Abdominal Pain Include IBS Year 4 Internal Medicine Notes

Abdominal Pain Include IBS Year 4 · Internal Medicine Collection: 4TH YEAR ALL NOTES / IMED / I MED BEAUTIFUL NOTES / GIT -- ● Objectives: ● Should know the different types of abd pain ● Is acute or chronic? ● Hx taking skills with knowing the key questions ● Important abdominal pain signs. ● A good differential diagnosis of each abdominal area. ● Labs interpretation. ● To know the most common cause of chronic abdominal pain and how to handle it.\n[ Color index: ​Important​ ​Notes ​ ​Extra​ ]\n[​ ​Editing file​ ​ ​ ​Feedback​ ​ ​Share your notes​ ​ ​Shared notes​ ​ ​Twitter​ ] ● Resources: ● 435 slides\n\n● Done by:​ ​Samar Alotaibi & Nouf AlRushaid ● Team sub-leader:​ Jwaher Alharbi ● Team leaders:​ ​Khawla AlAmmari & Fahad AlAbdullatif ● Revised by: Ahmad Alyahya \n\n Objective 1: Should know the different types of abdominal pain!\n\n -Abdominal pain can be a challenging complaint for both primary care and specialist\nphysicians because it is frequently a benign complaint, but it can also herald serious acute\npathology.\n-Abdominal pain is present on questioning of 75% of otherwise healthy adolescent\nstudents and in about half of all adults.\n● Classification: \nBased on duration:\nWhen? For how long? \nAcute abdominal pain Chronic abdominal pain \n● Less than 12 weeks. ● More than 12 weeks.\n● The pain worsened progressively. ● The pain remained unchanged for months.\n● Pain in a sick or unstable patient should be\nmanaged as acute. ​Irrespective of the duration \nAcute abdominal pain ( Surgical abdomen ) \n● Defined as a condition with a rapidly worsening prognosis in the absence of surgical intervention.\n● Two syndromes that constitute urgent surgical referrals are ​obstruction​ and ​peritonitis​ ​(perforation)\n● Pain is typically severe in these conditions, and can be associated with unstable vital signs, fever, and\ndehydration. \nBased on the origin:\n-What kind of pain? \nVisceral pain Parietal Gut organs are insensitive to stimuli such as burning and cutting The parietal peritoneum is innervated by somatic nerves, and its but are sensitive to distension, contraction, twisting and involvement by inflammation, infection or neoplasia causes sharp, stretching. Pain from unpaired structures is usually but not well-localized and lateralized pain. always felt in the midline. \n● Involves hollow or solid organs; midline pain ● Involves parietal peritoneum.\ndue to bilateral innervation. \n● Causes vague discomfort to excruciating pain. ● Causes tenderness and guarding which\nprogress to rigidity and rebound as peritonitis\ndevelops. \nPoorly localized Localized pain \nCourse:​ Non specific. Course:​ ​Localised tenderness Guarding Rigidity Rebound. \n● Epigastric region: ​ stomach, duodenum, - Course: starts as visceral pain and then parietal\nbiliary tract (localized) pain\n● Periumbilical:​ small bowel, appendix, cecum - As localized peritonitis ( inflammation of the\n● Suprapubic:​ colon, sigmoid, GU tract peritoneum) tenderness, guarding and rebound\ntenderness \n\n Referred pain Produces symptoms (not signs) Based on developmental embryology such as:\n● Ureteral obstruction​ → Testicular pain.\n● Subdiaphragmatic irritation​ → Ipsilateral shoulder pain.\n● Gynecologic pathology ​→ Back or proximal lower extremity.\n● Biliary disease​ → Right infrascapular pain.\n● MI ​→ Epigastric, neck, jaw.\n\n Psychogenic pain Cultural, emotional and psychosocial factors influence everyone’s experience of pain. In some patients, no organic cause can be found despite investigation, and psychogenic causes (depression or somatization disorder) may be responsible.\n\n Based on the location:\n-Where exactly? Huge DDX \nEpigastric pain \n● Myocardial infarction\n● Peptic ulcer.\n● Acute cholecystitis.\n● Perforated esophagus \nRight upper quadrant Left upper quadrant \n● Acute cholecystitis. ● Ruptured spleen.\n● Duodenal ulcer. ● Gastric ulcer.\n● Hepatitis. ● Arotic anyrusem.\n● Congestive hepatomegaly. ● Perforated colon.\n● Pyelonephritis. ● Pyelonephritis.\n● Appendicitis. ● Pneumonia (left).\n● Pneumonia (right). \nRight lower quadrant Left lower quadrant \n● Apendicitis. ● Sigmoid diverticulitis.\n● Salpingitis. ● Salpingitis.\n● Tubo-ovarian abscess. ● Tubo-ovarian abscess.\n● Ruptured ectopic pregnancy. ● Ruptured ectopic pregnancy.\n● Renal/ureteric stone. ● Irreducible herina.\n● Irreducible herina. ● Perforated colon.\n● Mesenteric adenitis. ● Crohn’s disease.\n● Meckel’s diverticulitis. ● Ulcerative colitis.\n● Crohn's disease. ● Renal / ureteral stone.\n● Perforated cecum.\n● Psoas abscess \n\n ● The acute abdomen:\nThis accounts for approximately 50% of all urgent admissions to general surgical units. The\nacute abdomen is a consequence of one or more pathological processes:\nInflammation Perforation Obstruction \nPain develops gradually, usually over When a viscous perforates, pain starts Pain is colicky, with spasms which\nseveral hours. It is initially rather abruptly​; it is severe and leads to cau