Acute Abdominal Pain: (P.530)
Pathophysiology: It is important to understand the physiology of pain specific to each organ and site in the abdomen. For instance, distention of the bowel produces pain, whereas mechanical laceration does not. In general, pain arising in the viscera and transmitted in the vagal visceral afferent nerves and sympathetic afferent nerves give sensations of deep, boring, poorly localized pain that is frequently accompanied by autonomic features such as nausea, vomiting, and diaphoresis. Pain transmitted via the spinal somatic afferent nerves innervating the body wall and peritoneum is generally described as sharp and well localized to the anatomic site of the inflammation or injury. This is a complex subject, the details of which are beyond the scope of this book, but knowledge of the innervation of each abdominal organ (somatic versus visceral, vagus, and/or sympathetic) will help the examiner understand the nature and pattern of the patient's pain history. Severe, acute abdominal pain can herald a variety of disorders from the benign to the immanently life-threatening; this situation is known in surgical slang as the acute abdomen. The specific diagnosis must be sought with a sense of urgency, because early surgical intervention may be lifesaving in some disorders (leaking abdominal aortic aneurysm, appendicitis) and contraindicated in others (acute intermittent porphyria, sickle cell crisis). Great reliance is necessarily placed on history and physical examination. Some assistance is obtained from imaging examinations, while laboratory tests are less important. A careful history and personally repeated examinations over a few hours, be it day or night, are mandatory. Of particular importance are the locations of the pain and tenderness , any change in location, and their variations in quality during the period of observation. Relatively few findings may distinguish several conditions. For example, the patient with intraabdominal visceral pain may walk about, but when the viscus perforates, causing peritonitis, the patient lies very still in bed. Usually the severity of the symptoms brings the patient to the physician within a few hours of onset. Acute processes or acute complications of chronic diseases are most likely. Pain increased with walking, jumping, sneezing, or coughing is equivalent to the jar test and suggests the presence of peritoneal inflammation . A pregnancy test must be obtained in all women of childbearing age with acute abdominal pain.
dịch phần bôi đen:
Theo weaver: clause này muốn nói đến việc khám lại sau vài giờ để theo dõi đau bụng cấp là điều phải làm, ban ngày hay ban đêm đều quan trọng.