急腹症医学课件

1、急腹症医学急 腹 症Acute Abdominal Pain急腹症医学概念急腹症医学前言 Abdominal pain is a complaint seen commonly in the outpatient setting. The differential diagnosis of a patient presenting with acute abdominal pains.pathophysiology of the painthe clinical presentationCourseinitial management急腹症医学 A focused history physic

2、al examination adjunctive testing strategy急腹症医学pathophysiology of the pain The abdominal viscera are innervated with nocioceptive afferents within the mesentery, on peritoneal surfaces,and within the mucosa and muscularis of hollow organs.急腹症医学The pain genesisMechanicalstretchChemical substance P se

3、rotonin prostaglandins hydrogen ions急腹症医学Stimuli Dull crampy poorly localized pain sensations急腹症医学Three broad patternsvisceralParietalreferred急腹症医学Visceral typically involves stretch and distension of the abdominal organs. although torsion, and contraction also contribute. The pain stimulus is carri

4、ed on slow-conducting C-fibers.急腹症医学 dull ache. Pain location corresponds to those dermatomes that match the innervation of the injured organ.急腹症医学Parietal Sharp well localized A- fibers, with a rapid conduction velocity急腹症医学Referred pain occurs when visceral afferents carrying stimuli from a diseas

5、ed organ enter the spinal cord at the same level as somatic afferents from a remote anatomic location.急腹症医学 Furthermore,disease processes from organs outside of the abdominal cavity can present with abdominal pain.急腹症医学History assessment of the condition medical problems medications family history,

6、substance abuse history, recent travel history occupational history.急腹症医学Nature of the pain its quality Location rapidity of onset Chronicity radiation, Intensity exacerbating factors alleviating factors Associated symptoms急腹症医学Physical examination general observation(review of the vital signs) abdo

7、minal inspectionauscultationpalpation急腹症医学急腹症医学Diagnosis of abdominal pain based on location and distributionRight upper quadrant Peptic ulcer disease Biliary diseaseBiliarycolicCholedocholithiasisCholecystitisCholangitis Liver diseaseHepatitisNeoplasmAbscessCongestive hepatopathyLung diseasePneumon

8、iaSubphrenic abscessPulmonary embolismPneumothoraxAbdominal wallHerpes zosterMuscular StainKidney diseasePyelonephritisPerinephric abscessNephrolithiasisColonic causesColitisRight sided diverticulitis急腹症医学Middle upper abdomen Peptic ulcer disease Pancreatitic diseasePancreatitisPancreatic neoplasm B

9、iliary diseaseBiliary colicCholedocholithiasisCholecystitisCholangitisEsophageal diseaseReflux esophagitisInfectious esophagitisPill esophagitisCardiac diseaseMyocardial ischemiainfarctionPericarditisAAA rupture/aorticdissectionMesenteric ischemia急腹症医学Left upper quadrant Peptic ulcer disease Splenic

10、 diseaseSplenic ruptureSplenic infarct Pancreatic diseasePancreatitisPancreatic neoplasmLung diseasePneumoniaSubphrenic abscessPulmonary embolismPneumothoraxKidney diseasePyelonephritisPerinephric abscessNephrolithiasis急腹症医学Periumbilical Appendicitis (early) Small bowel obstruction Gastroenteritis M

11、esenteric ischemia AAA rupture Aortic dissection急腹症医学Right lower quadrant Appendicitis Inflammatory bowel disease OB-GYN causesOvarian tumorOvarian torsionEctopic pregnancyPelvic inflammatory disease (PID)Kidney diseasePyelonephritisPerinephric abscessNephrolithiasisIntestinal diseaseRight sided div

12、erticulitisIleocolitisGastroenteritisHernia急腹症医学Suprapubic Inflammatory bowel disease OB-GYN causesOvarian tumorOvarian torsionEctopic pregnancyPID DysmenorrheaColonic diseaseProctocolitisDiverticulitisUrinary tract diseaseCystitisNephrolithiasisProstatitis急腹症医学Left lower quadrant Inflammatory bowel

13、 disease OB-GYN causesOvarian tumorOvarian torsionEctopic pregnancyPID Kidney diseasePyelonephritisPerinephric abscessNephrolithiasisIntestinal diseaseSigmoid diverticulitisIleocolitisGastroenteritisHernia急腹症医学Diffuse Gastroenteritis Bowel obstruction Peritonitis Mesenteric ischemia Inflammatory bow

14、el disease Diabetic ketoacidosis Porphyria UremiaHypercalcemiaSickle cell crisisVasculitisHeavy metal intoxicationOpiate wihdrawalFamilial mediterranean feverHereditary angioedema急腹症医学 based on history and physical alone, Physicians were able to correctly differentiate between organic and nonorganic

15、 causes of abdominal pain nearly 80%急腹症医学 significant abnormality of the vital signs, mental status changes, involuntary guarding, rebound abdominal tenderness, complete absence of bowel sounds, and pain out of proportion to abdominal tenderness急腹症医学 without signs or symptoms of an acute abdominal c

16、atastrophe,an acute expedited outpatient evaluation should be performed.急腹症医学laboratory and imaging studies plain abdominal radiographs have been the initial imaging test of choice. rapidly at a relatively low cost急腹症医学 up to 60% of cases of suspected small bowel obstruction. with a perforated viscu

17、s, sensitivity of plain films is reported to be as high as 100%. as small as 1 to 2 cc of air has been reported using this method急腹症医学CT is sensitive for the diagnosis rapid helical scanning methods, advances in intravenous and oral contrast agents, three-dimensional reformatting急腹症医学 Computed tomography has proven to be more sensitive and specific for nearly all etiologies of acute abdominal pain急腹症医学 急腹症医学急腹症医