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Acute pain

Table of contents
Acute pain
Anamnesis of abdominal pains
Physical inspection
Diagnostic testings
Assessment and diagnostic approach

Close concepts: pain in an abdominal cavity, belly pain

The concept "abdominal pain" characterizes feeling of morbidity or discomfort in the field of an abdominal cavity. Difficulties directed by the exact diagnosis are connected with the fact that abdominal pains can accompany extremely large number of diseases. One of three extensive nosological groups is the reason of pains in an abdominal cavity: the diseases of abdominal organs irradiating pains at the diseases which are localized out of an abdominal cavity and general diseases.

Diseases of abdominal organs

Bases of diagnosis of acute abdominal pains consist in understanding of the mechanism of their emergence. According to anatomy of a nervous system of an abdominal cavity distinguish two main types of abdominal pains.

Visceral pain. Abdominal organs and the visceral peritoneum covering them are supplied with a network of the nerve terminations relating to system of celiac nerves. Nerve terminations branch and block each other therefore visceral pain has no accurate localization. The receptors perceiving visceral pain react to increase in intracavitary pressure, but not to direct irritations, for example, destruction of fabrics or a burn. Irrespective of localization obstruction or stretching practically of any hollow body is shown by feeling of not clear discomfort in the center of a stomach in the beginning. The periumbilikalny pain caused by expansion of a gleam of a worm-shaped shoot of a pas initial stages of appendicitis can be an example of similar not clear feeling.

Parietal pain. The parietal peritoneum is supplied with somatic esodic nerves that allows to localize precisely the inflammatory process arising in the field of nerve terminations. For example, as at appendicitis the transmural inflammation develops, the irritation of a parietal peritoneum is resulted by pain with accurate localization in the right lower quadrant of a stomach.

The pain irradiating in a stomach at the diseases which are localized out of an abdominal cavity

Abdominal pains at the diseases which are localized out of an abdominal cavity meet often as in this case central routes of afferent neurons are mentioned. As a result heavy stenocardia and other primary diseases of bodies of a thorax can be shown by abdominal pains. Diseases of bodies of retroperitoneal space, for example, the rupture of an aortic aneurysm which is often followed by abdominal pains can be an example. The most frequent reasons of the irradiating abdominal pains are provided to tab. 1.

Table 1. The most common causes of the pains irradiating in a stomach

Localization

Diseases

Bodies of a thorax and heart

Pericardis

Pleurisy

Pneumonia

Acute myocardial infarction

Abdominal wall

Pararectal hematoma

Muscle strain

Retroperitoneal  space

Renal colic

Kidney heart attack

Bodies of a basin

 

Rupture of aneurism of a ventral aorta

Waves in the middle of a menstrual cycle

Endometriosis

 

At diagnosis of the reason of abdominal pains it is necessary to use also knowledge of embryology. For example, emergence at renal colic of an acute pain in a small egg is explained by homogeny of testicles and kidneys.

General diseases

Abdominal pains also occur among numerous symptoms of the general diseases listed in tab. 2.

Table 2. The general diseases causing abdominal pains


Metabolic

Acute porphyria
Uraemia
Diabetic ketoacidosis Addisonichesky crisis

Hematologic

Sickemia Leukoses

Toxic

Poisonings with heavy metals Bacterial infection (staphylococcus, tetanic stick) Drug disease
Reactions to a sting of insects

 

Prevalence and reasons of abdominal pains

Abdominal pains are the main complaint at least at one of 20 patients coming to department of acute management of the large medical center. It is interesting that the abdominal pain of not clear etiology (41,3%) was the most frequent final diagnosis in this research.

Three other most widespread states also did not demand surgical intervention: gastroenteritis (6,7%), inflammatory diseases of bodies of a basin (6,7%) and infections of an uric path (5,2%). The most widespread surgical pathology, appendicitis, met only in 4,3% of cases. The provided results demonstrate that acute abdominal pains are caused in most of patients by nonsurgical diseases and that quite often accurate diagnosis does not manage to be made. And nevertheless the doctor is obliged to exclude the life-threatening states demanding surgical intervention as the reason of abdominal pains. Therefore, in the course of diagnosis it is necessary to differentiate first of all the patients demanding fast diagnosis and immediate treatment as, for example, at a rupture of an aortic aneurysm, and patients with more favorable states at which process of diagnosis can be carried out without haste.



 
"Pains in the field of a basin at women   Allocations from a nipple"