DOCSLIB.ORG

Abdominal Pain Part 2

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Abdominal Pain Part 2 Abdominal Pain Part II Jassin M. Jouria, MD Dr. Jassin M. Jouria is a medical doctor, professor of academic medicine, and medical author. He graduated from Ross University School of Medicine and has completed his clinical clerkship training in various teaching hospitals throughout New York, including King’s County Hospital Center and Brookdale Medical Center, among others. Dr. Jouria has passed all USMLE medical board exams, and has served as a test prep tutor and instructor for Kaplan. He has developed several medical courses and curricula for a variety of educational institutions. Dr. Jouria has also served on multiple levels in the academic field including faculty member and Department Chair. Dr. Jouria continues to serves as a Subject Matter Expert for several continuing education organizations covering multiple basic medical sciences. He has also developed several continuing medical education courses covering various topics in clinical medicine. Recently, Dr. Jouria has been contracted by the University of Miami/Jackson Memorial Hospital’s Department of Surgery to develop an e- module training series for trauma patient management. Dr. Jouria is currently authoring an academic textbook on Human Anatomy & Physiology. ABSTRACT Abdominal pain is one of the most common complaints that patients make to medical professionals, and it has a wide array of causes, ranging from very simple to complex. Although many cases of abdominal pain turn out to be minor constipation or gastroenteritis, there are more serious causes that need to be ruled out. An accurate patient medical history, family medical history, laboratory work and imaging are important to make an accurate diagnosis. Initial assessment and diagnostic testing will provide an early indication of cause and the possible treatment options, which are discussed. nursece4less.com nursece4less.com nursece4less.com nursece4less.com 1 Policy Statement This activity has been planned and implemented in accordance with the policies of NurseCe4Less.com and the continuing nursing education requirements of the American Nurses Credentialing Center's Commission on Accreditation for registered nurses. It is the policy of NurseCe4Less.com to ensure objectivity, transparency, and best practice in clinical education for all continuing nursing education (CNE) activities. Continuing Education Credit Designation This educational activity is credited for 4 hours. Nurses may only claim credit commensurate with the credit awarded for completion of this course activity. Statement of Learning Need Health professionals in acute and non-acute health settings need to be able to recognize overt and subtle signs of conditions associated with abdominal pain in order to properly treat and/or refer to a specialist. Course Purpose To provide nurses with knowledge of the causes and treatments of acute and chronic abdominal pain. nursece4less.com nursece4less.com nursece4less.com nursece4less.com 2 Target Audience Advanced Practice Registered Nurses and Registered Nurses (Interdisciplinary Health Team Members, including Vocational Nurses and Medical Assistants may obtain a Certificate of Completion) Course Author & Planning Team Conflict of Interest Disclosures Jassin M. Jouria, MD, William S. Cook, PhD, Douglas Lawrence, MA, Susan DePasquale, MSN, FPMHNP-BC – all have no disclosures Acknowledgement of Commercial Support There is no commercial support for this course. Please take time to complete a self-assessment of knowledge, on page 4, sample questions before reading the article. Opportunity to complete a self-assessment of knowledge learned will be provided at the end of the course. nursece4less.com nursece4less.com nursece4less.com nursece4less.com 3 1. The most common locations of referred abdominal pain include a. face, wrist, elbows, hands. b. back, shoulders, chest, groin. c. internal organs only. d. skin or peripheral areas only. 2. Pain referred to the chest is commonly caused by a. gallstones. b. bowel obstruction. c. gastroesophageal reflux disease. d. None of the above 3. True or False: The clinician should base a diagnosis of abdominal pain solely on the region of associated pain. a. True b. False 4. In a study published in the Journal of Clinical Nursing, nursing perceptions of barriers to adequately control a patient’s pain included: a. Lack of clinical guidelines. b. Lack of standard assessment tool for pain management. c. Limited autonomy when making decisions about pain control. d. All of the above 5. Recurrent abdominal pain is a. mild, nagging pain with no resolution. b. chronic, intermittent pain with separate episodes within 3-months. c. more often seen among children. d. Answers b., and c., above nursece4less.com nursece4less.com nursece4less.com nursece4less.com 4 Introduction A complicating dynamic in the diagnostic workup of a patient with abdominal pain is the varied typical or atypical pain symptoms and the wide range of conditions that could occur in a clinical scenario. As mentioned in Abdominal Pain Part I, the assessment of pain in the abdomen can be a challenge to diagnose. A thorough patient history is necessary to help isolate potential cause and to identify correct treatment. Additionally, the physical assessment of the abdomen and corresponding diagnostic tests must involve a systematic, standard approach to foster a correct diagnosis of the cause of abdominal pain. Abdominal Pain And Anatomical Location While abdominal pain is often broken down into anatomical location, it is important to recognize that often pain in the abdomen may result from an obscure cause, which can complicate diagnosis. Pain may also be referred from the site of origin. The following section covers some of the types of pain and correlating acute or chronic disease conditions. Referred Pain Referred pain is felt in a site other than the original location of injury or pathology. By understanding common sites of referred pain, the clinician may be able to quickly isolate the underlying cause of the pain the patient is having, both within the abdomen and at a distant site. The patient may have abdominal pain that is also referred to other parts of the body; and, the original abdominal pain may or may not still be present. Often, sites where pain is referred are innervated along the same pathways as the abdominal pain.1 nursece4less.com nursece4less.com nursece4less.com nursece4less.com 5 Referred pain may make the abdominal assessment more complex. Abdominal pain is still usually present, and the initial pain may have worsened in intensity to the point that the pain radiates to other locations. When pain is present in both the abdomen and a referred location, it can be difficult to pinpoint the exact cause, what makes the pain worse or relieves it, and how long the type of pain has been present. Some of the most common locations of referred abdominal pain include to the back, shoulders, chest, or groin. Back Pain A number of painful conditions in the abdomen can cause referred pain in the back. Pain that originates in the pancreas, liver, gall bladder, abdominal aorta, stomach, and kidneys may all cause discomfort that is felt not only in or near these structures, but also in areas of the back. Affected organs such as the liver, gall bladder, and stomach will typically cause referred pain in the center of the back; whereas, the kidneys tend to radiate pain to the lower back. Fortunately, referred pain tends to radiate to the same locations in most people. For example, individual patients who present with gall bladder pain will tend to have similar type referred pain to the center of the back. The healthcare provider should learn and understand the common areas of referred pain so that he or she can quickly recognize referred pain locations associated with abdominal organ dysfunction. Pain with abdominal organs that refer to the back can often be intense and severe, particularly when associated with damage from ischemic pain or a significant inflammatory condition, such as severe pancreatitis. The pain may begin in the abdomen. As the pain intensifies, nerve sensors carry the nursece4less.com nursece4less.com nursece4less.com nursece4less.com 6 pain to the back. In some cases, the pain in the back may be just as much or more severe than the pain in the abdomen. Shoulder Pain Pain that develops in the shoulders and that is not explained by other events, such as an injury or disease process, may be considered referred shoulder pain when it coincides with symptoms of abdominal pain. Pain in the shoulders and scapula areas can be referred from one or more locations in the abdomen. An abscess in the abdomen may radiate pain to the shoulder, and pain from any condition that causes irritation to the diaphragm may also radiate to this area. Pain associated with the gall bladder, such as gallstones or pain in the bile duct leading to the small intestine often radiates to the shoulder or scapula, in addition to referring to the back.37 Visceral pain associated with the gall bladder may be referred to the shoulder because the pain messages travel along a shared dermatome, which is an area of skin that receives sensation from the same spinal nerve.36 Kehr’s sign refers to a condition in which a patient is suffering from pain in the shoulder area when the injury is in the abdomen. A German surgeon, Hans Kehr, first described Kehr’s sign after seeing a patient with severe clavicle pain due to a splenic abscess. The condition is defined as pain in the area above the clavicle as a result of irritation of the diaphragm. The phrenic nerve that stretches between the diaphragm and the neck carries the pain signal from the area of abdominal injury up to the clavicle and shoulder.82 Patients who have undergone surgical procedures, such as a laparoscopy, may develop shoulder pain. The pain is referred from the abdominal area nursece4less.com nursece4less.com nursece4less.com nursece4less.com 7 from the use of air through a surgical instrument to inflate the abdomen during the procedure.
Load more

Recommended publications
  • General Signs and Symptoms of Abdominal Diseases
    General signs and symptoms of abdominal diseases Dr. Förhécz Zsolt Semmelweis University 3rd Department of Internal Medicine Faculty of Medicine, 3rd Year 2018/2019 1st Semester • For descriptive purposes, the abdomen is divided by imaginary lines crossing at the umbilicus, forming the right upper, right lower, left upper, and left lower quadrants. • Another system divides the abdomen into nine sections. Terms for three of them are commonly used: epigastric, umbilical, and hypogastric, or suprapubic Common or Concerning Symptoms • Indigestion or anorexia • Nausea, vomiting, or hematemesis • Abdominal pain • Dysphagia and/or odynophagia • Change in bowel function • Constipation or diarrhea • Jaundice “How is your appetite?” • Anorexia, nausea, vomiting in many gastrointestinal disorders; and – also in pregnancy, – diabetic ketoacidosis, – adrenal insufficiency, – hypercalcemia, – uremia, – liver disease, – emotional states, – adverse drug reactions – Induced but without nausea in anorexia/ bulimia. • Anorexia is a loss or lack of appetite. • Some patients may not actually vomit but raise esophageal or gastric contents in the absence of nausea or retching, called regurgitation. – in esophageal narrowing from stricture or cancer; also with incompetent gastroesophageal sphincter • Ask about any vomitus or regurgitated material and inspect it yourself if possible!!!! – What color is it? – What does the vomitus smell like? – How much has there been? – Ask specifically if it contains any blood and try to determine how much? • Fecal odor – in small bowel obstruction – or gastrocolic fistula • Gastric juice is clear or mucoid. Small amounts of yellowish or greenish bile are common and have no special significance. • Brownish or blackish vomitus with a “coffee- grounds” appearance suggests blood altered by gastric acid.
    [Show full text]
  • Type of Breathing- Slow, Rapid, Deep, Shal
    Primary survey check pulse; type of pulse- slow, rapid, weak, strong check breathing; type of breathing- slow, rapid, deep, shallow maintain open airway; clear blood vomitus check to see that airway is unobstructed help the athlete find the most comfortable posistion for breathing be prepared to prefrom artificial ventilation and CPR if needed transport to emergency facility Secondary seurvey history what happend? What is the mechanism of injury? When did it happen? Have you ever had any injury to this region before? Have you ever been ill or had a recent episode of mononucleosis? Was there a direct blow? If so by what? Where were you hit? Back, chest, or abdominal area? How large was the area of contact? Did you go to the bathroom prior to practice? Where does it hurt? Point to the area of pain how severe is the pain? What kind of do you have? Sharp, dull, achy, throbbing, radiating what increase the pain? What relieves the pain? Have the symptoms been constant or intermittent? Does the pain increase during respiration or movement? Is the pain located in the chest wall or does it feel deeper or inside the cavity? Do you have any referred pain to your shoulders? Kehr’s sign? Do you have any refferred pain to your flanks? Did you feel anything at the time of injury? Did you hear any sounds at the time of injury? Do you have any crepitation? Possible rib fx or costochondral separation do you feel any tightness, cramping, or rigidity of the abdominal musculature? Do you feel nauseaqted? Do you have any difficulty breathing? Have you urinated
    [Show full text]
  • Evaluation of Abdominal Pain in the Emergency Department Hartmut Gross, M.D., FACEP
    Evaluation of Abdominal Pain in the Emergency Department Hartmut Gross, M.D., FACEP Abdominal pain complaints comprise about 5% of all Emergency Department visits. The etiology of the pain may be any of a large number of processes. Many of these causes will be benign and self-limited, while others are medical urgencies or even surgical emergencies. As with any complaint in the ED, the worst diagnosis is always entertained first. Therefore, there is one thought, which the ED practitioner must maintain in the foreground of his mind: “Is there a life threatening process?” Etiology A breakdown of the most common diagnoses of abdominal pain presentations is listed below. Note that nearly half of the time, “unknown origin” is the diagnosis made. This is a perfectly acceptable conclusion, after a proper work-up has ruled out any life threatening illness. Common Diagnoses of Non-traumatic Abdominal Pain in the ED 1 Abdominal pain of unknown origin 41.3% 2 Gastroenteritis 6.9% 3 Pelvic Inflammatory Disease 6.7% 4 Urinary Tract Infection 5.2% 5 Ureteral Stone 4.3% 6 Appendicitis 4.3% 7 Acute Cholecystitis 2.5% 8 Intestinal Obstruction 2.5% 9 Constipation 2.3% 10 Duodenal Ulcer 2.0% 11 Dysmenorrhea 1.8% 12 Simple Pregnancy 1.8% 13 Pyelonephritis 1.7% 14 Gastritis 1.4% 15 Other 12.8% From Brewer, RJ., et al, Am J Surg 131: 219, 1976. Two important factors modify the differential diagnosis in patients who present with abdominal pain: sex and age. Other common diagnoses of abdominal pain in men and women are as follows.
    [Show full text]
  • Pain Pathways in Orthopaedic Practice J
    Postgrad Med J: first published as 10.1136/pgmj.38.437.157 on 1 March 1962. Downloaded from POSTGRAD. MED. J. (I962), 38, I57 PAIN PATHWAYS IN ORTHOPAEDIC PRACTICE J. D. G. TROUP, M.R.C.S., L.R.C.P.* Aberdeen DESPITE Steindler's (1959) admirable lectures on of which time is one of the most significant, have the subject, pain in orthopiedic practice remains a to obtain before pain can be appreciated in tissues difficult problem. To some extent the difficulty is remote from a primary lesion, and when the pain is exaggerated by the adoption of diagnoses based on present, so too are palpably pathological changes. pathological processes which are insusceptible of It is probably true that a peripheral pathway for proof-diagnoses for which it is impossible to pain can be excited centrally or by any stimulus establish an association between symptoms and proximal to it, but the pathway cannot be estab- their alleged origin, let alone a direct causal link. lished in the first place without initial pathological For instance a nipped zygapophyseal synovial changes in the periphery. fringe may well cause acute symptoms, but as there is no means of examining the synovia of The Appreciation of Pain zygapophyseal joints, to make this the diagnosis The appreciation of pain is divided into two is purely speculative. Nevertheless pathological parts; first the sensory component-where it is and guesswork of this sort is regrettably common, and what it feels like, and secondly the affective when some of the latest advances in neuro- component which dictates to what extent the pain by copyright.
    [Show full text]
  • Costochondritis
    Department of Rehabilitation Services Physical Therapy Standard of Care: Costochondritis Case Type / Diagnosis: Costochondritis ICD-9: 756.3 (rib-sternum anomaly) 727.2 (unspecified disorder of synovium) Costochondritis (CC) is a benign inflammatory condition of the costochondral or costosternal joints that causes localized pain. 1 The onset is insidious, though patient may note particular activity that exacerbates it. The etiology is not clear, but it is most likely related to repetitive trauma. Symptoms include intermittent pain at costosternal joints and tenderness to palpation. It most frequently occurs unilaterally at ribs 2-5, but can occur at other levels as well. Symptoms can be exacerbated by trunk movement and deep breathing, but will decrease with quiet breathing and rest. 2 CC usually responds to conservative treatment, including non-steroidal anti-inflammatory medication. A review of the relevant anatomy may be helpful in understanding the pathology. The chest wall is made up of the ribs, which connect the vertebrae posteriorly with the sternum anteriorly. Posteriorly, the twelve ribs articulate with the spine through both the costovertebral and costotransverse joints forming the most hypomobile region of the spine. Anteriorly, ribs 1-7 articulate with the costocartilages at the costochondral joints, which are synchondroses without ligamentous support. The costocartilage then attaches directly to the sternum as the costosternal joints, which are synovial joints having a capsule and ligamentous support. Ribs 8-10 attach to the sternum via the cartilage at the rib above, while ribs 11 and 12 are floating ribs, without an anterior articulation. 3 There are many causes of musculo-skeletal chest pain arising from the ribs and their articulations, including rib trauma, slipping rib syndrome, costovertebral arthritis and Tietze’s syndrome.
    [Show full text]
  • Hepatálny Ascites a Jeho Komplikácie
    Ascites - principles of diagnosis and treatment Practical course in Internal medicine, 4. year GM I. Department of Internal medicine Faculty of Medicine, Comenius University & University Hospital Bratislava Summer semester 2019/2020 Ascites • Ascites describes the condition of pathologic fluid collection within the abdominal cavity • Word „ascites“ is of Greek origin (askos) - and means bag or sac • Healthy men have little or no intraperitoneal fluid, but women may normally have as much as 20 mL, depending on the phase of their menstrual cycle Ascites - etiology 3 2 5 Liver cirrhosis (ALD 60%, HBV/HCV infection 10%, cryptogenic 10% 10 Malignity Heart failure Tuberculosis Other 80 Ascites – etiology Portal hypertension Portal hypertension PRESENCE ABSENCE SAAG ≥ 11 g/l SAAG < 11 g/l • Hypoalbuminemia • Prehepatic • Nephrotic syndrome • Splenic or portal vein trombosis • Severe malnutrition • Schistosomiasis • Protein-losing enteropathy • Intrahepatic • Malignancy • Pre-/intra-/postsinusoidal • Liver cirrhosis • Infection • Alcohol liver diesease • Tuberculosis • Infective, autimunne, toxic, other ... • Spontaneous bacterial peritonitis • Liver metastases • Pancreatitis • Posthepatic • Polyserositis in systemic or • Budd-Chiari syndrome, veno- occlusive disease endocrinal disorders • Cardiac (hypothyreosis, connestive • Right heart failure tissue diseases, vasculitis ...) • Constrictive pericarditis • Meigs syndrome Ascites – patophysiology disturbance of the balance between the formation and absorption of free abdominal fluid ↓ Fluid absorption ↑ Fluid production Ascites – combination of mechanisms in liver cirrhosis Natural history of chronic liver disease 1. Latent - hidden disorder of water and sodium management - decreased peripheral vascular resistance, increased minute volume, ECT expansion, no edema, normal activity RAAS, ADH, SNS) 2. Positive sodium balance - inability to exclude Na load, ECT expansion, swelling, mild ascites, normal function of RAAS, SNS, ADH 3.
    [Show full text]
  • Pseudoanginal Chest Pain Associated with Vagal Nerve Stimulation: a Case Report James B
    Nichols et al. BMC Neurology (2020) 20:144 https://doi.org/10.1186/s12883-020-01693-5 CASE REPORT Open Access Pseudoanginal chest pain associated with vagal nerve stimulation: a case report James B. Nichols1, Abigail P. McCallum1, Nicolas K. Khattar1, George Z. Wei1, Rakesh Gopinathannair2, Haring J. W. Nauta1 and Joseph S. Neimat1* Abstract Background: Vagal nerve stimulation (VNS) can be an effective therapy for patients with epilepsy refractory to anti- epileptic drugs or intracranial surgery. While generally well tolerated, it has been associated with laryngospasm, hoarseness, coughing, dyspnea, throat and atypical chest pain, cardiac symptoms such as bradycardia and occasionally asystole. We report on a patient receiving vagal nerve stimulation who experienced severe typical anginal chest pain during VNS firing without any evidence of cardiac ischemia or dysfunction. Thus, the pain appeared to be neuropathic from the stimulation itself rather than nociceptive secondary to an effect on heart function. Case presentation: A 29-year-old man, with a history of intractable frontal lobe epilepsy refractory to seven anti- epileptic medications and subsequent intracranial surgery, underwent VNS implantation without complications. On beginning stimulation, he began to have intermittent chest pain that corresponded temporally to his intermittent VNS firing. The description of his pain was pathognomonic of ischemic cardiac chest pain. On initial evaluation, he displayed Levine’s sign and reported crushing substernal chest pain radiating to the left arm, as well as shortness of breath walking upstairs that improved with rest. He underwent an extensive cardiac workup, including 12-lead ECG, cardiac stress test, echocardiogram, 12-day ambulatory cardiac monitoring, and continuous ECG monitoring each with and without stimulation of his device.
    [Show full text]
  • Surgical Treatment of Angina Pectoris He Extensive
    SURGICAL TREATMENT OF ANGINA PECTORIS INGA LINDGREN, M.D., AND HERBERT OLIVECRONA, M.D. Neurosurgical Clinic, Serafimerlasarettet, (Director: Professor H. Olivecrona) and IVth Medical Service, St. Erik's Hospital (Director: Professor H. Berglund), Stockholm, Sweden (Received for publication October ~3, 1946) HE EXTENSIVE researches of Blumgart I have shown that the structural basis for coronary pain is an arteriosclerotic process with obstruction T or obliteration of one or more coronary arteries before an adequate collateral circulation has been developed. On the other hand, if the develop- ment of the collateral circulation has kept pace with the progressive arterial narrowing, myocardial damage and pain are absent even if one or more of the coronary arteries are obstructed. If the increased blood supply to the myocardium demanded by muscu- lar exercise cannot be delivered through the ordinary or collateral channels, coronary pain results. A short rest is usually sufficient to restore the circula- tory balance and the pain subsides. Dilatation of the coronary arteries by nitroglycerine hastens the process and may, if the drug is taken before muscular exertion, prevent an anticipated attack. Vasoconstriction, on the other hand, is an important factor in anginal pain. Practically every sufferer from angina pectoris is worse in the winter; his capacity for muscular work is much less in cold weather. Sudden cooling from any cause is frequently sufficient to bring on an attack. Freedberg, 7 in a series of experiments, has been able to show the effect of cooling upon the exercise tolerance in angina pectoris. He found by testing the same patient's capacity for exercise at different temperatures that the tolerance was much less at temperatures of 7-13~ (45-55~ than at ~4~ (75~ His in- vestigations thus lend experimental support to clinical experience that cold weather has a bad effect on sufferers from angina pectoris.
    [Show full text]
  • Advanced Assessment in Clinical Practice: Abdominal Assessment
    Abdominal assessment ______________________________________________________________________ Advanced Assessment in Clinical Practice: Abdominal Assessment I. Assessment of the abdomen A. Basic anatomy and physiology 1. Esophagus 2. Stomach 3. Small intestines 4. Large intestines 5. Liver ∑ Hepatic artery ∑ Portal vein ∑ Hepatic veins ∑ Metabolizes CHO, fats and proteins. ∑ Stores vitamins, minerals, and iron. ∑ Detoxifies harmful substances. ∑ Produces antibodies. ∑ Makes hormones, prothrombin, fibrinogen and protein. 6. Gallbladder 7. Pancreas 8. Spleen 9. Kidneys 10. Bladder Advanced Assessment Page 60 ©Educational Concepts, LLC Abdominal assessment ______________________________________________________________________ B. Areas of the abdomen Right upper quadrant Left upper quadrant Liver and gallbladder Left lobe of the liver Pylorus Spleen Duodenum Stomach Head of the pancreas Body of the pancreas Right adrenal gland Left adrenal gland Portion of the right kidney Portion of the left kidney Hepatic flexure of the colon Splenic flexure of the colon Portions of the ascending and Portions of the transverse and transverse colon descending colon Right lower quadrant Left lower quadrant Lower pole of the right kidney Lower pole of the left kidney Cecum and appendix Sigmoid colon Portion of the ascending colon Portion of the descending colon Bladder if distended Bladder if distended Ovary and salpinx Ovary and salpinx Uterus if enlarged Uterus if enlarged Right spermatic cord Left spermatic cord Right ureter Left ureter C. Assessment parameters
    [Show full text]
  • Diagnostic Approach of Patient with Ascites: a Case Report
    International Journal of Science and Research (IJSR) ISSN: 2319-7064 SJIF (2019): 7.583 Diagnostic Approach of Patient with Ascites: A Case Report Theodore Dharma Tedjamartono1, Ketut Suryana2 1Intern of Internal Medicine Department in Wangaya Hospital, Denpasar, Bali, Indonesia Correspondence: theodored71[at]gmail.com 2Internist of Internal Medicine Department in Wangaya Hospital, Denpasar, Bali, Indonesia ketutsuryana[at]gmail.com Abstract: Ascites is an accumulation of fluid in the peritoneal cavity due to increase of capillary permeability, portal venous pressure, oncotic pressure, or lymphatic obstruction. From all the pathophysiological mechanisms mentioned, about 80% of the cases occur due to increased portal venous pressure (portal hypertension). It has been known that portal hypertension is associated with chronic liver disease (CLD). Nevertheless, ascites can also be found in several diseases such as kidney disease, heart disease, infection, malignancy or others. Determining the underlying disease of ascites is a challenge for the clinician; anamnesis including the course of the disease, risk factors, comorbidities are needed to be done properly. Ascites usually accompanied by other symptoms, for example in liver disease (signs of portal hypertension), kidney disease (anasarca), heart failure (increased jugular venous pressure, murmurs, gallops), and malignancies (mass, lymphadenopathy), thus physical examination should be performed in every patient carefully. In minimal amount of fluid, abdominal ultrasonography (USG) are recommended.
    [Show full text]
  • Abdominal Pain
    10 Abdominal Pain Adrian Miranda Acute abdominal pain is usually a self-limiting, benign condition that irritation, and lateralizes to one of four quadrants. Because of the is commonly caused by gastroenteritis, constipation, or a viral illness. relative localization of the noxious stimulation to the underlying The challenge is to identify children who require immediate evaluation peritoneum and the more anatomically specific and unilateral inner- for potentially life-threatening conditions. Chronic abdominal pain is vation (peripheral-nonautonomic nerves) of the peritoneum, it is also a common complaint in pediatric practices, as it comprises 2-4% usually easier to identify the precise anatomic location that is produc- of pediatric visits. At least 20% of children seek attention for chronic ing parietal pain (Fig. 10.2). abdominal pain by the age of 15 years. Up to 28% of children complain of abdominal pain at least once per week and only 2% seek medical ACUTE ABDOMINAL PAIN attention. The primary care physician, pediatrician, emergency physi- cian, and surgeon must be able to distinguish serious and potentially The clinician evaluating the child with abdominal pain of acute onset life-threatening diseases from more benign problems (Table 10.1). must decide quickly whether the child has a “surgical abdomen” (a Abdominal pain may be a single acute event (Tables 10.2 and 10.3), a serious medical problem necessitating treatment and admission to the recurring acute problem (as in abdominal migraine), or a chronic hospital) or a process that can be managed on an outpatient basis. problem (Table 10.4). The differential diagnosis is lengthy, differs from Even though surgical diagnoses are fewer than 10% of all causes of that in adults, and varies by age group.
    [Show full text]
  • Signs and Symptoms
    Signs and symptoms For the most part, symptoms are related to disturbed bowel functions. Pain first, vomiting next and fever last has been described as classic presentation of acute appendicitis. Pain starts mid abdomen, and except in children below 3 years, tends to localize in right iliac fossa in a few hours. This pain can be elicited through various signs. Signs include localized findings in the right iliac fossa. The abdominal wall becomes very sensitive to gentle pressure (palpation). Also, there is severe pain on suddenly releasing a deep pressure in lower abdomen (rebound tenderness). In case of a retrocecal appendix, however, even deep pressure in the right lower quadrant may fail to elicit tenderness (silent appendix), the reason being that the cecum, distended with gas, prevents the pressure exerted by the palpating hand from reaching the inflamed appendix. Similarly, if the appendix lies entirely within the pelvis, there is usually complete absence of the abdominal rigidity. In such cases, a digital rectal examination elicits tenderness in the rectovesical pouch. Coughing causes point tenderness in this area (McBurney's point) and this is the least painful way to localize the inflamed appendix. If the abdomen on palpation is also involuntarily guarded (rigid), there should be a strong suspicion of peritonitis requiring urgent surgical intervention. Rovsing's sign Continuous deep palpation starting from the left iliac fossa upwards (anti clockwise along the colon) may cause pain in the right iliac fossa, by pushing bowel contents towards the ileocaecal valve and thus increasing pressure around the appendix. This is the Rovsing's sign.[5] Psoas sign Psoas sign or "Obraztsova's sign" is right lower-quadrant pain that is produced with either the passive extension of the patient's right hip (patient lying on left side, with knee in flexion) or by the patient's active flexion of the right hip while supine.
    [Show full text]