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دانشجویان پزشکی 87 کرمان
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دانشجویان پزشکی 87 کرمان

Condition

Usual Pain Characteristics

Possible Associated Findings

Appendicitis

 

Initially  peri umbilicl or epigastric colicky;later becomes localized to RLQ, often at McBurney point

Guarding  tenderness; iliopsoas  and  obturator signs,RLQ skin hyperesthesia an orexia  nausea or vomiting after onset of pain;l ow-grade fever;  Aaron, Rovsing , Markle,and McBurney signe

Peritonitis

 

Onset sudden or gradual pain generalized or localized  dull or severe and unrelenting ; guarding  pain on deep inspiration

Shallow respiration;*Blumberg,M arkle, and  Balance signs; reduced or absent  bowel sounds, nausea  and  vomiting; obturator and  iliopsoas tests

Cholecystitis

 

Severe unrelenting RUQ or epigastric pain; unrelenting  RUQ or epigastric pain ; maybe referred to right subscapular area

RUQ tenderness and rigidity, Murphy sign,palpable gall bladder,anorexia,v omiting,fever,possible jaundice

Pancreatitis

 

Dramatic, sudden, excruciating  LUQ, epigastric,or umbilical pain; may be present in one or both flanks; may be referred to left shoulder

Epigastric  tenderess vomiting,fever,shock; GreyT urner sign; Cullen sign: both signs occur 2 to 3 days after onset

Salpingitis

 

Lower quadrant ,worse on left

Nausea vomiting, f ever,suprapubic tenderness rigid abdomen,pain on pelvic examination

PUD

 

Lower quadrant ,increases  with activity

Tender adnexa and cervix, cervical discharge dyspareunia

Diverticulitis

 

Epigastric  radiating  down left side of Abdomen especially after eating ;may be referred to back

Flatulence, or borygmus ,diarrhea, d ysuria tenderness on palpation

Perforated gastric

or duodenal ulcer

 

Abrupt RUQ; may be referred to shoulders

Abdominal free air and distention with increased resonance over liver ;tenderness in  epigastrium or RUQ; rigid abdominal wall, rebound  tenderness

Intestinal

obstruction

 

Abrupt, severe ,spasmodic re ferred  to Epigastrium umbilicus

Distention ,minimal  rebound tenderness  vomiting, localized Tenderness visible peristalsis bowel sound s absent( with paralytic obstruction)o r hyper active high pitched (with mechanical obstruction

Volvulus

 

Referred to hypo gastrium and umbilicus

Distention, nausea ,vomiting ,guarding   sigmoid loop volvulus m aybe palpable

Leaking abdominal aneurysm

 

Steady throbbing midline over aneurysm; may radiate to back, flank

Nausea vomiting, abdominal mass ,bruit

Biliary stones, colic

 

Episodic severe, R UQ, or epigastrium lasting l5 min to several hours; may be referred to subscapular area, especially right

RUQ tenderness  soft abdominal wall ,anorexia, vomiting, Jaundices ,abnormal temperature

Ectopic pregnancy

 

Lower quadrant referred to shoulder; with rupture is agonizing

Hypo gastric  tenderness symptoms of  pregnancys, potting, irregular Mense , soft  abdominal wall mass  on bimanual pelvic examination; Ruptured :shock ,rigid  abdominal wall, distention; Kehr, Cullen signs

Ruptured ovarian

cyst

 

Lower quadrant ,steady increases with cough or motion

Vomiting ,low-grade fever ,anorexia, tenderness on pelvic examination

Splenic  rupture

 

Intense ;L UQ, radiating to left shoulder; may worsen with  foot of bed elevated

Shock, pallor, lowered  temperature

Renal calculi

 

Intense flank ,extending to  groin and Genitals may be episodic

Fever , hematuria ; Kehr sign

lrritable bowel syndrome

 

Hypogastric pain;crampy ,variable in frequent;Associated with bowel function

Negative physical examination Pain associated with gas ,bloating ,distention ;relief  with Passage of  flatus, feces

Lactose intolerance

 

Crampy pain after eating milk or milk products

Associated diarrhea ;negative physical examination

Diverticular disease

 

Localized  pain

Abdominal tenderness fever

Constipation

 

Colicky or dull  and  steady pain that does not progress and  worsen

Fecal mass  palpables, stool in rectum

Uterine fibroids

 

Pain related to mense  in tercourse

Palpable myoma(s)

Hernia

 

Localized pain that increase  with exertion or lifting

Hernia on physicael xamination

GERD

 

Burning gnawing pain in mid-epigastrium, worsens with  recumbency

Negative  physical  examination

Peptic ulcer

 

Burning or gnawing pain

May have epigastric tenderness on palpation

Gastritis

Constant  burning pain in epigastrium

May be accompanied  by nausea vomiting,d iarrhea,or fever Physicael xamination negative

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