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الناقل : elmasry | الكاتب الأصلى : dr_heba | المصدر : sayadla.com


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 &centrally)
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. GO UP
 
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 . GO UP
3) Ieft hypochondrium :
-Diagnosis: it may be a) Splenic rupture in history of trauma .
b)Left lower lobe pneumonia.
-Treatment: refer to sp Doctor. GO UP
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….. GO UP
6) Right iliac fossa :
Diagnosisa)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. GO UP
7) Left iliac fossa :
-Diagnosis :a)irritable bowel disease
-clinical picture pain most commonly associated with digestive disorder .
-Treatment : an:: Manqol.com ::ti spasmodic for colon.
* Colona - * cloxid - * colospasmin forte (tablet before meal 3 t.d.s)
b) Ectopic pregnancy:
-as mentioned before……. GO UP
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
 
 
 
 **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 ….