急腹症教学课件.pptVIP

急 腹 症Acute Abdominal Pain 昆明医学院第一附属医院急诊科 郑宏宇 概念 外科急腹症是一组以急性腹痛为主要表现，绝大多数需要紧急外科手术处理的急性炎症、出血、梗阻、穿孔及血运障碍性疾病的总称。 前言 Abdominal pain is a complaint seen commonly in the outpatient setting. The differential diagnosis of a patient presenting with acute abdominal pains. A focused history physical examination adjunctive testing strategy 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. The pain genesis Mechanical stretch Chemical substance P serotonin prostaglandins hydrogen ions Stimuli  Dull crampy poorly localized pain sensations Three broad patterns visceral Parietal referred Visceral typically involves stretch and distension of the abdominal organs. although torsion, and contraction also contribute. The pain stimulus is carried on slow-conducting C-fibers. dull ache. Pain location corresponds to those dermatomes that match the innervation of the injured organ. Parietal Sharp well localized A-〥 fibers, with a rapid conduction velocity Referred pain occurs when visceral afferents carrying stimuli from a diseased organ enter the spinal cord at the same level as somatic afferents from a remote anatomic location. Furthermore,disease processes from organs outside of the abdominal cavity can present with abdominal pain. History assessment of the condition medical problems medications family history, substance abuse history, recent travel history occupational history. Nature of the pain its quality Location rapidity of onset Chronicity radiation, Intensity exacerbating factors alleviating factors Associated symptoms Physical examination general observation(review of the vital signs) abdominal inspection auscultation palpation Diagnosis of abdominal pain based on location and distribution Right upper quadrant Peptic ulcer disease Biliary disease Biliarycolic Choledocholithia