STUDY - Technical - New Dacian's Medicine
Abdominal
PAIN (Classical / Allopathic Medicine)
Although abdominal
pain usually results from a GI disorder, it can also be caused
by a reproductive, genitourinary (GU), musculoskeletal, or
vascular disorder; drug use; or ingestion of toxins. At times,
this symptom signals life-threatening complications.
Abdominal pain
arises from the abdominopelvic viscera, the parietal
peritoneum, or the capsules of the liver, kidney, or spleen.
It may be acute or chronic, diffuse or localized. Visceral
pain develops slowly into a deep, dull, aching pain that's
poorly localized in the epigastric, periumbilical or lower
midabdominal (hypogastric) region. In contrast, somatic
(parietal, peritoneal) pain produces a sharp, more intense,
and well-localized discomfort that rapidly follows the insult.
Movement or coughing aggravates this pain.
Pain may also be
referred to the abdomen from another site with the same or a
similar nerve supply. This sharp, well-localized, referred
pain is felt in the skin or deeper tissues and may coexist
with skin hyperesthesia and muscle hyperalgesia.
Mechanisms that
produce abdominal pain include stretching or tension of the
gut wall, traction on the peritoneum or mesentery, vigorous
intestinal contraction, inflammation, ischemia, and sensory
nerve irritation.
ALERT:
If the patient is experiencing sudden, severe abdominal pain:
- quickly take his vital signs
- palpate for pulses below the waist
- be alert for signs of hypovolemic shock, such as tachycardia and hypotension
- prepare him for emergency surgery, if necessary.
If the patient has no life-threatening signs or symptoms, perform a focused assessment.
If the patient is experiencing sudden, severe abdominal pain:
- quickly take his vital signs
- palpate for pulses below the waist
- be alert for signs of hypovolemic shock, such as tachycardia and hypotension
- prepare him for emergency surgery, if necessary.
If the patient has no life-threatening signs or symptoms, perform a focused assessment.
HISTORY:
Ask the patient if the pain is constant or intermittent, and ask when the pain began. Determine the duration of a typical episode.
Ask the patient where the pain is located and whether it radiates to other areas. Find out if movement, coughing, exertion, vomiting, eating, elimination, or walking worsen or relieve the pain.
Review the patient's medical history for vascular, GI (gastrointestinal), GU (genitourinary), or reproductive disorders.
When appropriate, ask the female patient about the date of her last menses, changes in her menstrual pattern, or dyspareunia.
Ask the patient about appetite changes, or onset and frequency of nausea or vomiting.
Ask the patient about changes in bowel habits, such as constipation, diarrhea, or changes in stool consistency. When was the patient's last bowel movement?
Ask the patient about urinary frequency, urgency, or pain. Is the urine cloudy or pink?
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs. Also, ask the patient about alcohol intake.
Ask the patient if the pain is constant or intermittent, and ask when the pain began. Determine the duration of a typical episode.
Ask the patient where the pain is located and whether it radiates to other areas. Find out if movement, coughing, exertion, vomiting, eating, elimination, or walking worsen or relieve the pain.
Review the patient's medical history for vascular, GI (gastrointestinal), GU (genitourinary), or reproductive disorders.
When appropriate, ask the female patient about the date of her last menses, changes in her menstrual pattern, or dyspareunia.
Ask the patient about appetite changes, or onset and frequency of nausea or vomiting.
Ask the patient about changes in bowel habits, such as constipation, diarrhea, or changes in stool consistency. When was the patient's last bowel movement?
Ask the patient about urinary frequency, urgency, or pain. Is the urine cloudy or pink?
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs. Also, ask the patient about alcohol intake.
PHYSICAL
ASSESSMENT:
Take the patient's vital signs.
Assess skin turgor and mucous membranes.
Inspect the abdomen for distention or visible peristaltic waves and, if indicated, measure his abdominal girth.
Auscultate for bowel sounds, and characterize their motility.
Percuss all quadrants, carefully noting the percussion sounds.
Palpate the entire abdomen for masses, rigidity, and tenderness. Note guarding.
Take the patient's vital signs.
Assess skin turgor and mucous membranes.
Inspect the abdomen for distention or visible peristaltic waves and, if indicated, measure his abdominal girth.
Auscultate for bowel sounds, and characterize their motility.
Percuss all quadrants, carefully noting the percussion sounds.
Palpate the entire abdomen for masses, rigidity, and tenderness. Note guarding.
SPECIAL
CONSIDERATIONS:
Withhold analgesics from the patient until a diagnosis is determined because they may mask symptoms. Also, withhold food and fluids until it's decided that surgery is unnecessary.
Withhold analgesics from the patient until a diagnosis is determined because they may mask symptoms. Also, withhold food and fluids until it's decided that surgery is unnecessary.
PEDIATRIC
POINTERS:
Remember that a parent's description of a child's complaints is a subjective interpretation of what the parent believes is wrong.
In children, abdominal pain can signal a disorder with greater severity or with different associated signs than are common in adults.
Acute pyelonephritis may cause abdominal pain, vomiting, and diarrhea but not the classic urologic signs found in adults.
Peptic ulcer, which is becoming increasingly common in teenagers, causes nocturnal pain and colic that, unlike peptic ulcer in adults, may not be relieved by food.
Abdominal pain in children can also result from lactose intolerance, allergic-tension-fatigue syndrome, volvulus, Meckel's diverticulum, intussusception, mesenteric adenitis, diabetes mellitus, juvenile rheumatoid arthritis, or an uncommon disorder such as heavy metal poisoning.
Remember that a parent's description of a child's complaints is a subjective interpretation of what the parent believes is wrong.
In children, abdominal pain can signal a disorder with greater severity or with different associated signs than are common in adults.
Acute pyelonephritis may cause abdominal pain, vomiting, and diarrhea but not the classic urologic signs found in adults.
Peptic ulcer, which is becoming increasingly common in teenagers, causes nocturnal pain and colic that, unlike peptic ulcer in adults, may not be relieved by food.
Abdominal pain in children can also result from lactose intolerance, allergic-tension-fatigue syndrome, volvulus, Meckel's diverticulum, intussusception, mesenteric adenitis, diabetes mellitus, juvenile rheumatoid arthritis, or an uncommon disorder such as heavy metal poisoning.
AGING ISSUES:
Advanced age may decrease the signs and symptoms of acute abdominal disease. Pain may be less severe, fever less pronounced, and signs of peritoneal inflammation diminished or absent.
Advanced age may decrease the signs and symptoms of acute abdominal disease. Pain may be less severe, fever less pronounced, and signs of peritoneal inflammation diminished or absent.
PATIENT
COUNSELING:
Instruct the patient on what to expect from diagnostic testing, which may include pelvic and rectal examination; blood, urine, and stool tests; X-rays; barium studies; ultrasonography; endoscopy; and biopsy. If surgery is needed, perform preoperative teaching.
Instruct the patient on what to expect from diagnostic testing, which may include pelvic and rectal examination; blood, urine, and stool tests; X-rays; barium studies; ultrasonography; endoscopy; and biopsy. If surgery is needed, perform preoperative teaching.
Bibliography:
1. Rapid Assessment, A
Flowchart Guide to Evaluating Signs & Symptoms, Lippincott
Williams & Wilkins, 2004.
2. Professional Guide to
Signs and symptoms, Edition V, Lippincott
Williams & Wilkins, 2007.
3. Guide to common
symptoms, Edition V, McGraw - Hill, 2002.
Dorin,
Merticaru (2010)