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Pain

Department of Physical Diagnostics


1st Teaching Hospital
Key Notes in Interviewing of Pain

• Sites
• Character
• Causes
• Duration
• Radiation
• Accompanied symptoms
• Relaxing factors
Abdominal Pain
Causes of Abdominal Pain
• Diseases of abdominal organs
– Acute: inflammation, fracture, obstruction,
perforation, torsion, embolism
– Chronic: inflammation, viscera enlargement,
obstruction, ulceration, torsion, tumor
• Diseases of extra-abdominal organs
– Thorax diseases: referred pain, pneumonia,
pleuritis, myocardial infarction
– General diseases: uremia, lead intoxication,
hematoporphyria, Henoch-Sch Ö nlein purpura
Clinical Features

• Sites: related to location of the pathological


changes
• Characters: lancinating, drilling, burning,
colic
• Onset: continuous, paroxysmal, intermittent
• Radiation
• Factors triggering or relieving pain: meal
Common Diseases
– A 35 year old man
suffered abdominal
pain after a dinner.
The pain was initially
localized around the
umbilicus, and later
on shifted to the
right iliac fossa. The
patient felt nausea
and vomited. T: 37.7

Case 2:
• A man aged 23 years suffered from periodical
burning pain in epigastrium for 2 months. The
pain got severe after meal or at midnight and
could be relieved by antacid. 6 hours ago the
patient experienced severer pain and
hematemesis after ingested one tablet of aspirin
because of common cold.
• The former patient had some food,
trying to relieve the pain but it didn't
work. 12 hours later he developed
outburst acute severe lancinating
pain in epigastrium and even couldn't
move his body or have deep breath.
• An 82-year-old man developed
cramping abdominal pain for 3
days just before the spring
festival. He ate nothing, and
could’t drink because of vomiting.
He had obstipation
for 5 days.
Ureter Calculi
• A 35-year-old man had
recurrent left abdominal
pain for half a year. The
pain lasts for about 2
days and relieves. The
pain referred to the left
groin area and is
accompanied by
hematuria
Acute pancreatitis  
• A 42-year-old heavy-drinker
developed continuous,
paroxysmally enhanced
severe pain in umbilical
region after a drinking. The
patient had no history of
peptic ulcer or gallstone……
Chest Pain
Causes

Esophagus

Chestwall

Pleura
Mediastinum

Lung

Heart
subphrenic
• A 65-year old man developed chest
pain in the morning for 3 months. The
pain localized in pre-cardial area,
radiating to left shoulder & arm, lasting
for 5 mins and relieved. The patient felt
palpitation and chest distress when the
pain attacked. BP: 160/105mmHg.
• the former patient developed severe
chest pain 6 hours ago when he
enjoyed watching TV of a football
game. The pain persisted, and
couldn't be relieved by nitroglycerin.
BP: 80/60mmHg.
• A ____ old man suffered fever,
cough, left chest pain for 2 weeks.
The pain was lacerating, and the
patient might feel better when he
hold his breath.
Dyspnea
Causes
• Pulmonary:
– Inspiratory
– Expiratory
– Mixed
• Cardiac
• Toxic
• Other:
– Hysterical
– hemopathic
Pulmonary Dyspnea
• Inspiratory dyspnea
• Mechanism: narrowing of larynx
or large airway
• Features:
– Difficult in taking in air
– Prolonged inspiration phase
– May be accompanied by “three
depressions sign” and stridor in
inspiration phase
Pulmonary Dyspnea
• Expiratory dyspnea
• Mechanisms:
– Decreased elasticity of the lung tissue
– Narrowing of bronchiole
– Bronchioles are pressed in inspiration
phase
• Features:
– Difficult in expirate
– Prolonged expiration phase
– Too much air trapped in the lung
Pulmonary Dyspnea
• Mixed:
– Mechanisms:
• Generalized lesion in the lung
• Restricted dilatation of the alveoli due
to the thickness of the chest wall and
pleura
– Features:
• Difficult in inpirate and expirate
• Tachypnea
• Abnormal breath sounds or adventitious
sounds
Cardiac dyspnea
• Mechanisms:
– Congestion and decreased compliance
of the lung mainly due to left heart
insufficiency
• Features:
– Worsen by exertion, relieved by rest
– Nocturnal paroxysmal dyspnea
– “Cardiac asthma” : large amount of pink
frothy sputum, fine rales in both lung
fields, relieved by sitting position
Nocturnal Paroxysmal dyspnea
Hemoptysis and hematemesis
Definitions
• Hemoptysis: the
expectoration of any blood
• Hematemesis: efflux of
blood from the GI
tract(usually bright red or
“coffee-ground” material is
vomited)
Differences Between Hemoptysis and
Hematemesis
Hemoptysis Hematemesis
Causes Heart or lung dis. Gastrointestinal , hepatic,
biliary tract dis.
Pre-bleeding Itching in the throat, Discomfort in the upper
abdomen, nausea, vomitting
symptoms cough
bleeding Bright red Coffee-ground, dark or
bright red
Material in blood Sputum Food residue
pH alkaline acid
melena No (unless blood is Yes
swallowed)
Sputum after Blood streaked No
bleeding

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