Approach to abdominal pain Khwaja Moqim Sediq

1. “
”
‫بسم‬
‫الرحمن‬ ‫هللا‬
‫الرحیم‬
Issue approach to abdominal pain
Preapared by dr khwaja khwaja moqim sedeqi

2. “
”
Outline
introduction
types
cause of abdomen pain
evaluation of abdomen pain
approach to abdomen pain
testing
treatment
Pain is the unsatisfactory feeling that is associated with a tissue
damage
‫است‬ ‫شده‬ ‫تصنیف‬ ‫مزمن‬ ‫و‬ ‫حاد‬ ‫شکل‬ ‫به‬ ‫وصفی‬ ‫بصورت‬
Acute pain, from suddenly tissue damage. Short duration caused to active ANS during the pain
start vasoconstriction and tachycardia called fight and flight action ‫بوده‬ ‫متهیج‬ ‫و‬ ‫نارام‬ ‫مریض‬

3. “
”
Chronic pain ‫امده‬ ‫بوجود‬ ‫نسجی‬ ‫صدمه‬ ‫از‬ ‫زیاد‬ ‫وقت‬ ‫گذشتن‬ ‫از‬ ‫بعد‬ ‫درد‬ ‫این‬
‫ندارد‬ ‫وجود‬ ‫درد‬ ‫این‬ ‫به‬ ‫واضح‬ ‫علت‬
Abdominal pain
Abdominal pain is common and often minor severe abdominal pain that comes on quickly however
almost always indicates a significant problem the pain me be only sign of the need for surgery and
must be attended to swiftly older adult and those who have{HIV}infection or who are taking
immune suppressant include corticosteroid may have less abdominal pain than younger healthy
adult with a similar disorder and even if condition in is serious the pain may develop more gradually
young children especially newborns and infant may develop abdominal pain but are unable to
communicate the reason for their distress
‫میدهد‬ ‫نشان‬ ‫را‬ ‫توجه‬ ‫قابل‬ ‫مشکل‬ ‫یک‬ ‫همیشه‬ ‫بیافتدتقریبا‬ ‫اتفاق‬ ‫شدت‬ ‫با‬ ‫اگر‬ ‫بوده‬ ‫شایع‬ ‫درد‬
‫بزرکساالن‬ ‫شود‬ ‫توجه‬ ‫ان‬ ‫به‬ ‫عاجل‬ ‫باید‬ ‫باشد‬ ‫جراحی‬ ‫عمل‬ ‫به‬ ‫نیاز‬ ‫از‬ ‫نشانه‬ ‫تنها‬ ‫ممکن‬ ‫درد‬
‫مصاب‬ ‫یاکسانیکه‬HIV ‫کمتر‬ ‫درد‬ ‫ممکن‬ ‫میکنند‬ ‫استفاده‬ ‫استروید‬ ‫ادویه‬ ‫ویاکسانیکه‬ ‫هستند‬
‫کند‬ ‫احساس‬ ‫جوان‬ ‫بزرگساالن‬ ‫به‬ ‫نسبت‬

4. “
”
Abdominal pain
This is a term used to define a group of abdominal condition in which early
surgical treatment must be considered few medical conditions mimic
surgical condition and sometime unnecessary surgery is performed
Some patient with myocardial infraction just present with epigastric and
vomiting patient of diabetic keto acidosis or porphyria may present with
abdominal pain there for proper history and examination is required with abdominal
pain there for proper history or examination is required
‫به‬ ‫مقدم‬ ‫باید‬ ‫ها‬ ‫ان‬ ‫در‬ ‫که‬ ‫میرود‬ ‫بکار‬ ‫بطنی‬ ‫امراض‬ ‫از‬ ‫گروهی‬ ‫تعریف‬ ‫برای‬ ‫که‬ ‫است‬ ‫اصطالحی‬
‫اوقات‬ ‫گاهی‬ ‫رامیکند‬ ‫جراحی‬ ‫امراض‬ ‫تقلید‬ ‫داخله‬ ‫امراض‬ ‫از‬ ‫کمی‬ ‫تعداد‬ ‫شود‬ ‫فکر‬ ‫جراحی‬
‫اپی‬ ‫درد‬ ‫با‬ ‫مایوکارد‬ ‫احتشا‬ ‫دچار‬ ‫مریضان‬ ‫از‬ ‫بعضی‬ ‫مثال‬ ‫میشود‬ ‫انجام‬ ‫ضروری‬ ‫غیر‬ ‫جراحی‬
‫درد‬ ‫با‬ ‫ممکن‬ ‫پروفریا‬ ‫ویا‬ ‫دیابتی‬ ‫اسیدوز‬ ‫کیتو‬ ‫مریضی‬ ‫یا‬ ‫مینماید‬ ‫مراجعه‬ ‫استفراغ‬ ‫و‬ ‫گستریک‬
‫میباشد‬ ‫الزم‬ ‫درست‬ ‫معاینه‬ ‫و‬ ‫مناسب‬ ‫تاریخچه‬ ‫گرفتن‬ ‫بنابرین‬ ‫کند‬ ‫مراجعه‬ ‫بطن‬

5. “
”
Type of abdominal pain
1.Visceral pain comes from the organs within the abdominal cavity the visceral nerves do
not respond to cutting tearing or inflammation instead the nerve respond to the organ
bening stretched as intestine expand by gas or muscle contract
2,somatic pain come from the peritoneum that line the abdominal cavity nerve in the
peritoneum respond to cutting and irritation infection or inflammation somatic pain is
sharp
3.Refferred pain is that is felt in an area that is distant from the source for examples a
person who has gallbladder disease may feel pain in the shoulder blade

6. DIFFERENTIAL DIAGNOSIS OF ABDOMINAL PAIN BY LOCATION
1PUD
2GASTRITIS
3ESOPHAGITIS
4GERD
5RUP AORTIC ANURESM
6PERICARDITIS
1SPELENIC RUOTURE
2GASTRIC ULCER
3PANCREATITIS
4SUB DIAPH ABCEAS
R UPPER QUADRANT EPIGASTRIC L UPPER QUADRANY
1 CHOLYCYSTITIS
2 PANCREATITIS
3 HEPATITIS
4PLEURISY
5PNUMONIA/EMPEM
A
R LOWER QUADRANT PERUMBLICAL L LOWER QUADRANT
1APPENDISITIS
2INGUNAL HERNIA
3ECTOPIC
4PREGNANCY
5IBS
6NEPHROLITHIASIS
1GASTOENTRITIS
2BOWEL OBES
3EARLY APPANDICITIS
4RUP AORTIC
ANEURUSM
1DIVERTICULITIS
2SALPHANGITIS
3IBS
4ECTOPIC
PREGNANCY

8. “
”
Cause of abdominal pain
infection .ulcer .perforation .or rupture of organs.ibs
‫کنیم‬ ‫تقسیم‬ ‫که‬ ‫میشه‬ ‫بخش‬ ‫سه‬ ‫به‬
1
. immediately life threating disorders
which require rapid diagnosis and surgery include
A.ruptured abdominal aortic aneurysm
B.perforated stomach or intestine block of blood flow mesenteric
ischemia
D. ruptured ectopic pregnancy
2Serious disorders that are nearly as urgent include
A intestinal obstructions
B appendicitis
C pancreatitis

9. “
”
3 disorder outside abdomen cause abdominal pain
A heart attack and pneumonia
B testicular torsion
C diabetic ketoacidosis, methanol poisoning
D sickle cell deaseas ,porphyria

11. APPROACHTO ABDOMINAL PAIN
1FEW ABDOMINALCONDITION REQUIRE URGENT SURGARY IT IS BELONGESTO
PATIENTCONDITION
2only patient with intraabdominal hemorrhage must be rushed to opreatin room start
fluid repacment and start surgary
3unfortunately many of these patient die in radiology department or emergency room
while awaiting unnessary examination
4there are no absolute contra indication to operation when massive intraabdominal
hemorrhage is present
5 but its not mutch for patient with GIB we can do anathor treatment also
6in this codition patient history is very important for diagnosis
7diagnosis of acute abdomen is easy but chronic abd pain can not diagnosed easily
One of the most cause of abd pain is IBD
In all abd pain we have to not use analgesics or opiates

12. APPROACHTO ABDOMINAL PAIN
8 IN FEMALES ABD AND PELVIC PAIN CAN OCCURE IN PREGNANCY DUTO
CODITIONTHAT required operation same otherwise noteworthy lab value
like leukocytosis may present the normal physiologic
9 in examination a patient with peritoneal inflammation has been examined
brusquely accurate assessment by next examiner becomes almost
impossible
10 eliciting rebound tenderness sudden release of a deeply palpating hand in
a patient with peritonitis is unnecessary
11 history taking sufficient time be spent in the examination abdominal
sign me be minimal
12 abd sign me be virtually or totally or totally absent in cause of pelvic
peritonitis carefully pelvic and rectal examination are mandatory in every
patient with abdominal pain

13. 13 tenderness on pelvic or rectal examination in the absence of other
abdominal signs can be caused by operative indications such us perforated
appendicitis ,diverticulitis ,twisted ovarian cyst ,
14 auscultation is one of the least revealing aspect of physical examination
in strangulation small intestinal obstruction ,or perforated appendicitis
may occur in presence of normal peristaltic sound
15 when the proximal part of intestine above the obstruction become
markedly distended and edematous peristaltic sound me be lose

14. Testing
lab examination me be value able
but leukocytosis should never be the single deciding factor or not
operation indicated a white blood cell count 20000may be observed with
perforation viscus but pancreatitis ,acute cholycystitis ,PID, may
associated with leukocytosis
RBC and HB also important to check for anemia
Urinalysis may reveal the state of hydration or rule out sever renal disease
diabetes or urinary infection

15. Blood ,urea
nitrogen
glucose
serum bilirubin
liver function test
may be help full
amylase without pancreatitis may going up in PUD acute cholycystitis

16. Radiography of abdomen have limited utility may be unnessary in patient
who have acute appendicitis or strangulated external hernia
CT scan is prefer to abdominal radiography when evaluating non traumatic
acute abdomen pain
We can use also barium or water soluble contrast for upper part ofGIS may
be demonstrate partial intestinal obstruction
If there is question of obstruction of colon avoid from oral administration
of barium sulphate
Best one off all is laparoscopy an CT scan
Ct scan enlarged pancreas ruptured spleen etc
Laparoscopy pelvic condition like ovarian cyst salphangitis tubal
pregnancy etc
SonographY is good for diagnose of enlarged gall bladder presence of gall
stone enlarged ovary tubal pregnancy etc

17. SOMETIMES EVEN UNDER BEST CIRCUMESTANCE WITH ALL AVAILABLE
AIDSdefinitive diagnosis can not be stablished
‫های‬ ‫پرسش‬ ‫با‬ ‫دوباره‬ ‫تصمیم‬ ‫بودن‬ ‫مشکوک‬ ‫صورت‬ ‫در‬
‫قطعی‬ ‫تشخیص‬ ‫متوان‬ ‫معاینات‬ ‫با‬ ‫و‬ ‫مکرر‬ ‫و‬ ‫هوشیارانه‬
‫گذاشت‬

18. Thanks fromall