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1)Epigastric pain :
-Diagnosis
:
it may be
A)Acute gastritis - peptic ulcer – esophageal reflux .
-Clinical
picture
patient complain
is pain in epigastrium related to meal & usually associated
with vomiting &burning pain after meal.
-Ask about:
taking (NSAID -
smoking - spicy food ).
-Advise :
avoid spicy &heavy meals - stop smoking -little use of
NSAID& take it after meals.
Avoid sleep
directly after meals.
-Emergency
treatment ;
1)Anti spasmodic
ampoule *Visceralgine (act
peripherally )
*Buscoban (act peripherally
¢rally)
2)H2-antagonist
ampoule *Zantac.
N.B :we
use ampoule for rapid relief of pain &we can mix safely
*visceralgine &*zantac.
-Treatment :
1)H2-antagonist
-Rantidin (*Ranitak150mg)
one
tablet twice daily.
2)proton pump inhibitor
-Omeprazole (*Napizole
20mg) capsule twice daily.
Withdrawal of dose after one or two weak to one
capsule daily.
3)Dompridone
-*Motilium
(tablet before meal 3 t.d.s ) for gastric reflux
.
B)Pancrititis :
-Clinical
picture
patient with
sever pain &has specific position (Lying forward).
-Treatment:
refer to sp. Doctor.
C)Myocardial infraction or Angina Pectoris
-Clinical
picture :
Sever chest pain
in left shoulder arm &jaw radiating to
epigastrium&retrosternal, associated with sweating &vomiting
.
-Ask about :
history of cardiac disease
-Emergency
treatment :
Nitro glycerine
(*Dinitra 5-10mg) sublingually.
Then refer to sp.
Doctor.
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2) Right hypochendrium:
- ask about : -
history of liver & kidney disease?
-Diagnosis : it may
be
a)biliary
colic
It is a sever colicky
pain which radiating to the right shoulder & scapula and
associated with fatty meal. It's commonly appear in forty,
faty , femal ,fair ,fertile (5Fs) and associated with
jaundice in calcular cholecystietis.
·
You
can give as Emergency treatment :
-
*Visceralgine amp (for speedy
recover of pain) .
-
Systemic
Antibiotic
à
3rd – generation (cephalosporine) against
bacterial Infection which may cane information. (*cefotax
vial)+ Metronidazole *Flagyl.
-
eff
.granules [*coli – uinal &*
uninal] and advice him to drink large amount of water.
N.B : lab – report about
(salts & Stones & pus cells … ) can help you .
b)
Hepatitis:
clinical picture : dull pain associated with fatigue ,malaise and Jaundice .
treatment
: Refer to Sp.doc
.
c) Right
lower lobe pneumonia
clinical picture:
triad of pneumonia
"fever ,tachypnea &cough"
patient with high
temperature , increased respiratory rate , productive cough.
associated with right hypochondrial pain.
Treatment :
refer to sp. Doctor .
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3)
Ieft hypochondrium :
-Diagnosis: it may
be a) Splenic rupture in
history of trauma .
b)Left lower lobe pneumonia.
-Treatment: refer
to sp Doctor.
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4)
Right&Left flank pain:
- Diagnosis:
Renal or ureteric pain
à
colic pain "agonizing pain" in Right & left flank (Renal
angel) radiating to the groin with suprapupic pain, dysuria,
vomiting, hematouria and fever .
à
Emergency treatment :
·
*visceralgine
ampoule .
·
treatment :
·
Anti
septic : eff – granules (*Coli-
urinal &* proximol) 3 times daily.
·
analgesic
à*
urinex cap 3 times daily
N.B
: urine analysis : Is very Important to
guide you :-
1)
pus cells
:
à
if pus
cells < 30 HPF
*
macrofuran 50 mg cap
/ 6 hrs
*uvamin
retard 100 mg / 12 hrs
à
if pus cells > 30 HPF
(Quinolone – derivative) -*
Ciprofloxacin cap / 12 hr
OR - *Ofloxin
tab . /12 hr
(sulfa–drug) -*Septazole
N.B:
sulfa–drugs don't used with *proximol
eff . to avoid PPT .
2)
crystals : ureat crystals
à
*urosolvin sachets
oxalates
crystalsà*Epimag
eff (act on exogenous oxalates)
*citrocid–mg eff.(act
on endogenous&exogenous oxalates
)GO UP
5)
periumbilical pain :
Diagnosis:
a)small
bowel obstruction:
Ask about
history of vomiting & constipation and abdominal distension
in periumbilical area .
Treatment: you can give anti spasmodic
and refer to sp . doctor
b) other
intestinal infection:
will
be discussed later…..
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6)
Right iliac fossa :
Diagnosis a)Acute
appendicitis
- Right iliac pain start
around umbilicus localized to right iliac fossa with (+ve
Psoas Stretch Sign) , vomiting & fever.
Emergency treatment
: give anti spasmodic ampoule (*
visceralgine)
N.b
:1) don't
give Analgesic as
it mask pain . which may cause rupture without pain
2)
Psoas Stretch Sign:
passive extension or
hyper extension of the hip increases the abdominal pain due
to psoas muscle being in contact with the inflamed appendix.
b)
Ectopic pregnancy :
-clinical picture
: in females with history of amenorrhea, pelvic inflammatory disease &
+ve history of I.U..D vaginal
discharge .
-may be associated with
fever.
Treatment :
refer to sp.doctor.
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7)
Left iliac fossa :
-Diagnosis :
a)irritable
bowel disease
-clinical picture
pain most commonly associated with digestive disorder .
-Treatment : anti spasmodic for colon.
* Colona - * cloxid
- * colospasmin forte
(tablet before meal 3 t.d.s)
b)
Ectopic pregnancy
:
-as mentioned before…….
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8)Suprapupic region :
-Diagnosis : it may be
a) pelvic
inflammatory disease
:
-it is syndrome due to
ascending infection of the vagina , cervix , endometrium or
fallopian tubes & / or contiguous structure .
-Clinical picture :
Acute lower abdominal pain , fever , tenderness in the lower
abdomen associated with vaginal discharge.
-Treatment :
anti inflammatory drug. *Antiflam 50mg
tab. 3 t.d.s.
b) Renal
or ureteric pain :
-Treatment : as mentioned before
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**General Notes :
1)Large Bowel
Obstruction:
à
sever constipation , pain in flanks , fever & general look
is ill .
2)
Diabetic mellitus Abdominal pain :
-in patient with history of
un controlled D.M may cause Acute abdominal pain ….
References :
-MRCs systemic modules .
-Blue prints in obsteritics
&Gynecology.
-Bily &Loves.
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