I. Mechanism of the occurrence of abdominal pain.
Abdominal pain has a twofold nature.
Beneficial: to promote patients to seek medical attention and facilitate doctors’ diagnosis.
Harmful: cause a series of physiological and biochemical reactions, and even shock.
(i) injurious stimuli causing abdominal pain.
1, dysfunction of the digestive tract.
2, mechanical obstruction of the digestive tract.
3, inflammation of abdominal organs.
4, Injury and rupture of abdominal organs.
5.Disorders of blood flow to the abdominal organs.
6, malignant tumor.
7, other rare etiologies: such as lead poisoning, spinal cord disease, etc.
(II) Several links involved in the formation of pain.
1, intra-abdominal sensation.
The endoreceptors distributed in the peritoneum, abdominal organs and various tissues are mainly exposed nerve endings.
2. Pain-causing substances.
①Inorganic ions: k+ H+, etc.
②Amines: 5-hydroxytryptamine, which is a strong pain-causing substance.
③Peptides: bradykinin, decapeptide, undecapeptide.
3.Mechanical or physical pain-causing factors.
Such as excessive expansion of the digestive tube, pulling and twisting of the intestinal tube, which directly stimulate the nerves or receptors to cause pain.
4.Conversion of painful stimuli into painful afferent impulses.
After the endoreceptors are stimulated by pain-causing substances, the receptors produce action potentials to form an electrical signal to the center.
5. Transmission of nociception to the central nerve.
Nociception in the abdominal cavity has two different pathways to the central visceral sensory nerves somatic sensory nerves.
Both sensory nerves are located in the posterior root ganglion of the spinal nerve and then transmitted to the brain via the spinal cord.
Second, the classification of abdominal pain.
Transient colic: mostly spasm of cavernous organs.
Persistent distension (pure pain): inflammation or dilatation of the organs.
1.According to the nature of abdominal pain.
Persistent sharp pain: mostly perforation or rupture of cavernous organs.
Burning pain: mostly gastrointestinal ulcers.
Stabbing pain: mostly plasma membrane inflammation.
2.According to the abdominal pain conduction pathway.
① visceral abdominal pain.
② Somatic abdominal pain.
③ radiating pain or involvement pain, mechanism, drawing.
Third, the common diseases of different parts of abdominal pain.
1, total abdominal pain: sudden total abdominal pain indicates extensive lesions or serious pathology. Mostly peritonitis, such as perforation or rupture of the cavernous organs.
2, subxiphoid pain (heart fossa pain): gastroduodenal disease.
3, right upper abdominal pain: biliary tract disease, liver disease, right kidney ureteral disease.
4.Left upper abdominal pain: pancreatic, spleen, left renal ureter disease.
5.Right lower abdominal pain: orchiocele. Ileocecal tumor, tuberculosis, intussusception, Crohn’s disease. Mesenteric lymphadenitis, tuberculosis, etc. Obstetrical and gynecological diseases.
6.Left lower abdominal pain: descending colon and sigmoid colon diseases.
Fourth, the diagnosis and differential diagnosis of abdominal pain.
Abdominal pain is a symptom, not an independent disease. Detailed medical history should be taken to understand the cause, urgency, location, nature, intensity, impingement pain and the relationship with other accompanying symptoms of abdominal pain. If accompanied by fever, the sequence with fever. If jaundice, the relationship between the appearance of jaundice and pain. Then, for example, the difference between gastric ulcer pain and duodenal ulcer pain.
V. Characteristics of abdominal pain in common diseases.
1, acute diffuse peritonitis, such as gastrointestinal perforation, gastrointestinal rupture.
2, gastritis, gastric ulcer, duodenal bulb ulcer.
3, small bowel inflammation, such as hemorrhagic necrotizing small bowel inflammation, intestinal ascariasis.
4.Lancetitis, right adnexitis, ovarian tumor torsion.
5, intestinal obstruction (intestinal adhesions, torsion, overlap, tumor, incarcerated hernia, etc.).
6, cholelithiasis, cholecystitis, cholangitis (gallbladder, common bile duct, intrahepatic bile duct).
7.Pancreatitis, pancreatic cancer.
8.Ureteral calculus.
9.Pneumonia, pleurisy.
10, spinal cord disease, such as spinal cavernous disease.