Left and right lower back pain

Introduction Acute and chronic left and right abdominal pain, accompanied by hematuria is a manifestation of abdominal pain, should be diagnosed with urinary calculi, urinary retention caused by prostatic hypertrophy.

Cause

Etiology classification

According to the etiology, mechanism, nature, degree, condition, system and location of abdominal pain, it can be divided into two categories: general abdominal pain classification and etiology classification.

First, general abdominal pain classification

(1) Classification by cause

1, traumatic

1 intra-abdominal parenchyma and cavity organ traumatic abdominal pain such as liver and spleen rupture, gastrointestinal rupture and contusion;

2 abdominal wall and waist trauma caused by abdominal pain;

3 other causes such as craniocerebral, chest, limbs, genitourinary and obstetrics and gynecology trauma caused by abdominal pain.

2, inflammatory and non-inflammatory

1 inflammatory bio- and chemical-induced abdominal pain, such as acute gastroenteritis, appendicitis, various types of perforation and peritonitis; 2 non-inflammatory abdominal pain such as blood vessels, immunity, endocrine, metabolism and so on.

3, mental and psychological

1 various neurological diseases, spinal cord fistula gastrointestinal crisis, etc.;

2 mental patients such as abdominal rickets, abdominal epilepsy, autonomic disorders, abdominal pain and so on.

(2) Classification by pathogenesis

1, pathophysiological such as intracranial tumor, spinal cord compression and so on.

2, mental and psychological such as abdominal migraine.

(3) Classification by disease

1, acute abdominal pain such as various types of acute inflammation, perforation, rupture, torsion, obstruction, necrosis and so on.

2, chronic abdominal pain such as various chronic inflammation, vascular embolism, tumor, endocrine, parasitic, dysfunction.

(4) Classification by nature

1, mild as slightly pain, dull pain, cramps, soreness, pain, soreness and so on.

2, moderate as sharp pain, tingling, burning pain, cutting pain, top pain and so on.

3, severe as pain, colic, severe pain, explosive pain and so on.

(5) Classification by system

1, the nervous system of the central nervous system, peripheral nerves. Autonomic nerves.

2, cardiovascular system angina, myocardial infarction, pericarditis and so on.

3, respiratory pneumonia, pneumococcal pneumonia, pleurisy and so on.

4, digestive system inflammation, ulcers, tumors, torsion, necrosis and so on.

5. Acute hemolysis, hemophilia, leukemia, etc. in the blood system.

6, endocrine system, diabetic ketoacidosis, hyperthyroidism crisis.

7, urinary system acute glomerulonephritis, pyelonephritis, hydronephrosis, kidney stones and so on.

8, abdominal muscle and soft tissue injury caused by abdominal pain, strain and so on.

9, immune system gastrointestinal urticaria abdominal pain, abdominal allergies, abdominal pain and so on.

10, connective tissue system abdominal rheumatic abdominal pain, lupus erythematosus, hardness disease, dermatomyositis and so on.

(6) According to the part, abdominal pain

1. Somaticity is caused by painful fibers of the somatic nerves. When mechanical, chemical, and inflammatory, such as gastrointestinal, hepatobiliary, pancreatic, and other abdominal pains are more obvious, the positioning is more accurate and the recognition is strong.

2. Visceral is transmitted by the pain fibers of the autonomic nerve.

(1) It is not sensitive to acupuncture, cutting, burning and other stimuli.

(2) It is extremely sensitive to sudden expansion and expansion of hollow organs, smooth muscle spasm, and chemical pain-induced stimuli (widely stimulated by visceral nerve endings)

(3) Chronic, gradual onset of abdominal pain changes are not obvious, such as gallbladder hydrops, hydronephrosis, pancreatic cysts, swelling and pain.

(4) Abdominal pain is transmitted through fine C-type fiber, so the positioning is not accurate, such as appendicitis, cholecystitis and ulcer disease, but most of the pain in the upper abdomen is also more accurate from the embryonic development law to determine the location of abdominal pain, such as stomach twelve Intestinal hepatobiliary pancreas is derived from the foregut in the embryonic stage, so the onset of abdominal pain is mostly in the upper abdomen. The colon of the small intestine to the spleen is derived from the midgut during the embryonic period. Therefore, the abdominal pain is mostly in the middle of the abdomen, the descending colon, the sigmoid colon, and the upper rectum. In the embryonic period stems from the hindgut, so the abdominal pain is mostly in the lower abdomen.

3. Involvement is caused by painful fiber conduction of visceral nerves, and the location of abdominal pain is blurred. However, due to the involvement of abdominal pain (radiation pain), it can also help to locate, in two ways:

(1) Abdominal organ disease: gallbladder pain radiates right shoulder and back", pancreatic pain radiates left waist, spleen pain radiates left shoulder and back, small intestine pain radiates around the umbilicus, ureteral pain radiates groin and inner thigh.

(2) Abdominal diseases: such as right lower lobe pneumonia, pleurisy. Chest diseases such as myocardial infarction are radiated to the abdomen and cause pain.

Second, according to the cause of illness classification

(1) Acute abdominal pain

1. Trauma includes open, closed injury and crush syndrome.

(1) Open injury: sub-cutting (surgical incision) stab wound (knife, needle, nail), abrasion (skin abrasion) laceration (skin, fat muscle, fascia, peritoneal injury) penetrating injury, firearm injury , laceration (such as abdominal wall or waist soft tissue avulsion).

(2) Closed injury: abdominal and parenchymal injuries (liver, spleen, pancreas, intestinal rupture, bruises, retroperitoneal hematoma, etc.) abdominal wall and lumbar soft tissue injury (skin, fat, muscle, peritoneum, etc.) Causes abdominal pain.

(3) Squeeze syndrome: Abdominal pain caused by abdominal ischemia, hypoxia, degeneration, necrosis or hemorrhage, such as abdominal burying, squeezing, and bundling.

(4) Other parts of the injury: such as craniocerebral, chest, urogenital, maternity, lumbar vertebrae and other injuries caused by abdominal pain.

2, abdominal disease

(1) Inflammation:

1 visceral acute inflammation: acute enteritis, acute gastritis, acute gastroenteritis, acute pseudomembranous colitis, acute diffuse hemorrhagic gastritis, active peptic ulcer, acute hemorrhagic necrotic enteritis, acute Crohn's disease or Ulcerative colitis, acute diverticulitis (including duodenum, small intestine, colonic diverticulitis), gastric mucosal prolapse and bleeding, acute gastric dilatation, acute gastric pyloric obstruction, gastric polyps and hemorrhage, gastric tumor and bleeding, acute Simple and suppurative appendicitis, acute abdominal pain in the appendix.

2 acute liver, gallbladder, pancreas, spleen, kidney inflammation: acute liver abscess, acute hepatic congestion or inflammation, subcutaneous appendix (congenital variation) inflammation, intrahepatic bile duct stones obstructing inflammatory hemorrhage, intrahepatic hemangioma rupture, acute gallbladder Inflammation, acute suppurative cholecystitis, acute cholelithiasis cholecystitis, acute balloon cystic cholecystitis, acute gallbladder gangrene, acute biliary ascariasis, gallbladder or biliary bleeding (trauma, inflammation, tumor, vascular disease) typhoid cholecystitis, Acute obstructive suppurative cholangitis, acute pancreatitis, acute hemorrhagic necrotizing pancreatitis, spleen abscess, spleen inflammation, acute pyelonephritis, glomerulonephritis, peri-ureteral inflammation, peri-renal abscess, acute bladder myositis. Acute renal hemorrhage, stagnant water, obstruction, etc.

3 peritoneal and lymphadenitis: acute primary and secondary peritonitis, acute pelvic inflammatory disease, endometriosis, ectopic pregnancy bleeding, acute salpingitis. An acute mesenteric lymphadenitis and the like.

(2) Perforation and rupture of intra-abdominal organs:

1 perforation: ulcer perforation (stomach, duodenum, etc.) gastric cancer perforation, typhoid intestinal perforation, diverticulitis perforation, cholecystitis and cancerous perforation, uterine perforation (valves), gastrointestinal metal foreign body perforation, small intestine and colon cancer perforation , the wrist is wounded and perforated.

2 rupture: liver and spleen and kidney rupture (trauma), bladder rupture (disease, urinary retention), ectopic pregnancy, ovarian tumor rupture, ovarian follicles and corpus luteum rupture.

(3) Acute visceral obstruction and torsion:

1 obstruction: adhesive acute intestinal obstruction, various intra-abdominal stenosis, stag beetle intestinal obstruction, intestinal stenosis obstruction, intestinal foreign body obstruction, neoplastic intestinal obstruction, intestinal stenosis obstruction, intussusception obstruction, biliary ascariasis, Biliary stones. Biliary stenosis, biliary tract tumor, biliary compression, ureteral bladder stones, fallopian tube obstruction, etc.

2 torsion: acute gastric torsion, omental torsion, small intestine torsion, blindness, sigmoid torsion, gallbladder torsion, spleen pedicle torsion, sinus cyst torsion, uterine subserosal pedicle torsion, pregnancy uterus torsion.

(4) visceral acute vascular disease: acute mesenteric vascular thrombosis and embolism, acute hepatic vein thrombosis, acute portal vein thrombosis; spleen infarction, renal infarction, dissection aneurysm, aortic aneurysm, etc.

3, abdominal disease

(1) Chest disease: intercostal nerve pain pleurisy, pulmonary infarction, angina pectoris, right heart left heart failure, acute myocardial infarction, acute occlusive pericarditis.

(2) Metabolic and endocrine diseases: diabetic ketoacidosis, hypoglycemia and insulinoma, pheochromocytoma, hyperthyroidism and hypothyroidism, acute adrenal insufficiency, Addison's disease, hepatic blood Lynn disease, uremia, hyponatremia, hypocalcemia, hypercalcemia, chlorosis, etc.

(3) Neuropsychiatric diseases: herpes zoster, radiculopathy, peripheral neuritis, sciatica, abdominal epilepsy, abdominal rickets, brain tumors and inflammation, autonomic disorders, etc.

(4) Connective tissue diseases: abdominal fibromyalgia, scleroderma, dermatomyositis, progressive muscular dystrophy, systemic lupus erythematosus, nodular polyarteritis, and the like.

(5) Hematological diseases: leukemia, hemophilia, polycythemia vera, thrombocytopenia, lymphoma, acute hemolysis, malignant cell disease, etc.

(6) toxic abdominal pain: chronic lead poisoning, acute sputum poisoning. Mercury poisoning, arsenic poisoning, poisoning into account book poisoning, pituitary vasoside poisoning, acute gasoline poisoning, benzene poisoning, puffer fish poisoning, fish bitter poisoning.

(7) Other diseases: malaria abdominal pain, urticaria, epidemic hemorrhagic fever with allergic purple epilepsy, abdominal pain caused by suppurative panniculitis.

(two) chronic abdominal pain

1, visceral disease

(1) Gastrointestinal tract: chronic gastritis, gastric ulcer, gastroptosis, gastric mucosal prolapse, stomach tuberculosis, gastrointestinal stones, gastric lymphoma. Chronic pyloric obstruction, postoperative gastric syndrome, corrosive gastritis, gastric foreign body, stomach sinusitis, gastric schistosomiasis, duodenal ulcer, tuberculous insufficiency obstruction, diverticulitis, intestinal tuberculosis, intestinal dysentery, infection and ulceration Colitis, chronic Crohn's disease, various intestinal parasitic diseases, localized enteritis, intestinal foreign body, various intestinal congenital lesions, chronic appendicitis, etc.

(2) peritoneum and lymph nodes: tuberculous peritonitis, chronic peritonitis, mesenteric lymphadenitis.

(3) Liver, gallbladder, pancreas, spleen: chronic hepatitis, amebic liver abscess, liver tuberculosis, chronic cholecystitis, chronic gallbladder hydrops, chronic pancreatitis, ectopic pancreas, pseudocyst, pancreatic tuberculosis, spleen inflammation . Spleen tuberculosis, spleen cysts, splenomegaly, etc.

(4) genitourinary: chronic pyelonephritis and glomerulonephritis, renal ptosis, kidney, hydronephrosis, polycystic kidney disease, interstitial nephritis, renal tuberculosis, chronic perirenal abscess, chronic ureteritis, chronic bladder Inflammation, chronic salpingitis, chronic hydrosalpinx, chronic oophoritis, chronic pelvic inflammatory disease, pelvic congestion syndrome, endometriosis, uterine and ovarian tuberculosis, chronic endometritis.

2, abdominal and visceral benign, malignant tumor

(1) Gastrointestinal tumors:

1 gastric polyps, gastric hemangioma, gastric lipoma, gastrinoma, gastric leiomyoma, gastric fibroma, gastric neurofibromatosis, gastric mixed tumor, various sarcoma in the stomach, gastric malignant lymphoma. Gastric cancer, etc.;

2 duodenal, intestinal and colonic benign and malignant tumors. Intestinal adenomas (polyps), leiomyomas, hemangioma, lipoma, lymphangioma, fibroids, schwannomas, ganglionoma, adenocarcinoma, Carcinoid, leiomyosarcoma, liposarcoma, angiosarcoma, lymphosarcoma, malignant lymphoma, Hodgkin's disease, Caber sarcoma, vascular endothelial sarcoma, extravascular sarcoma, fibrosarcoma, malignant neurofibromatosis, malignant schwannomas, Malignant ganglion cell tumors, etc.

(2) Liver, gallbladder, pancreas, and spleen tumors:

1 primary liver cancer, secondary liver cancer, hepatic sarcoma, hepatic vascular aneurysm (sarcoma X hepatic hemangioma, benign liver adenoma, polycystic liver; 2 primary and secondary gallbladder carcinoma, gallbladder adenoma, gallbladder fibroma, nerve Fibroids, leiomyomas, hamartomas, and rare lipomas;

3 pancreatic cancer, pancreatic adenoma, insulinoma, glucagonoma, pancreatic vaso-intestinal peptide, pancreatic cancer, pancreatic true and false cysts in parasitic cysts, hamartoma, vascular tumors;

4 spleen tumors (hemangioma, lymphosarcoma, reticuloma, fibrosarcoma, splenic metastases, splenic aneurysms X spleen cysts.

(3) peritoneal and mesangial tumors: peritoneal cancer (primary less, mostly secondary X pseudotumor, mesothelioma, mixed mesothelioma. Omental true and false cysts, metastatic cancer, etc. Mesenteric Cysts and tumors: mesenteric cysts such as serous cysts, dermoid cysts, new organisms such as cystic lymphangioma, parasitic cysts, traumatic hemorrhagic cysts, inflammatory cysts, etc. Mesenteric tumors: benign tumors such as neurofibroma , fibroids J tumors, leiomyomas, hemangioma, etc.; malignant tumors such as malignant lymphoma, fibrosarcoma, neurofibrosarcoma, leiomyosarcoma J sarcoma, angiosarcoma and so on.

(4) Primary retroperitoneal tumor: 2/3 is a malignant tumor, and benign is rare. Benign tumors such as lipoma, leiomyomas, fibroids, rhabdomyomas, lymphangiomas, lymphomas, hemangioma, angioendothelioma, mesenchymal tumors, schwannomas, neurofibromatosis, ganglioniomas, chromaffin cells Tumor, pheochrome paraganglioma. Various cysts, teratomas, dermoid cysts, chordomas, etc. Malignant tumors such as liposarcoma, leiomyosarcoma, fibrosarcoma, rhabdomyosarcoma, lymphangiosarcoma, lymphosarcoma, reticulum sarcoma. Hodgkin's disease, vascular endothelial sarcoma and cutaneous sarcoma, mesenchymal sarcoma, malignant schwannomas, fibrosarcoma, neuroblastoma, ganglion cell neuroblastoma, malignant pheochromocytoma, malignant stunt cell tumor, fine Protocelloma, chorionic epithelial carcinoma, malignant teratoma, malignant chordoma, undifferentiated carcinoma, sarcoma tumor, etc.

(5) genitourinary tumors: kidney cancer, renal pelvis tumor, renal embryonic tumor, renal hamartoma, renal eosinophilic tumor, renal paragonoma; ureteral papilloma and papillary carcinoma, ureteral solid cancer; Tumors such as papillary tumors, solid cancer, carcinoma in situ; gynecological tumors such as uterine sarcoma, uterine fibroids, uterine body cancer, ovarian cysts, ovarian cancer.

3, visceral vascular disease mesenteric arteriosclerosis, multiple arteritis pleural type, superior mesenteric artery syndrome, abdominal aortic aneurysm, chronic superior mesenteric vein thrombosis, chronic hepatic vein thrombosis, portal venous J occlusive intestinal ischemia. Liver and brand hemangioma.

4, visceral dysfunction, stomach cramps, gastric neurosis, Gongmeng, reflux esophagitis, postoperative gastric dumping syndrome, intestinal fistula, intestinal lipid metabolism syndrome, ulcer indigestion, biliary dyskinesia, brand music Syndrome, gastrointestinal dysfunction, hepatic syndrome and so on.

5, abdominal disease see acute abdominal pain.

mechanism

First, visceral abdominal pain

The peritoneum of the parietal layer is sensitive to physical and chemical stimuli, but the visceral organs and visceral peritoneum distributed by the visceral sensory nerve endings are not sensitive. Such as hollow organ perforation and parenchymal rupture caused by acute peritonitis, abdominal tenderness, rebound tenderness, muscle tension is most obvious, is caused by peritoneal fluid stimulation of the parietal peritoneum; such as gastrointestinal acupuncture, cutting and cauterization (electrical Burning) are not sensitive, but the lumen is inflated, and the abdominal pain is severe when the tension is increased. For example, intussusception, torsion, obstruction, intestinal fistula, etc., colic, and mesenteric traction pain is more significant. Normal appendix does not cause pain in acupuncture, cutting, and burning, while stretching and squeezing are painful. Liver, spleen, kidney, etc. are not seen for cutting, acupuncture, burning, but the pain is obvious when the capsule is exudate, bleeding or pulling.

The uterus is not sensitive to cutting or burning, but uterine contractions and cervical dilatation during labor can cause severe pain. In general, visceral abdominal pain comes from the peritoneum and viscera of the organ. It is caused by the finest fibers of the unmyelinated autonomic nerve, which is slower and sparsely distributed in the peritoneum and viscera of the organ. It is also the starting part. Such as nerve fibers from the lower esophagus, stomach, liver, gallbladder, pancreas, large blood vessels and other organs to the celiac ganglion; fibers from the small intestine, colon to the superior mesenteric ganglion; pelvic organ fibers to the inferior mesenteric ganglion. Visceral pain characteristics:

1 The acupuncture, cutting, cauterization and other irritating pains are not obvious. The pain distribution of the pericardium, part of the mesenteric root and the nerve endings of the leg muscles before and after the fiber distribution is thin. When the abdominal lesions involve the above parts, the corresponding spinal nerves can be used. The distributed skin area produces a painful sensation, which is somatic abdominal pain. Its nerve conduction fibers are mainly composed of myelin A-delta fibers. The characteristics of somatic abdominal pain are sharp and limited, and are consistent with the location of the lesion. The location is clear, and there are local tenderness and abdominal muscle reflex spasm and muscle tension. For example, suppurative cholecystitis with localized upper abdominal gallbladder area localized tenderness, abdominal muscles Rebound tenderness and muscle tension are caused by peritonitis; acute gastrointestinal perforation and intra-abdominal hemorrhage are all such as acute perforation of the stomach and duodenum and acute traumatic hemorrhage of the liver and spleen.

Second, inductive abdominal pain

When the visceral pain fibers are strongly stimulated, the excitation of the visceral nerve to the heart can affect the spinal nerves of the corresponding segment to be reflected in the skin region of the nerve, so that the body surface produces pain, that is, induced abdominal pain (also called radiation pain). Or the relationship between different visceral human nerves and spinal cord segments involved in painful people is roughly determined by Head. For example, the symptoms of inductive abdominal pain are characterized by sharp pain, obvious localization, corresponding skin surface hyperalgesia and abdominal muscle tension related to spinal cord segment. Infected abdominal pain caused by visceral lesions can be radiated to distant body surface, such as cholelithiasis cholecystitis in addition to right upper quadrant pain can occur right shoulder and right upper arm pain, a small number from the liver, gallbladder. Duodenal ligament of the centripetal fiber Radiation pain occurs in the right neck skin area and the right upper arm skin area of the right iliac nerve and the brachial plexus in the right ventricle. The esophageal lesion can be radiated from the posterior sternum to the left supraclavicular fossa and the left axillary fossa; Gastric lesions have radiation pain in the heart and both sides of the abdomen and back; pancreatic lesions radiate to the lower back; ureteral lesions radiate to the lower and lower back, groin, inner thigh Scrotum; rectal lesions pain radiating to the Ministry of dice, perineum and anus.

The above three types of abdominal pain are related to each other. Early visceral lesions are dysfunctional abdominal pain, which in turn aggravates pathological changes in abdominal pain as inductive or somatic abdominal pain. Such as early simple appendicitis is luminal obstruction, mild congestion, edema is visceral abdominal pain with paroxysmal abdominal pain (smooth muscle ischemic to radiation to the upper abdomen or umbilical pain is induced abdominal pain, the location is not clear, if Gradually increase suppuration or gangrene or even perforation, inflammatory pus stimulates the peritoneum of the parietal layer to be persistently aggravated. The signs of peritonitis are somatic abdominal pain, and the right lower abdomen is obviously tender, rebounding and muscle tension, with the weight of the wheat point. The location is clear, so it can be diagnosed.

Third, abdominal pain, psychological behavior changes in the clinical found that there is no organic disease or tissue damage, abdominal pain is gradually increasing, people call "cardiac abdominal pain", or mental factors abdominal pain, actually caused by central nervous system excitation, but with General subjective factors (personality, mood, attitude, experience, mental abnormality, etc.) are related to objective factors (environment, social culture, race, gender, age, occupation, suggestion, etc.). Introverts are poorly tolerant to pain, and extroverts are highly resistant to pain. Patients with mental disorders such as mental snoring, neurosis, and mental depression have abdominal pain, organic fetal disease, psychological abdominal pain, and a complex psychological state.

an examination

Related inspection

Ultrasound examination of urine, routine nephropathy, urine routine

Total gastric acidity determination

Total acidity includes free acids, bound acids, and organic acids derived from food or bacterial metabolism such as lactic acid, vinegar, and acidic phosphates.

Peak gastric acid secretion measurement (PAO) --

The sum of the two measured values with the highest gastric acid content in 4 samples is multiplied by 2, which is PAO. It is directly related to the size of the parietal cell mass.

Maximum gastric acid secretion measurement (MAO) --

After stimulation with pentagastrin gastrin, the parietal cells fully exert their secretory function within 1 hour, and the amount of gastric acid that can be secreted is called MAO.

Determination of gastric free hydrochloric acid --

The free acid is hydrochloric acid, and the combined acid refers to hydrochloric acid which is loosely bound to protein.

Determination of gastric basic gastric acid secretion (BAO) --

The amount of basal gastric acid secretion (BAO) refers to the amount of gastric acid secretion that is continuous with each other in the absence of food or drug stimulation.

Pepsin assay --

The precursor of pepsin is pepsinogen, which is secreted by the main cells of the fundus gland and converted to gastric protease in gastric acid. Determination of pepsin can help diagnose stomach diseases.

Adrenocorticotropic hormone (ACTH) --

Corticotropin is a micro-peptide hormone secreted by the pituitary gland and is a major regulator of adrenal cortex activity.

Luteinizing hormone (LH) --

Luteinizing hormone is involved in promoting ovulation induction by follicle stimulating hormone, promoting the formation and secretion of estrogen and progesterone, promoting testicular synthesis and secretion of androgens.

Serum cortisol (FC) --

Cortisol is produced and secreted by the adrenal cortex and belongs to the corpus callosum glucocorticoids. Its secretion is controlled by the anterior pituitary adrenocorticotropic hormone. The determination of serum cortisol directly reflects the secretory function of the adrenal cortex.

Total protein (TP) --

Serum protein is the most abundant substance in serum solids.

Protein electrophoresis --

Serum proteins are colloidal substances that carry a charge under certain conditions and move in an electric field.

Serum globulin (G, GL0) --

Serum globulin is a mixture of various proteins, including immunoglobulin veneers and complements, a variety of glycoproteins, metal-binding proteins, various lipoproteins, and enzymes. The content of globulin is generally obtained by subtracting albumin from total protein.

Differential diagnosis

Abdominal pain: It is one of the common clinical symptoms, which can be acute or chronic, and its etiology is complicated. Most of them are organic and functional. Most of them are caused by intra-abdominal organ diseases, and can also be caused by extra-abdominal organ diseases. Therefore, comprehensive consideration should be made in the diagnosis, and the medical history and various examination results should be analyzed in detail. The clinical diagnosis of abdominal pain with detailed medical history, detailed physical examination, necessary and auxiliary examination combined with comprehensive analysis of the cause can lead to a more accurate diagnosis.

Low back pain: The pain point indicated by the patient is equivalent to the level of the buttocks area, and a few are in the lower half of the humerus, often accompanied by symptoms of lower abdominal pain. It is aggravated by premenstrual, long standing and sexual intercourse. It is a symptom of the pelvic blood stasis.

1. Pelvic pain, the cervix is purple-blue, the uterus is large and soft, and the accessory area around the palace is soft and tender.

2. B-ultrasound, pelvic venography, laparoscopic examination, pelvic varices can be found.

Diffuse low back pain: one of the symptoms of plasma cells. Plasmacytoma is a primary and systemic malignant tumor originating from the bone marrow. It is derived from B lymphocytes and has the property of differentiating into plasma cells. Isolated solitary cell tumors are rare and can be cured. Among them, multiple plasmacytoma is the most common, characterized by osteolytic lesions and plasma cell infiltration of bone marrow. In addition, often associated with anemia, hyperglobulinemia, hypercalcemia, impaired renal function and predisposition to infection. Clinically, patients with over 40 years of age may have skeletal or diffuse low back pain, fatigue, paleness, and mild weight loss. The possibility of myeloma should be suspected.

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