The window of severe illnesses | Abdominal pain thinks that eating bad stomach, who knows that it is almost possible ...

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Guard the life oasis and care for health with your heart. The "Window of Severe" column is a science popularization column opened by the Department of Critical Medicine of Guangdong Provincial Hospital of Traditional Chinese Medicine. It regularly pushs you the knowledge of critical critical illness and unveiled the mysterious veil of intensive medicine.

Mr. Chen, 57, suddenly felt that his stomach was painful and thought that he had eaten the wrong thing, so he didn't care too much. After finding some stomach medicine, he didn't pay much attention after soothing. Later, the stomach became more and more painful, swollen, and vomiting. On the third day, Mr. Chen even had a conscious blurring symptoms.

Mr. Chen's family members urgently called ambulances to the emergency treatment of Guangdong Provincial Hospital of Traditional Chinese Medicine. After taking CT, the problem was very serious. It turned out that intestinal obstruction occurred. After the surgeon's consultation, he clearly told his family members to perform emergency surgery immediately. It was found that Mr. Chen's sigmal colon was severely adhered and obstructed, so that the intestinal necrosis was severe, and the infectious shock occurred, and it was sent to ICU monitoring treatment after surgery. After a week of nervous rescue and treatment, Mr. Chen was finally out of danger and was discharged smoothly.

Abdominal pain is a very common symptom of clinical practice. The cause is very complicated. Common gastroenteritis, and even colds can accompany the symptoms of abdominal pain. Many people often ignore the harm of abdominal pain.

The cause of the cause of traditional Chinese medicine believes that the invasion of the cold evil and staying the meridians are the main cause of pain. In addition, wind, heat, humidity, dryness, qi inverse, insect accumulation, food accumulation, congestion, insufficient qi and blood can cause abdominal pain. The "Nei Jing" reminds the theoretical views of "no pain" and "unwilling to pain". "Suwen · Pain Theory" pointed out that the meridians are more popular, the circular is endless, the coldness is too late, the cry is not good, the guest is less blood outside the pulse, and the guests are unprepared in the pulse, so they are painful. "Golden Main Thinking" is full of cold hernias. The cure of the disease is cured. Tenth: The sick person is full, and the pain is not painful. The yellow tongue is yellow. Chinese medicine has a long understanding of abdominal pain.

Most abdominal pain is caused by abdominal organs and abdominal wall diseases, and a few can be caused by the thoracic organs and systemic lesions. Among them, acute abdominal disease, severe condition, rapid changes, and intricate clinical manifestations are clinically critical and critical.

So, what diseases are caused by common abdominal pain?

1. Infectious diseases of inflammation

1. Acute appendicitis

First of all, the middle and upper abdomen continuous pain. After a few hours, metastatic right lower abdominal pain is the characteristic of acute appendicitis abdominal pain, accounting for about 70%-80%. It can be accompanied by nausea, vomiting or diarrhea. Election.

2. Acute gastroenteritis

There is a history of unclean diet, the abdominal pain above the abdomen and the surroundings of the umbilical umbilical, often with continuous pain with paroxysmal, accompanied by nausea, vomiting, diarrhea, abdominal distension, and fever may also occur. In severe cases, dehydration may occur.

3. Acute pancreatitis

Most of the history of gallstone disease often occurs after overeating or alcoholism. The upper abdomen is persistent pain and radiates to the back of the waist. Patients with severe illnesses have spread rapidly to the whole abdomen, often fever, and early syndrome of shock or multi -organ functional incomplete syndrome.

4. Acute cholecystitis, gallbladder embedded and acute obstructive purulent cholangitis

Acute cholecystitis, often develops after diet in fat, continuous pain in the right upper abdomen, radiation to the right shoulder, is mostly accompanied by fever, nausea, vomiting, but generally no jaundice; It can cause the upper abdominal arranged colic, radiate to the back of the right shoulder, and may have jaundice; acute obstructive purulent cholangitis often has a history of recurrence of the right upper abdominal pain. Typical people often have Charcot triple diseases: abdominal pain, cold war, high fever and high fever and high fever and high fever Jaundice can be accompanied by nausea and vomiting. Severe acute cholangitis often manifests as REynOLDS five united diseases: abdominal pain, cold war, high fever, jaundice, toxic shock and conscious disorders.

Second, organic disease

1. Acute intestinal obstruction

Features of pain, vomiting, swelling, and closure. Children are mostly caused by intestinal tapeworms, intestinal cases, etc., and adults are mostly caused by hernia embedded or intestinal adhesion, while the elderly are caused by intestinal tumors. Small intestinal stalks block abdominal pain in the umbilicus, which shows a defamination colic, accompanied by nausea, vomiting, abdominal distension and stop defecation and exhaust. Cereal obstruction often has abdominal distension and anal stop defecation exhaust. Common causes are colon cancer, intestinal cover and intestinal twisting.

2. Acute digestive tract perforation

The upper abdomen has severe pain, such as cutting samples, sustainability, and rapid spread to the whole abdomen in the short term, which may have nausea, vomiting, and fever. With bleeding, there can be vomiting or black. Pentoma obstruction can vomit and stay overnight.

3. Abdominal organs rupture

It is often caused by abdominal trauma. The cavity organ rupture such as the intestinal tube rupture or the substantial organ rupture such as liver and spleen rupture. Liver cancer lesions can rupture due to external force or spontaneous rupture. Suddenly, persistent abdominal pain involves full abdomen, often accompanied by shock.

Third, vascular disease

1. Intestinal membrane dynamic vein embolism or thrombosis

Patients with arterial embolism mostly have a history of heart disease (myocardial infarction or atrial fibrillation), urgency of onset, severe abdominal pain, accompanied by nausea and vomiting, which is characterized by severe symptoms and mild signs: with intestinal necrosis and peritonitis In the development of the abdomen, the abdomen has obvious tenderness, reflex pain, and abdominal muscle tension and other peritoneal stimulation signs, and the intestinal sounds have weakened or disappeared. Those who have venous thrombosis have more liver medical history or surgery, and the onset of onset is slow. It is manifested as abdominal discomfort, constipation or diarrhea. After a few days or weeks, severe abdominal pain, persistent vomiting, diarrhea and blood and water samples compare with comparison. Arterial embolism is more common.

2. chest, abdominal aorta propyl layer

Patients have a history of hypertension. They are manifested in continuous pain in the chest or abdomen. They are unbearable. They are cut or torn pain. Patients often show shock signs such as pale skin, sweating, surrounding purple maggots, but blood pressure is still higher than normal, and can be accompanied by lower limb arteries ischemia or even paraplegia. 3. Abdominal aortic rupture

Senior patients who are often 60-70 years old are called "silent killer". The onset process is relatively concealed. As the aortic continues to expand, the tumor continues to increase, and the risk of rupture is gradually increasing. Once the tumor is ruptured, the mortality rate is as high as 80%. Typical clinical manifestations are: strict pain on the abdomen and back of the back, and the symptoms such as combal lumps, gastrointestinal compression, hypotension or shock can be touched under the umbilical or sword process.

Fourth, gynecological disease

In acute abdomen, special groups, such as women, should pay attention to the following diseases.

1. Acute pelvic inflammation

Most of the women in childbearing age. It is manifested as persistent pain or diffuse abdominal pain in the lower abdomen. When the menstrual or menstruation is just stopped, it can be accompanied by nausea, vomiting, frequent urination, urgency, and dysuria. Poor abdominal tenderness or muscle tension, reflective pain.

2. Extracealation of pregnancy rupture

Those who have menstruation for more than 6 weeks or months of childcare age have suffered pain in the lower abdomen, often showing continuous pain, a small amount of vaginal bleeding, and often shock.

3. Ovarian luteum rupture

Two menstrual pain in the middle period of menstruation is more common in the lower abdomen of the lower abdomen, which is more common in fertility. The luteal breakdown due to direct or indirect external force, such as sexual life, increased abdominal pressure. Specific diseases, a large number of blood loss occurred, dizziness, dizziness, dizziness, decreased blood pressure, and cold limbs.

4. Chocolate cyst rupture

Speed ​​and severe abdominal pain during menstruation or recent periods, accompanied by nausea, vomiting, etc., peritoneal stimulation is positive. There is fever, but no blood pressure decreases and shock. Patients often have a history of ovarian chocolate cysts, irregular menstruation and dysmenorrhea history.

5. Ovarian cyst twists

A woman with a history of ovarian cysts has a strenuous colic of the lower abdomen on one side, with tenderness and reflection pain. Frequent nausea, vomiting and even shock.

5. Other diseases

1. Urinary tract stones

The ureteral stones were back pain at first. When the stones moved to the remote ureter, the pain would also move to the lower abdomen, or left or right, often suddenly occurred, showing a fertility colic, which can radiate to the perineum. Male patients may have testicular reflection. pain. Pain seizures are often accompanied by hematuria.

2. Acute myocardial infarction

Symptoms of acute myocardial infarction and acute pericarditis can sometimes be manifested as abdominal pain. The part of myocardial infarction, such as on the diaphragm, especially those with large area, mostly have upper abdomen pain, which is more common in middle -aged and elderly people. Its pain is mostly tired, tense or after a full meal. Radiation in the inside of the arm. It is often accompanied by nausea and shock may occur.

3. Diabetic ketone acid poisoning

In the early stage of diabetes, diabetonal acid poisoning was a special manifestation of acute abdominal pain. Diabetic ketone is acute and mortality in the disease and high mortality. In addition to abdominal pain in the initial period, it is mainly weak, nausea, vomiting, appetite, more diaphragm, deep breathing, rotten apple flavor in the exhalation, accompanied by headaches, accompanied by headache Symptoms such as irritability and drowsiness. When the condition is further developed, severe dehydration symptoms will occur. In the late stage, all kinds of reflexes were slow or even disappeared, and eventually coma. Patients with diabetes, especially patients with type 1 diabetes, if abdominal pain occurs, first consider whether keto acid poisoning occurs.

There is no trivial matter of abdominal pain. When the symptoms of abdominal pain are severe, persistent or unable to relieve, it is recommended to see the consultation in time to avoid delay and treatment.

Kong Yongjie

Indications, Master of Medicine

Good at: acute myocardial infarction, coronary heart disease, heart failure, Chinese and Western medical diagnosis and treatment, interventional treatment, arrhythmia, Chinese and Western medical treatment and pacemaker implantation, ECMO treatment and hemodynamic management, respiratory failure, severe infection, multi -organ dysfunction, multi -organ dysfunction, multi -organ dysfunctional disorders Care and treatment of critical illness such as syndrome.

Supply: Discipline of Critical Medicine, Dade Road General Hospital of Guangdong Provincial Hospital of Traditional Chinese Medicine

Executive editor: Wu Yuan Tuan

Audit school pair: Zhuang Yingge

Editor in charge: Song Liping

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