ABDOMINAL PAIN I


Dr. Carlos Azañero Inope Carlos Azañero Inope
                       Dr.
ACUTE ABDOMINAL PAIN




Evaluation of the patient with acute abdominal pain is one of
the most challenging aspects of eme...
ACUTE ABDOMINAL PAIN




Abdominal pain is the
presenting complaint in as
many      as  10%       of
emergency departament...
ACUTE ABDOMINAL PAIN



Though the etiology of pain is
initially undetermined in as 30-
40% of patients, recognition of
su...
ANATOMIC ESSENTIALS




Abdominal pain is typically derived
from one or more three distinct
pain pathways: visceral, parie...
Visceral Abdominal Pain




Visceral Abdominal Pain is
usually caused by distention of
hollow organs or capsular
stretchin...
Visceral Abdominal Pain

Less commonly, it si caused by isquemia or inflammation.




The tissue congestion sensitizes ner...
Visceral Abdominal Pain




If the involved organ is affected
by peristalsis, the pain is often
described      as     inte...
Visceral Abdominal Pain




The visceral pain fibers are
bilateral, unmyelinated, and enter
the spinal cord at multiple le...
Dr. Carlos Azañero Inope
Dr. Carlos Azañero Inope
Parietal (Somatic)
      Abdominal Pain




Results from ischemia, inflammation,
or    stretching  of   the     parietal
p...
Parietal (Somatic)
      Abdominal Pain




Myelinated afferent fibers transmit
the painful stimulus to specific dorsal
ro...
Parietal (Somatic)
        Abdominal Pain


The parietal pain, in contrast to
visceral pain, often can be localized to
the...
The classic presentation of
                  appendicitis     involves   both
                  visceral and parietal pai...
Referred Pain




Is defined as pain felt at a
distance from the diseased
organ. It results from
shared central pathways f...
HISTORY

1. Where is your pain? Has it
always been there?




Keep in mind that the location of
abdominal pain may vary wi...
HISTORY

2. Does the pain radiate anywhere?



The pain of biliary colic may radiate to
the right infraescapular region .
...
HISTORY

3. How did the pain begin (sudden
vs gradual onset) ? How long have
you had the pain?



                        ...
HISTORY

3. How did the pain begin (sudden
vs gradual onset) ? How long have
you had the pain?



Pain for > 6 hours or < ...
HISTORY

4. What were you doing the pain
began?




Severe Pain that awakens a
patient    from  sleep   :
PERFORATION OR I...
HISTORY

4. What were you doing the pain
began?




Abdominal   Pain     following
trauma : INTRA-ABDOMINAL
INJURY to the ...
HISTORY

5. What does the pain feel like?




Burning or Gnawing Pain: Peptic
Ulcer Disease




                        Dr...
HISTORY

 5. What does the pain feel like?



 Sharp Pain: Biliary Colic



 Tearing   Pain:     Aortic
 Disecction


Pene...
HISTORY

6. Does anything      make the pain
better or worse?




Parietal Peritoneal Pain is aggravated
by    movement.  ...
HISTORY

6. Does anything     make the pain
better or worse?




The Pain ulcer peptic disease
improves with eating wherea...
HISTORY




The Pain accentuated by
reclining and relieved by
sitting upright should raise
suspicion for a retroperineal
p...
www.carlosvirtual.com




                       Copyright © 2007- 2008 - Perú
      Dr. Carlos Azañero Inope
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Acute Abdominal Pain

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Acute Abdominal Pain

  1. 1. ABDOMINAL PAIN I Dr. Carlos Azañero Inope Carlos Azañero Inope Dr.
  2. 2. ACUTE ABDOMINAL PAIN Evaluation of the patient with acute abdominal pain is one of the most challenging aspects of emergency medicine. Dr. Carlos Azañero Inope
  3. 3. ACUTE ABDOMINAL PAIN Abdominal pain is the presenting complaint in as many as 10% of emergency departament patients. Dr. Carlos Azañero Inope
  4. 4. ACUTE ABDOMINAL PAIN Though the etiology of pain is initially undetermined in as 30- 40% of patients, recognition of surgical or life-threatening causes is most important than establishing a firm diagnosis. Dr. Carlos Azañero Inope
  5. 5. ANATOMIC ESSENTIALS Abdominal pain is typically derived from one or more three distinct pain pathways: visceral, parietal (somatic) and referred. Dr. Carlos Azañero Inope
  6. 6. Visceral Abdominal Pain Visceral Abdominal Pain is usually caused by distention of hollow organs or capsular stretching of solid organs. Dr. Carlos Azañero Inope
  7. 7. Visceral Abdominal Pain Less commonly, it si caused by isquemia or inflammation. The tissue congestion sensitizes nerve endings of visceral pain fibers and lowers the threshold for stimulus. Dr. Carlos Azañero Inope
  8. 8. Visceral Abdominal Pain If the involved organ is affected by peristalsis, the pain is often described as intermittent, crampy, or colicky in nature. Dr. Carlos Azañero Inope
  9. 9. Visceral Abdominal Pain The visceral pain fibers are bilateral, unmyelinated, and enter the spinal cord at multiple levels. The visecral abdominal pain is usually dull, poorly localized and experienced in the midline.. Dr. Carlos Azañero Inope
  10. 10. Dr. Carlos Azañero Inope
  11. 11. Dr. Carlos Azañero Inope
  12. 12. Parietal (Somatic) Abdominal Pain Results from ischemia, inflammation, or stretching of the parietal peritoneum . Dr. Carlos Azañero Inope
  13. 13. Parietal (Somatic) Abdominal Pain Myelinated afferent fibers transmit the painful stimulus to specific dorsal root ganglia on the same side and dermatomal level as the origin of the pain. Dr. Carlos Azañero Inope
  14. 14. Parietal (Somatic) Abdominal Pain The parietal pain, in contrast to visceral pain, often can be localized to the region of the painful stimulus. This pain is typically sharp, knife-like and constant; coughing and moving are likely to aggravate it.. Dr. Carlos Azañero Inope
  15. 15. The classic presentation of appendicitis involves both visceral and parietal pain. The pain of early presentation is often periumbilical (visceral ) but localizes to the right lower quadrant ( RLQ) when the inflammation extends to the peritoneum (parietal). Dr. Carlos Azañero Inope
  16. 16. Referred Pain Is defined as pain felt at a distance from the diseased organ. It results from shared central pathways for afferent neurons from diferent locations. Dr. Carlos Azañero Inope
  17. 17. HISTORY 1. Where is your pain? Has it always been there? Keep in mind that the location of abdominal pain may vary with time, especially as the underlying disease evolves and the pain progresses from visceral to somatic. Dr. Carlos Azañero Inope
  18. 18. HISTORY 2. Does the pain radiate anywhere? The pain of biliary colic may radiate to the right infraescapular region . The pain of pancreatitis to midback . Pain that radiates to the flank or genitals may represent a kidney stone or rupture AAA. Dr. Carlos Azañero Inope
  19. 19. HISTORY 3. How did the pain begin (sudden vs gradual onset) ? How long have you had the pain? Rupture AAA . Sudden or abrupt onset of abdominal pain often indicates Perforated Ulcer . a serious underlying disorder. Ectopy Pregnancy . Dr. Carlos Azañero Inope
  20. 20. HISTORY 3. How did the pain begin (sudden vs gradual onset) ? How long have you had the pain? Pain for > 6 hours or < 48 hours duration, or pain that is steadily increasing in intensity is more likely to require surgical intervention . Dr. Carlos Azañero Inope
  21. 21. HISTORY 4. What were you doing the pain began? Severe Pain that awakens a patient from sleep : PERFORATION OR ISCHEMIA Dr. Carlos Azañero Inope
  22. 22. HISTORY 4. What were you doing the pain began? Abdominal Pain following trauma : INTRA-ABDOMINAL INJURY to the solid organs or bowel. Dr. Carlos Azañero Inope
  23. 23. HISTORY 5. What does the pain feel like? Burning or Gnawing Pain: Peptic Ulcer Disease Dr. Carlos Azañero Inope
  24. 24. HISTORY 5. What does the pain feel like? Sharp Pain: Biliary Colic Tearing Pain: Aortic Disecction Penetrating Pain: Pancreatitis Dr. Carlos Azañero Inope
  25. 25. HISTORY 6. Does anything make the pain better or worse? Parietal Peritoneal Pain is aggravated by movement. This finding necessitates the exclusion of appendictis. Dr. Carlos Azañero Inope
  26. 26. HISTORY 6. Does anything make the pain better or worse? The Pain ulcer peptic disease improves with eating whereas biliary colic worsens with measles Dr. Carlos Azañero Inope
  27. 27. HISTORY The Pain accentuated by reclining and relieved by sitting upright should raise suspicion for a retroperineal process such as pancreatitis. Dr. Carlos Azañero Inope
  28. 28. www.carlosvirtual.com Copyright © 2007- 2008 - Perú Dr. Carlos Azañero Inope
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