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COLIC ABDOMEN

Jenis nyeri perut


Nyeri visceral
Trjadi bila terdapat rangsangan pada organ perut misalnya
karena cedera atau radang
Nyeri visceral tidak dapat ditunjuk secara tepat letaknya
Penderita dapat aktif bergerak
Nyeri visceral memperlihatkan pola yang khas sesuai
persyarafan embrional
Nyeri visceral dari lambung, duodenum, sistem hepatobilier
dan pankreas (foregut) dirasakan di ulu hati
Nyeri di duodenum sampai pertengahan kolon transversum
(midgut) dirasakan di umbilikus
Kelainan dari kolon transversum ke sigmoid (hindgut)
menyebabkan nyeri di perut kanan bawah
Nyeri somatik
Terjadi karena rangsangan pada bagian yang dipersarafi oleh
saraf tepi misalnya regangan pada peritoneum parietalis dan
luka pada dinding perut
Nyeri dirasakn seperti ditusuk/disayat
Pasien dapat menunjukkan letak nyeri
Pasien tidak dapat aktif bergerak

Sifat nyeri
Nyeri alih
Terjadi jika suatu segmen persyarafan melayani lebih dari 1
daerah
Nyeri proyeksi
Nyeri yang disebakan oleh rangsangan saraf sensorik akibat
cedera atau peradangan saraf
Hiperestesia/hiperalgesia
Ditemukan di kulit jika ada peradangan di bawahnya
Nyeri kontinue
Nyeri akibat rangsangan pada peritoneum parietal akan
dirasakan terus-menerus karena proses berlangsung terus
Nyeri kolik
Nyeri visceral akibat spasme otot polos organ berongga dan
biasanya disebabkan oleh hambatan pasase organ tersebut
Nyeri timbul akibat hipoksia yang dialami oleh jaringan
Nyeri hilang timbul
Disertai mual muntah
Nyeri iskemik
Tanda adanya jaringan yang terancam nekrosis
Nyeri hebat, menetap, tidak menyurut
Nyeri pindah
Nyeri berubah dengan perkembangan patologi
Nyeri visceral di sekitar pusat disertai mual
Letak Nyeri

Epigastric pain
GERD
MI
AAA- abdominal aortic aneurysm
Pancreatic pain
Gallbladder and common bile duct obstruction

Right Upper Quadrant
Acute Cholecystitis and Biliary Colic
Acute Hepatitis or Abscess
Hepatomegaly due to CHF
Perforated Duodenal Ulcer
Herpes Zoster
Myocardial Ischemia
Right Lower Lobe Pneumonia

Right Lower Quadrant
Appendicitis
Regional Enteritis
Small bowel obstruction
Leaking Aneurysm
Ruptured Ectopic Pregnancy
PID
Twisted Ovarian Cyst
Ureteral Calculi
Hernia

Left Upper Quadrant
Acute Pancreatitis
Gastric ulcer
Gastritis
Splenic enlargement, rupture or infarction
Myocardial ischemia
Left lower lobe pneumonia

Left Lower Quadrant
Diverticulitis
Leaking Aneurysm
Ruptured Ectopic pregnancy
PID
Twisted Ovarian Cyst
Ureteral Calculi
Hernia
Regional Enteritis

Periumbilical Pain
Disease of transverse colon
Gastroenteritis
Small bowel pain
Appendicitis
Early bowel obstruction

Diffuse Pain
Generalized peritonitis
Acute Pancreatitis
Sickle Cell Crisis
Mesenteric Thrombosis
Gastroenteritis
Metabolic disturbances
Dissecting or Rupturing Aneurysm
Intestinal Obstruction
Psychogenic illness

Reffered pain
Pneumonia (lower lobes)
Inferior myocardial infarction
Pulmonary infarction

Types of Abdominal Pain
Visceral
originates in abdominal organs covered by peritoneum
Colic
crampy pain
Parietal
from irritation of parietal peritoneum
Referred
produced by pathology in one location felt at another
location

ORGANIC VERSUS FUNCTIONAL PAIN
HISTORY ORGANIC FUNCTIONAL

Pain character Acute, persistent pain Less likely to change
increasing in intensity

Pain localization Sharply localized Various locations

Pain in relation to sleep Awakens at night No affect

Pain in relation to Further away At umbilicus
umbilicus

Associated symptoms Fever, anorexia, Headache, dizziness,
vomiting, wt loss, multiple system com-
anemia, elevated ESR plaints

Psychological stress None reported Present
WORK-UP OF ABDOMINAL PAIN
HISTORY
Onset
Qualitative description
Intensity
Frequency
Location - Does it go anywhere (referred)?
Duration
Aggravating and relieving factors
WORK-UP
PHYSICAL EXAMINATION
Inspection
Auscultation
Percussion
Palpation
Guarding - rebound tenderness
Rectal exam
Pelvic exam
WORK-UP
LABORATORY TESTS
CBC
Additional depending on rule outs
amylase, lipase, LFTs
WORK-UP
DIAGNOSTIC STUDIES
Plain X-rays (flat plate)
Contrast studies - barium (upper and lower GI series)
Ultrasound
CT scanning
Endoscopy
Sigmoidoscopy, colonoscopy
Common Acute Pain Syndromes
Appendicitis
Acute diverticulitis
Cholecystitis
Pancreatitis
Perforation of an ulcer
Intestinal obstruction
Ruptured AAA
Pelvic disorders

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