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• 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
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