abdominal colic diagnostic and management

Colicky abdominal

INTRODUCTION

Before discussing the pain of colic, will be presented in advance of abdominal pain in general. Abdominal pain resulting from the three channels, namely (Mahadevan, 2005):

• Abdominal viscera
Usually caused by distension of hollow organs or the tension in the capsule of solid organs. A rare cause of ischemia when the network is experiencing congestion atau inflamasi to sensitasion end visceral nerve pain and lower pain threshold. Pain inisering an early manifestation of a disease or discomfort a sense vague until the colic. If the organ is engage affected by peristaltic movements, the pain is often intermittent described as, cramps or colic.

• In this pain, bilateral pain due to nerve fibers, not myelin and entering spinal cord at varying levels, the viscera and abdominal pain is usually felt dull, hard to be localized and felt the middle body. Pain comes from the region of the abdominal viscera are referring origin of the embryonic organ. Foregut structures such as the stomach, duodenum, liver, biliary tract and pancreas produce upper abdominal pain, often perceived as pain epigastric region. Midgut structures such as the jejunum, ileum, appendix, and ascending colon causing pain periumbilikus. While the structure of the hindgut as the transverse colon, genitourinary system kolon desendens and cause lower abdominal pain.


• Abdominal pain parietal (somatic)
Parietal or somatic abdominal pain resulting from ischemia, inflamasiatau tension of the parietal peritoneum. Afferent nerve fibers that transmit pain stimulus bermielinisasi to the dorsal root ganglion and at the same dermatomal of origin of the pain. For this reason Yeri parietal  this is in contrast with visceral pain, can often be painful stimuluslocalized to the homelands. Is perceived to be a sharp pain, like a knife wound and survive; coughing and movement can trigger pain it. These conditions resulted in signs of physical examination can be searched delicate flavor, guarding, rebound pain and stiffness padaabdomen are palpable. Clinical presentation of appendicitis can of pain visceral and somatic. Pain in early appendicitis pain often in the form of periumbilikus (viscera), but localized in the region of the right quadrant bawahketika inflammation spreads to the peritoneum (parietal).

• Referred pain
Referred pain is pain that is felt at a distance from the diseased organ. This pain is produced from neuronal pathways afferent central terbagiyang from different locations. Examples are patients with pneumonia may experience abdominal pain due to neuron T9 distribution divided by the lungs and abdomen. Another example is the epigastric pain associated with myocardial infarction, pain in the shoulder associated with irritation of the diaphragm (eg, splenic rupture), nyeriinfrascapular pool associated with the disease and testicular pain associated with urethral obstruction.


Colicky abdominal pain

DEFINITION

Colicky abdominal pain is a pain in the form of intermittent severe attacks that can be localized and felt like a sharp feeling. The mechanism of this pain is due to either partial or total obstruction of hollow organs which contain smooth muscle tissue or organ involved is influenced peristalsis.
Classification of colicky abdominal
Classification based on etiology of some of them:

DIGESTIVE SURGERY SERIE : APPENDICITIS (SIGN, SYMPTOMS, ETIOLOGY, DEFINITION, DIAGNOSIS AND MANAGEMENT)

Appendix Definitions
Appendix appendix is ​​called an organ found in the cecum located in the proximal colon, a hitherto unknown function.

Anatomy
Appendix is ​​a tube-shaped organ with a length of approximately 10 cm (range 3-15 cm) and stem from the cecum. The appendix has a narrow lumen of the proximal section and wide in the distal. At birth, short and wide dipersambungan appendix with the cecum. During the children, growth is usually rotates into the intraperitoneal retrocaecal but still. At 65% of cases, the appendix is ​​intraperitoneal. It is possible to move the position of the appendix and the motion depends on the length of mesoapendiks lynchings. In the remaining cases, the appendix lies peritoneal, which is behind the ascending colon, or the lateral edge of the ascending colon. Clinical symptoms of appendicitis are known by the location of the appendix. In the appendix there are 3 tanea dipersambungan caecum coli are fused and can be useful in indicating where to detect the appendix. The position of the appendix is ​​most Retrocaecal (74%) and then following the Pelvic (21%), Patileal (5%), Paracaecal (2%), subcaecal (1.5%) and preleal (1%).

Appendix diperdarahi by apendicular arteries that branch from the bottom of the arteries ileocolica. Artery appendix includes end arteries. The appendix has more than 6 lymph channels leading to obstruct mesoapendiks ileocaecal lymph nodes.

Respiratory management with intubation for emergency personnel (SURGERY)

Chapter I

INTRODUCTION

Since the surgery, the medical community has actually attempted to perform acts of anesthesia aims to reduce and eliminate pain or pain. (Anonymous, 1989) In principle, a patient will be unconscious to perform actions that are performed physical such as hitting, choking, and so forth. It had to be done so that the patient does not feel pain, and finally jumped off the table which resulted in disruption of the proceedings of operation. (Anonymous, 1986).
Since the introduction of ether gas usage by William Thomas Greene Morton in 1846 in Boston United States, then gradually in ways that physical violence is often done to achieve a state of anesthesia becoming obsolete. Discovery was a turning point in the history of surgery, because it opens up the possibility of surgical horizons broader, easier and humane. (Anonymous, 1986).
In an operation, a surgeon can not work alone in dissecting patients while creating a state of anesthesia. Required the presence of an anesthetist to seek, handle and maintain a state of anesthesia the patient. The job of an anesthesiologist in an operating event include:
A. Relieve pain and emotional stress during the process of doing surgery or other medical procedures.
2. To manage common medical measures to the patients operated, keeping the functions of the organs of the body goes in the normal range so that patient safety is maintained.
3. Create the best possible operating conditions so that the surgeon can perform their duties easily and effectively.

One business that absolutely must be performed by an anesthesiologist is to maintain the functioning of organs in normal patients, with no significant effect due to the surgical process. Airway management became one of the most important part in an act of anesthesia. Because some of the effects of drugs used in anesthesia may affect the state of the airway goes well.

One attempt to maintain the patient's airway with endotracheal intubation action, namely by inserting a tube into the upper respiratory tract. Because the main requirements that must be considered in the general anesthesia is to keep the airway and breathing are always free to run smoothly and orderly. In fact, according to Halliday (2002) use of endotracheal intubation is also recommended for neonates with complicating factors that can interfere with the airway. This paper will elaborate on endotracheal intubation, and will only be limited to the issue.
Chapter II
Anatomy and Physiology


2.1 Anatomy - Upper Respiratory Physiology.

            Endotracheal intubation in action we must first understand the anatomy and physiology of the upper airway where intubation was installed. In the discussion of the anatomy and physiology, the authors will elaborate on some matters relating to the physiology of the oropharynx cavity, naso pharynx and some will be more emphasized in the larynx.
Human respiratory system has a picture of a common design that can be attributed to a number of important activities. This system would essentially consist of surface respiration and branched into conducting passages that make up the respiratory tree. Surface respiration is an area of approximately 200 m2, and forming something very thin, moist barrier to air and blood capillaries surrounding the millions of bags called alveoli that eventually form a mass of lung (Williams, 1995: 1630).

2.2 Internal and External Respiration

            Respiration is a combination of physiological processes in which oxygen is inhaled and carbon dioxide released by cells in the body. This is an important process of gas exchange. Respiration is divided into two phases. The first phase of external expiratory in the same sense with breathing. It is a combination of movement and skeletal muscle, where the air for the first time pushed into the lungs and then removed. These events include the inspiration and expiration. Phase to another is internal respiration which includes transfer / movement of the molecules of the respiratory gases (oxygen and carbon dioxide) through the membrane, fluid displacement, and the cells of the body as needed.

2.3 Respiratory Organs

Respiratory tract include: (a) nasal cavity (b) of the larynx (c) trachea (d) bronchi (e) lung and (f) pleura. Pharynx has two functions: to the respiratory system and digestive system. Some of the muscles involved in breathing process. The diaphragm is the most important respiratory muscle in addition to the internal and external muscular intercostalis some other muscles.

DIAGNOSTICS APPROACH TO ACUTE ABDOMEN

INTRODUCTION

To understand the meaning of the term "acute abdomen" indicating that an abnormality nontraumatik spontaneous and suddenly the main manifestations in the abdominal region with the main symptom is usually pain. may require operative measures when more than 6 hours duration .. Because usually the cause of intra-abdominal abnormalities are progressive, it is not good late in the diagnosis and treatment because of worsening outcomes.
Step approach to patients with acute abdominal condition must be carefully and thoroughly. Allegation of suspected acute abdomen should remain even if patients only have mild symptoms and atypical. History and physical examination performed to find probable cause and directs the option to set the primary diagnosis. A clinician then decides if the observation at the hospital to ensure that if additional inspection is required, if the initial surgery is indicated, or if the treatment is more operatif.
Obligation of the clinician must carefully identify the onset of symptoms of the most common cause of general acute abdomen. What's more, they must recognize the specific symptoms of the disease in endemic areas and where they practice.
Common cause of acute abdomen
A. Gastrointestinal tract
- Abdominal pain nonspecific
- Appendicitis
- Obstruction of the small intestine and colon
- Perforation of the peptic ulcer
- Hernia inkarserata
- Perforation of the intestine
- Diverticulitis

2. Liver, spleen and gall
- Acute kolesistisis
- Acute kholangitis
- Liver Abscess
- Acute Hepatitis
- Infrak spleen
3. Pancreas
- Acute pancreatitis
4. Urinary tract
- Renal colic
- Acute pyelonephritis
5. Gynecology
- Acute salpingitis
- A ruptured ectopic pregnancy
6. Vascular
- Acute ischemic colitis
- Mesenteric thrombosis
7. Peritoneum
- Intra-abdominal abscess
- Peritonitis tuberculosis
8. Retroperitoneum
- Bleeding retroperitoneum

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