HISTORY -PainAdetailed and organized history is essential to formulating an accurate differentialdiagnosisandsubsequenttreatmentregimenThehistorymust notonlyfocus on the investigation of thepaincomplaints,but onpastproblemsandassociatedsymptomsaswellHow to describethe pain:OnsetCharacterLocationDurationRadiationChronologyofthepainexperienced
HISTORY-Pain • A detailed and organized history is essential to formulating an accurate differential diagnosis and subsequent treatment regimen • The history must not only focus on the investigation of the pain complaints, but on past problems and associated symptoms as well • How to describe the pain: • Onset • Character • Location • Duration • Radiation • Chronology of the pain experienced
HISTORY -PainThe intensity and severity of the pain are related to the underlying tissue damageintestinal perforationarterialembolizationwithischemiabiliary colicCholecystitisColitisBowel obstruction
HISTORY-Pain • The intensity and severity of the pain are related to the underlying tissue damage • intestinal perforation • arterial embolization with ischemia • biliary colic • Cholecystitis • Colitis • Bowel obstruction
HISTORY-PainCholecystitisHepatitisPancreatitisPerforatedulcerUreteral colicAppendicitis(maybeconstant)RupturedDiverticulitisaorticTubo-ovariananeurysmabcessorectopicpregnancyFiGURE47-4 Characterofpain-sudden,severepainFIGURE47-2Characterofpain-gradual,progressivepainBiliarycolicPerforatedulcerUreteral colicPyelonephritis,(kidney stones),renal orureteral colicSmall bowelobstructionColonicobstructionFIGURE47-3Characterof pain-colicky,crampy,intermittentpainFIGURE47-5Referredpain.Solid circles areprimary or most intensesites of pain
HISTORY-Pain
HISTORY-PainLocation and radiation is equally as important as the character of the painTissueinjuryorinflammation cantriggervisceral andsomaticpainSolid organ visceral pain in the abdomen is generalized in the quadrant of the involvedorganAsinflammationexpandstoinvolvetheperitoneal surface,parietal nervefibersfromthespineallowforfocalandintensesensationAppendicitis:diffuseperiumbilical pain shifts toan intensefocal painintheright loweabdomenatmcburney'spointPainmayalsoextendwellbeyondthediseasedsite--Referred PainLiver/gallbladder/common bileductobstruction--RadiatetorightshoulderGenitourinary--primarily in the flank region--Radiateto scrotum orlabia
HISTORY-Pain • Location and radiation is equally as important as the character of the pain • Tissue injury or inflammation can trigger visceral and somatic pain • Solid organ visceral pain in the abdomen is generalized in the quadrant of the involved organ • As inflammation expands to involve the peritoneal surface, parietal nerve fibers from the spine allow for focal and intense sensation • Appendicitis: diffuse periumbilical pain shifts to an intense focal pain in the right lower abdomen at mcburney’s point • Pain may also extend well beyond the diseased site-Referred Pain • Liver/gallbladder/common bile duct obstruction-Radiate to right shoulder • Genitourinary-primarily in the flank region -Radiate to scrotum or labia
HISTORY-PainActivities that exacerbate orrelieve the pain arealso importantEating worsen the pain: bowel obstruction/biliary colic/pancreatitis/diverticulitis/bowelperforationFoodproviderelieffromthepain:nonperforatedpepticulcerdisease/gastritisCompulsive posititon:Patients with peritoneal inflammation will avoid any activity thatstretchesorjostlestheabdomen
HISTORY-Pain • Activities that exacerbate or relieve the pain are also important • Eating worsen the pain: bowel obstruction/biliary colic/pancreatitis/diverticulitis/bowel perforation • Food provide relief from the pain: nonperforated peptic ulcer disease/gastritis • Compulsive posititon: Patients with peritoneal inflammation will avoid any activity that stretches or jostles the abdomen