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Syndrome -Lecture 3

Abdominal pain can be acute or chronic and is associated with various gastrointestinal diseases, with mechanisms including mechanical, inflammatory, or ischemic causes. Pain can be classified as visceral, parietal, or referred, each with distinct characteristics and localization. Other gastrointestinal symptoms discussed include vomiting, dyspepsia, heartburn, diarrhea, and constipation, each with specific definitions, causes, and implications for patient care.

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Velma Pranay Reddy
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9 views

Syndrome -Lecture 3

Abdominal pain can be acute or chronic and is associated with various gastrointestinal diseases, with mechanisms including mechanical, inflammatory, or ischemic causes. Pain can be classified as visceral, parietal, or referred, each with distinct characteristics and localization. Other gastrointestinal symptoms discussed include vomiting, dyspepsia, heartburn, diarrhea, and constipation, each with specific definitions, causes, and implications for patient care.

Uploaded by

Velma Pranay Reddy
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPTX, PDF, TXT or read online on Scribd
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Abdominal Pain

Anzor Gogiberidze
Abdominal Pain
Abdominal pain is the presenting symptom of a number of gastrointestinal
diseases and can be acute or chronic

The causal mechanisms of abdominal pain are mechanical, inflammatory, or


ischemic

Generally, the abdominal organs are not sensitive to mechanical stimuli, such as
cutting, tearing, or crushing

These organs are, however, sensitive to stretching and distention, which


activate nerve endings in both hollow and solid structures
Abdominal Pain
Visceral
• stimulus (distention, inflammation,
ischemia) acting on an abdominal organ
• poorly localized,
• diffuse, or vague with a radiating pattern

Parietal (somatic)
• is more localized and intense
• Parietal pain lateralizes (the parietal
peritoneum is innervated from only one side
of the nervous system)
• It is typically aggravated by movement or coughing.
Patients with parietal pain usually prefer to lie still.
Reffered
• is visceral pain felt at some distance from a diseased or
affected organ
• well localized and is felt in the skin
dermatomes
• Pain from the biliary tree, to the right scapular
region
Pain or the
arising right
from posterior
the stomach,thorax.
for example, is experienced as a sensation of fullness, cramping
or gnawing in the midepigastric area.
Visceral Pain

Visceral pain occurs when hollow abdominal organs such as the intestine
or biliary tree contract unusually forcefully or are distended or stretched

Visceral pain varies in quality and may be gnawing, burning, cramping, or


aching. When it becomes severe, sweating, pallor, nausea, vomiting, and
restlessness may follow.
Vomiting (emesis)

Stimuli
• Severe pain
• distention of stomach and duodenum
• motion sickness
• CTZ in the medulla
• pathologies of the urogenital organs

Vomiting center
• in the medulla

Vomiting is the forceful emptying of stomach and intestinal


contents (chyme) by mouth

Nausea is a subjective experience associated with various


conditions (abnormal pain, labyrinthine movements)

Nausea correlates with a shift in the normal three cycle per minute gastric
myoelectrical activity to increased frequency (tachygastria) or reduced
frequency (bradygastria).
Vomiting (emesis)

Deep inspiration Glottis is closed  decreased intrathoracic


pressureduodenum and antrum is contracted  LES and body of the
stomach relax  chyme goes backward into the esophagus (pressure
gradient, reverse perystalsis)  chyme is expelled from the mouth
(diaphragmatic contractions, higher intrathoracic pressure, UES
Projectile Vomiting.

Causes

• increased ICP
• tumors
• aneurysms
• GI obstruction

Metabolic consequences

• fluid disturbances
• hyponatremia
• hypokalemia
• hypochloremia
• metabolic alkalosis

not preceded by nausea or retching


is caused by direct stimulation of the vomiting center
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Dyspepsia

Dyspepsia is a common symptom with an extensive differential diagnosis and a


heterogeneous pathophysiology. It occurs in up to 20 percent of the population, although
prevalence rates are lower using different iterations of the Rome criteria. Most affected
people do not seek medical evaluation for their symptoms. Although dyspepsia does not
affect survival, it is responsible for substantial health care costs and significantly affects
quality of life
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Heartburn
Aggravating Factors

• Foods: alcohol, chocolate, citrus fruits, coffee,


onions, and peppermint
• Positions: bending over, exercising, lifting, or lying
supine

Reasons

• GERD
• Peptic Ulcer

Heartburn is a rising retrosternal burning pain or discomfort occurring


weekly or more often.
Diarrhea

The following definitions have been suggested according to the duration of symptoms:
●Acute – 14 days or fewer in duration
●Persistent diarrhea – more than 14 but fewer than 30 days in duration
●Chronic – more than 30 days in duration

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Diarrhea

Severe illness
•Profuse watery diarrhea with signs of hypovolemia
•Passage of >6 unformed stools per 24 hours
•Severe abdominal pain
•Need for hospitalization
●Other signs or symptoms concerning for inflammatory diarrhea
•Bloody diarrhea
•Passage of many small volume stools containing blood and mucus
•Temperature ≥38.5ºC (101.3ºF)
●High-risk host features
•Age ≥70 years
•Comorbidities, such as cardiac disease, which may be exacerbated by hypovolemia or rapid in
•Immunocompromising condition (including advanced HIV infection)
•Inflammatory bowel disease
•Pregnancy

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Constipation

According to the Rome IV criteria, functional constipation is defined as any two of the
following features: straining, lumpy hard stools, sensation of incomplete evacuation, use of
digital maneuvers, sensation of anorectal obstruction or blockage with 25 percent of bowel
movements, and decrease in stool frequency (less than three bowel movements per week)

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Constipation

Slow transit constipation — Slow transit constipation (STC) is characterized by prolonged


delay in stool transit throughout the colon. This could be due to a primary dysfunction of
colonic smooth muscle (myopathy) or neuronal innervation (neuropathy) or secondary to
dyssynergic defecation

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Dyssynergic defecation — Dyssynergic defecation (DD) is caused by difficulty with bowel
movement or inability to expel stool from the anorectum. Many of these patients may also
have prolonged colonic transit time
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Constipation

Irritable bowel syndrome — Irritable bowel syndrome with predominant constipation (IBS-
C) is characterized by abdominal pain with altered bowel habits. These patients may or may
not have slow colonic transit or dyssynergia, and many have visceral hypersensitivity

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