs or days
CHRONIC
Periods of remissions & exacerbations with intervals of relief in btwn
Months or years
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Relation to normal physiological events
Pain related to ingestion of food
Gastric ulcer
Pain relieved by food intake Duodenal ulcer
Relief of pain by vomiting Gastric outlet obstruction
Pain on recumbency & relief on erect posture
GERD
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Pain on ingestion of fat Malabsorption
Pain on defaecation Colonic disease
Blood and mucus in faeces Colonic ulcer
Pain as food pass down to be digested & absorbed
Intestinal angina
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Past HistoryTraumaDM, CRF-Metabolic cause of painThrombotic disease-Vaso occlusionCAD-Embolic occlusion
Family History
o DM
o CAD
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Personal History
Appetite & Loss of weightBowel habits- Malena-Upper GIT ds
Hematochezia-Lower GIT dsDifficulty in micturitionMenstrual history
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General Examination
PALLOR Malabsorption,Acute or chronic blood loss
ICTERUS Hepatobiliary disease
CYANOSIS Cirrhosis liver with portal hypertension
CLUBBING Cirrhosis,ulcerative colitis,Crohn`s disease
LYMPHADENOPATHY Generalised or localised
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GIT Examination….
Inspection1. Shape2. Umbilicus3. Movements of the abdominal wall4. Skin and surface of abdomen
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•Palpation
1. Liver2. Spleen3. Kidneys4. Palpable mass
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• Percussion
Shifting dullness Fluid thrill Puddle sign
Auscultation
1. Bowel sounds2. Succusion splash
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Also examine….
GenitaliaHernial orificesPer rectal examinationPer vaginal examination
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THANK YOU!!!!