Leaning Forward Maneuver Pancreatic Pain

Pain is probably the most important symptom of abdominal disease. Although abdominal neoplasia may be painless, most abdominal disease manifests itself with some amount of pain. Pain can result from mucosal irritation, smooth muscle spasm, peritoneal irritation, capsular swelling, or direct nerve stimulation. Abdominal pain necessitates speedy diagnosis and therapy. When a patient complains of abdominal pain, ask the following questions:

''Has the pain changed its location since it started?'' ''Do you feel the pain in any other part of your body?'' ''How long have you had the pain?'' ''Have you had recurrent episodes of abdominal pain?'' Did the pain start suddenly?''

''Can you describe the pain? Is it sharp? dull? burning? cramping?'' ''Is the pain continuous? Does it come in waves?''

''Has there been any change in the severity or nature of the pain since it began?'' ''What makes it worse?'' ''What makes it better?''

Is the pain associated with nausea? vomiting? sweating? constipation? diarrhea? bloody stools? abdominal distention? fever? chills? eating?''

Have you ever had gallstones? kidney stones?''

If the patient is a woman, ask this question: When was your last period?''

Note the exact time at which the pain started and what the patient was doing at that time. Sudden, severe pain awakening a patient from sleep may be associated with acute perforation, inflammation, or torsion of an abdominal organ. A stone in the biliary or renal tract also causes intense pain. Note acuteness of the pain. Acute rupture of a fallopian tube by an ectopic pregnancy, perforation of a gastric ulcer, peritonitis, and acute pancreatitis cause such severe pain that fainting may result.

It is crucial to determine the location of the pain at its onset, its localization, its character, and its radiation. Commonly, when an abdominal organ ruptures, pain is felt ''all over the belly,'' without localization to a specific area. Pain arising from the small intestine is commonly felt in the umbilical or epigastric regions;for example, pain from acute appendicitis begins at the umbilicus.

After time, pain may become localized to other areas. Pain from acute appendicitis travels from the umbilicus to the right lower quadrant in about 1 to 3 hours after the initial event. Pain in the chest followed by abdominal pain should raise the suspicion of a dissecting aortic aneurysm.

Note the nature of the pain. Pain caused by a perforated gastric ulcer is often described as ''burning'';dissecting aneurysm as ''tearing'';intestinal obstruction as ''gripping'';pyelone-phritis as ''dull, aching'';and biliary or renal colic as ''crampy, constricting.''

Referred pain often provides insight as to the cause. Referred pain is a term used to describe pain originating in the internal organs but described by the patient as being located in

Acute cholecystitis

Figure 17-3 Common areas of referred pain. The dotted area is on the posterior chest.

Angina

Pleuritic pain

Renal colic appendicitis

Acute cholecystitis

Angina

Pleuritic pain

Renal colic appendicitis

Pancreatitis And Shoulder Pain

Splenic infarct

Appendicitis

Splenic infarct

Appendicitis

the abdominal or chest wall, shoulder, jaw, or other areas supplied by the somatic nerves. Pain appears to originate in areas supplied by the somatic nerves entering the spinal cord at the same segment as the sensory nerves from the organ responsible for the pain. For example, right-shoulder pain may result from acute cholecystitis;testicular pain may result from renal colic or from appendicitis. The common sites for referred pain are shown in Figure 17-3. The locations of pain in abdominal disease are summarized in Table 17-2.

The time of occurrence and factors that aggravate or alleviate the symptoms (e.g., meals or defecation) are particularly important. Periodic epigastric pain occurring 1 to 1 hour after eating is a classic symptom of gastric peptic ulcers. Patients with a duodenal peptic ulcer

Table 17-2. Location of Pain in Abdominal Disease

Area of Pain Affected Organ Clinical Example

Table 17-2. Location of Pain in Abdominal Disease

Area of Pain Affected Organ Clinical Example

Substernal

Esophagus

Esophagitis

Shoulder

Diaphragm

Subphrenic abscess

Epigastric

Stomach

Peptic gastric ulcer

Duodenum

Peptic duodenal ulcer

Gallbladder

Cholecystitis

Liver

Hepatitis

Bile ducts

Cholangitis

Pancreas

Pancreatitis

Right scapula

Biliary tract

Biliary colic

Midback

Aorta

Aortic dissection

Pancreas

Pancreatitis

Periumbilical

Small intestine

Obstruction

Hypogastrium

Colon

Ulcerative colitis

Diverticulitis

Sacrum

Rectum

Proctitis

Perirectal abscess

Table 17-3. Maneuvers for Ameliorating Abdominal Pain

Belching Eating Vomiting Leaning forward

Maneuver

Affected Organ

Stomach

Clinical Example

Gastric distention

Stomach, duodenum Stomach, duodenum Retroperitoneal structures

Peptic ulcer

Pyloric obstruction

Pancreatic cancer Pancreatitis

Flexion of knees

Peritoneum

Peritonitis

Flexion of right thigh Flexion of left thigh

Right psoas muscle Left psoas muscle

Appendicitis Diverticulitis have pain 2 to 3 hours after eating or before the next meal. Food tends to lessen the pain, especially in duodenal ulcers. Perforation of a duodenal ulcer to the pancreas may produce backache, simulating an orthopedic problem. Nocturnal pain is a classic symptom of duodenal peptic ulcer disease. Pain after eating may also be associated with vascular disease of the abdominal viscera. Patients with this condition are older and have postprandial pain, anorexia, and weight loss. This triad is seen in abdominal angina resulting from obstructive vascular disease in the celiac axis or the superior mesenteric artery. Table 17-3 summarizes the important maneuvers for ameliorating abdominal pain.

Managing Diverticular Disease

Managing Diverticular Disease

Stop The Pain. Manage Your Diverticular Disease And Live A Pain Free Life. No Pain, No Fear, Full Control Normal Life Again. Diverticular Disease can stop you from doing all the things you love. Seeing friends, playing with the kids... even trying to watch your favorite television shows.

Get My Free Ebook


Responses

  • matta
    Why pancreatitis pain decrease on leaning forward?
    1 year ago
  • vincent
    Why there is relieve in pain in bending forward in pancreatitis?
    1 year ago
  • luciano
    Why pancrestic pain relieved on stooping forwsrd?
    12 months ago
  • franziska
    Why bending forward relief pancreatic pain?
    11 months ago
  • Pirkka
    Can peritonitis pain be releived by leaning forward?
    10 months ago
  • rosina
    What disease condition that leaning forward relieve abdominal pain?
    8 months ago
  • keith
    Why pain is relieved by bending forward in pancreatitis?
    4 months ago

Post a comment