ACUTE ABDOMINAL PAIN

ACUTE ABDOMINAL PAIN

Is an unconfortable pain with onset six hours left, that brings general manifestations in the patient.

Types of pain

Visceral: Is a difuse pain, heavy and can have sympathetic sypmtoms concomitant.
Somatic: Is a localized pain, ellicited with compresion ansd is due to parietal peritoneum inflamation.
Refered: Is a refered pain that occurs in a distal zone from origin, is caused by dermatoma's inervation.
- Shoulder: biliar ways and diapragm.
- Subscapular: Gallblader
- Back: pancreas, gut, peptic ulcer and intestinal obstruction.
- Inguinal and perineal: Nephroplitiasys.

Cholic: Intermitent like cramping, can be urinary or gallblader stones. Peptic ulcer.
Heartbreaking: Very hard pain, can be abdominal arterial disection .
Burning: peptic ulcer, peritonitis and nephrolithiasis.
Alodinia: cutaneous pain with normal stimule. vertebral arthropathy and Herpes zoster.

If there is vomit concomitant:

Bilious vomit: is due to obstruction after the vater ampulla.
Transparent vomit: is due to obstruction before the vater ampulla.
fecaloid: smells, is very dark and is due to intestinal obstruction.
Coffee bar: Is bilious with food remainings, is due to ulcer and tumor.
Food vomit: with food intact is due to pyloric obstruction.
Hematemesis: Is due to esophageal varices and ulceration.

According localization

Epigastrium: pancreatitis, duodenitis, gastritis, peptic ulcer.
Mesogastrium: early appendicitis, pancreatitis, gastroenteritis.
Hipogastrium: Cystitis, prostatitis, diverticulitis.
Right hypochondrium: hepatitis, hepatic abscess, cholangitis, choledocolithiasis, cholecystitis, pancreatitis, peptic ulcer.
Left hypochondrium: Hypersplenism, splenic rupture, splenic infarction, diverticulitis.
Right iliac cavity: appendicitis, pyelonephritis, diverticulitis, Colon CA, salpyngitis, ovaric cyst, endometriosis, ectopic pregnance.
Lef iliac cavity: the same in the right cavity but appendicitis.

Pain characteristics:

• - If there is remision of the pain when vomiting occurs --> peptic ulcer and intestinal obstruction.
• - If the pain is worst during inspiration --> gallblader disease
• - If there is remision of the pain sitting or in mahometan position --> pancretitis
• - If the pain is worst when cought --> inflamation
• - If the food ingest makes worse the pain --> gastric ulcer, if the pain gets better--> duodenal ulcer.
• - If the respiratory movements makes worse the pain--> hepatic abscess, pneumonia, pleuresy.