ABDOMINAL PAIN

ABDOMINAL PAINDr. dr. Benyamin Lukito, Sp.PDdr. Anggun Mekar Kusuma, Sp.PD

ByDebby Apricella07120100062

IntroductionAbdominal pain accounts for 5% of all emergency department (ED) visitsPatients may have acute exacerbations of :Chronic problems (e.g., peptic disease, pancreatitis in alcoholics, inflammatory bowel disease), Acute surgical abdomens (e.g., appendicitis, ruptured viscus, acute volvulus) or Non-surgical abdominal emergencies (e.g., gastritis, biliary colic, gastroenteritis). Mechanisms of pain originating in the Abdomen

1. Parietal Pain2. Visceral Pain3. Referred Pain4. Vascular Disturbances5. Metabolic Causes6. Neurogenic Causes

Visceral Pain

Visceral pain is directly related to the organ involved. The majority of organs do not have an abundance of nerve fibers, so the patient might experience mild or less severe pain that is poorly localized. Its important to understand this does not mean the patient is experiencing a mild or less severe condition.

Characteristics:Less severe painPoorly localizedThe pain is usually dull or aching and constant or intermittent

Parietal Pain

Parietal pain occurs when there is an irritation of the peritoneal lining. The peritoneum has a higher number of sensitive nerve fibers, so the pain is generally more severe and easier to localize. The patient will typically present in a guarded position with shallow breathing. This minimizes the stretch of the abdominal muscles and limits the downward movement of the diaphragm, which reduces pressure on the peritoneum and helps ease the pain.

Characteristics:More severe painEasily localizedThe pain is usually sharp, constant and on one side or the other

Referred Pain

Referred pain is visceral pain that is felt in another area of the body and occurs when organs share a common nerve pathway. For this reason, it is poorly localized but generally constant in nature. An example is a patient with liver problems that experiences referred pain in the neck or just below the scapula.

Characteristics:Poorly localizedThe pain is usually constant

Immediate Life-Threatening Causes of Abdominal Pain

These must be recognized from the primary survey :Ruptured abdominal aortic aneurysm (AAA)Rupture of the spleen or liverRuptured ectopic pregnancyBowel infarctionPerforated viscusAcute myocardial infarction (MI)

Chronic Abdominal PainChronic intractable abdominal pain is defined as abdominal pain that is present for at least 6 months without diagnosis despite appropriate evaluation

How is the Cause of Abdominal Pain Diagnosed?

History Taking Physical ExaminationExams and TestsSurgery and Endoscopy

History Taking(S)ite - Where is the pain? Or the maximal site of the pain.(O)nset - When did the pain start, and was it sudden or gradual? progressive or regressive?(C)haracter - What is the pain like? An ache? Stabbing?(R)adiation - Does the pain radiate anywhere?(A)ssociations - Any other signs or symptoms associated with the pain(T)ime course - Does the pain follow any pattern?(E)xacerbating/Relieving factors - Does anything change the pain?(S)everity - How bad is the pain?

Associated Symptoms & Review of Systems e.g. anorexia, nausea, vomiting, flatus, diarrhea, and constipation, jaundice, dysuria, menstruation.

Physical ExaminationGeneral position in bed, posture, degree of discomfort, and facial expression. Vital signs Abdomen should be inspected for distention, scars, hernias, muscle rigidity, splinting during respiration, ecchymoses, and visible hyperperistalsis. .

Light, gentle palpation is superior to deep palpation in the identification of peritoneal irritation Palpation should begin at the point of least tenderness and proceed to the point of greatest tenderness, and rigidity should be determined

Abdominal percussion may elicit tympani

Enlargement of a diseased organ, tumor, or inflammation may produce a palpable mass Potential hernia orifices should be examined

Diagnostic ApproachLaboratory CBC, Urea & Electrolytes, Liver Function Test, ABG, Amylase Radiological : Plain Abodmen Imaging, Chest X-RayUltrasonography can provide rapid, accurate, and inexpensive anatomic information about the liver, biliary tree, spleen, pancreas, kidneys, and pelvic organCT Scan AbdomenMRIOther e.g. laparoscopy

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