COLIC ABDOMEN

Jenis nyeri perut

• Nyeri visceral

– Trjadi bila terdapat rangsangan pada organ perut misalnya karena cedera atau radang

– Nyeri visceral tidak dapat ditunjuk secara tepat letaknya

– Penderita dapat aktif bergerak

– Nyeri visceral memperlihatkan pola yang khas sesuai persyarafan embrional

• Nyeri visceral dari lambung, duodenum, sistem hepatobilier dan pankreas (foregut) dirasakan di ulu hati

• Nyeri di duodenum sampai pertengahan kolon transversum (midgut) dirasakan di umbilikus

• Kelainan dari kolon transversum ke sigmoid (hindgut) menyebabkan nyeri di perut kanan bawah

• Nyeri somatik

– Terjadi karena rangsangan pada bagian yang dipersarafi oleh saraf tepi misalnya regangan pada peritoneum parietalis dan luka pada dinding perut

– Nyeri dirasakn seperti ditusuk/disayat

– Pasien dapat menunjukkan letak nyeri

– Pasien tidak dapat aktif bergerak

Sifat nyeri

• Nyeri alih

– Terjadi jika suatu segmen persyarafan melayani lebih dari 1 daerah

• Nyeri proyeksi

– Nyeri yang disebakan oleh rangsangan saraf sensorik akibat cedera atau peradangan saraf

• Hiperestesia/hiperalgesia

– Ditemukan di kulit jika ada peradangan di bawahnya

• Nyeri kontinue

– Nyeri akibat rangsangan pada peritoneum parietal akan dirasakan terus-menerus karena proses berlangsung terus

• Nyeri kolik

– Nyeri visceral akibat spasme otot polos organ berongga dan biasanya disebabkan oleh hambatan pasase organ tersebut

– Nyeri timbul akibat hipoksia yang dialami oleh jaringan

– Nyeri hilang timbul

– Disertai mual muntah

• Nyeri iskemik

– Tanda adanya jaringan yang terancam nekrosis

– Nyeri hebat, menetap, tidak menyurut

• Nyeri pindah

– Nyeri berubah dengan perkembangan patologi

– Nyeri visceral di sekitar pusat disertai mual

Letak Nyeri

Epigastric pain

GERD MI AAA- abdominal aortic aneurysm Pancreatic pain Gallbladder and common bile duct obstruction

Right Upper Quadrant

Acute Cholecystitis and Biliary Colic Acute Hepatitis or Abscess Hepatomegaly due to CHF Perforated Duodenal Ulcer Herpes Zoster Myocardial Ischemia Right Lower Lobe Pneumonia

Right Lower Quadrant

Appendicitis Regional Enteritis Small bowel obstruction Leaking Aneurysm Ruptured Ectopic Pregnancy PID Twisted Ovarian Cyst Ureteral Calculi Hernia

Left Upper Quadrant

Acute Pancreatitis Gastric ulcer Gastritis Splenic enlargement, rupture or infarction Myocardial ischemia Left lower lobe pneumonia

Left Lower Quadrant

Diverticulitis Leaking Aneurysm Ruptured Ectopic pregnancy PID Twisted Ovarian Cyst Ureteral Calculi Hernia Regional Enteritis

Periumbilical Pain

Disease of transverse colon Gastroenteritis Small bowel pain Appendicitis Early bowel obstruction

Diffuse Pain

Generalized peritonitis Acute Pancreatitis Sickle Cell Crisis Mesenteric Thrombosis Gastroenteritis Metabolic disturbances Dissecting or Rupturing Aneurysm Intestinal Obstruction Psychogenic illness

Reffered pain

• Pneumonia (lower lobes)

• Inferior myocardial infarction

• Pulmonary infarction

Types of Abdominal Pain

• Visceral– originates in abdominal organs covered by peritoneum

• Colic– crampy pain

• Parietal– from irritation of parietal peritoneum

• Referred– produced by pathology in one location felt at another

location

ORGANIC VERSUS FUNCTIONAL PAINHISTORY ORGANIC FUNCTIONAL

Pain character Acute, persistent pain Less likely to changeincreasing in intensity

Pain localization Sharply localized Various locations

Pain in relation to sleep Awakens at night No affect

Pain in relation to Further away At umbilicus umbilicus

Associated symptoms Fever, anorexia, Headache, dizziness,vomiting, wt loss, multiple system com-anemia, elevated ESR plaints

Psychological stress None reported Present

WORK-UP OF ABDOMINAL PAIN

HISTORY

• Onset

• Qualitative description

• Intensity

• Frequency

• Location - Does it go anywhere (referred)?

• Duration

• Aggravating and relieving factors

WORK-UP

PHYSICAL EXAMINATION

• Inspection

• Auscultation

• Percussion

• Palpation

• Guarding - rebound tenderness

• Rectal exam

• Pelvic exam

WORK-UP

LABORATORY TESTS

• CBC

• Additional depending on rule outs

– amylase, lipase, LFT’s

WORK-UP

DIAGNOSTIC STUDIES

• Plain X-rays (flat plate)

• Contrast studies - barium (upper and lower GI series)

• Ultrasound

• CT scanning

• Endoscopy

• Sigmoidoscopy, colonoscopy

Common Acute Pain Syndromes• Appendicitis

• Acute diverticulitis

• Cholecystitis

• Pancreatitis

• Perforation of an ulcer

• Intestinal obstruction

• Ruptured AAA

• Pelvic disorders

THANK YOU