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
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  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. Copyright © 2007- 2008 - Perú Dr. Carlos Azañero Inope