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7/30/2019 Durerea Partea 2 -2012
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Dureri toracice
Parietale (cutanate, sc, musc, art, osoase, nervoase,sin)
Cardiace
Vasculare
Pleuro-pulmonare
Gastrointestinale
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Durerile toracice de origine
cardio-vasculara
Durerea cardiaca
Ischemica Istoric Heberden 1768; Herrick 1912 IM
Mecanism Caractere comune; specifice tipurilor de ischemie
Durerea pericardica Inf, neo, LES, IMA etc
Durerea aortica (DAo, AA, aortita)
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DAo
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Durerea din DAo
I mare, max de la inceput
Sfisietoare
Sediu migrator
Fenomene vegetative
+/- febra, ischemie acuta, semne neurologice,
dispnee
Istoric de HTAPosibila asociere intre Dao si IMA!!!
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Dureri toracice de origine
pleuro-pulmonara
Structuri inervate: Tr, bronhii princ, pleuraparietala
Pleuralapleurezii, ptx, T, fracturi costale Parietala - n ic
Diafragmatica n frenic trapez,
supraclavicular
Traheobronsica
traheobronsita, CS, Tcaractere
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Alte dureri toracice
Gastrointestinala
Esofagiana Odinofagia CS, caustica,medic, EDS,
T,inf, irit cr
Pirozis BRGE, RT, PCT
Spasm esofagian
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Durerea abdominala -1
Parietale somatice superficiale
Peritoneala - somatica profunda
Digestive Urogenitale
Iradiate - IMA, pleurezie
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Durere viscerala vs durere somatica
D viscerala D somatica
Origine Org cavitare/ capsula orgparenchimatoase
Peritoneu parietal, perete
abd
Localizare
Mediana/simetric, prost
delimitata
Circumscrisa, asimetrica
Conducere N splanhnici bilat Ff senz segmentare unilat
Trigger Spasm, distensie, tractiunemezenterica
Leziune tisulara (iritatie,
inflam, inf)
Caracter Crampa, rosatura, arsura Vie, acuta, intensa
Simpt asoc Agitatie, greata, voma,transpiratii
+/- febra
Ameliorare Agitatie, aplecare inainte etc. Imobilizare
Agravare repaos Miscare, tuse, stranut
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Durerea peritoneala
bine delim generalizata
I mare
accentuata la miscare, palpare
contractura abdominala
fenomene vegetative, +/- febra
Iritatii, inflamatii, infectii
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Durerile abdominale -2
Digestive
Gastroduodenale - ulcer; dif g/d, ulcer complicat (Boas)
Intestin Subtire
Gros
Biliara Pancreatica
Ficat/splina
Apendicita acuta
Colon iritabil, sdr Konig
CAD, saturnism
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Durerea din ulcer
Ulcer duodenal
- mica/ marea periodicitate
- caracter, pozitie, ameliorare
- creste G
Ulcer gastric
- caracter, pozitie, ameliorare
- scade G Modificarea caracterului D (lipsa periodicitatii, irad in
vertebra T10) complicatii
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Durerea intestinala
Colica intestinala Inf, toxiinfectii, ischemie, obstructie
- crampe (< 2 min ) la intervale de 3-5 min, mezogastric- greata, varsatura+/- diaree, febra
- ameliorare Q, apasare
D colonica din sdr subocluziv (Konig) Obstacol incomplet
- colica cu debut in loc fix, I progresiva
- ameliorare: defecatie, emisie de gaze, zg intest maiintense
D din colonul iritabil tot cadrul colic, I medie, constipatie-diaree, stress, schimbare de regim
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Durerea din apendicita acuta
Colica
Debut periombilical/ epigastric(viscerala)
FID (somatica) generalizare (peritonita)
Sb-it la palpare (pct McBurney si in FIS -Rovsing)si decompresie (tardiv)
Febra, greata, varsaturi, constipatie/diaree
Variante: - subhepaticHD Retrocecal lombar, fara ss peritoneale
Pelvin suprapubian
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Saturnismcolici severe, constipatie, anorexie, varsaturi- tulburari neurologice, anemie, afectare renala
- context
PAI D cont/colicativa severa, varsaturi, constipatie - pareze, parestezii - fara s de peritonita
- declansata de medicamente, alcool, perioperator, infectii,post, postmenstrual
CAD D abd generalizate, greata, varsaturi- neurop senz, deshidratare
- abd sensibil, rigid
- respiratie acidotica
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Colica biliara
Intensa
Epig/HDsubscapular, umar dr
Postprandial, nu se amelioreaza prin varsatura
2-6 h
Greata, varsatura
S Murphy
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Durerea pancreatica
Pancreatita acuta "In bara"
Continua, surda
Medie-severa
Pozitie antalgica Greata, varsaturi
Alcool, pasaj de calcul biliar
Cancer pancreatic
I