Conductive abdominal pain

Introduction When the ribs below the 7th rib are fractured, conductive abdominal pain occurs due to stimulation of the intercostal nerve at the fracture.

Cause

Occasionally, due to severe coughing or sneezing, the chest muscles suddenly contract and cause rib fractures, which are called spontaneous rib fractures, which occur in the 6th to 9th ribs of the armpit. When the rib itself has a lesion, such as a primary tumor or a metastatic tumor, a rib fracture may occur under a very light external force or no external force, which is called a pathological rib fracture.

Rib fractures occur mostly in the 4th to 7th ribs; the 1st to 3rd ribs have the protection of the clavicle, scapula and shoulder muscles and are not easy to be injured; the 8th to 10th ribs become shorter and connect to the cartilage rib arch, which is elastic. Buffering, the chance of fracture is reduced; the 11th and 12th ribs are floating ribs, with a high degree of activity and very few fractures. However, when the violence is strong, these ribs may have fractures.

Only one rib fracture is called a single rib fracture. Two or more rib fractures are called multiple rib fractures. Rib fractures can occur simultaneously on both sides of the chest. Only one fracture per rib is called a single fracture, and two or more fractures are called two or more fractures. Multiple multiple rib fractures or multiple rib fractures with multiple rib cartilage osteophytes or bilateral multiple costal cartilage fractures or osteophyte detachment, resulting in chest wall softening, known as chest wall floating injury, also known as sputum chest.

Local pain is the most obvious symptom of rib fracture, and it is aggravated by cough, deep breathing or body rotation. Sometimes the patient can hear or feel the rib fracture at the same time. Pain and thoracic stability are compromised, which limits respiratory mobility, shallow breathing, and reduced alveolar ventilation. Patients do not dare to cough and stay, causing obstruction of lower respiratory tract secretions, lung wetness, or atelectasis. This should be especially valued in patients with old and weak patients or patients with existing lung diseases. In the chest, when inhaling, the negative pressure in the chest increases, and the softened part of the chest wall is inwardly depressed; when exhaling, the pressure in the chest is increased, and the damaged chest wall is floating, which is opposite to the movement of other chest walls, called "abnormal breathing." motion". Abnormal respiratory movement can make the chest pressure imbalance on both sides, the mediastinum moves back and forth with the breathing, called "mediastinal swing", affecting blood reflux, causing circulatory dysfunction, which is one of the important factors leading to and aggravating shock. Chest pain and thoracic stability are more severe when the chest is broken. Abnormal breathing exercises restrict respiratory movement, cough, weakness, decreased vital capacity and functional residual capacity (FRC), decreased lung compliance and tidal volume, often accompanied by severe breathing. Difficulties and hypoxemia. In the past, I thought that

When the chest is inhaled, some of the gas flows back and forth between the healthy side and the injured side lung as it inhales and exhales. It cannot be exchanged with the atmosphere. It is called residual convection or oscillating gas, which is the main cause of respiratory dysfunction. . At present, it is believed that the oscillating gas does not exist, and the pulmonary contusion often accompanied by the chest can cause alveolar and interstitial hemorrhage, edema, alveolar rupture and atelectasis, which are important causes of respiratory dysfunction.

Most of the X-ray films can show rib fractures. However, for costal cartilage fractures, "willow branch fractures", fractures without dislocations, or middle rib fractures on the chest radiograph because the ribs on both sides overlap each other, it is not easy to find.

In addition to pleural and lung injury and the resulting hemothorax or (and) pneumothorax, rib fractures often involve other chest injuries or lesions outside the chest.

an examination

The diagnosis of rib fractures is based on injury history, clinical presentation, and chest X-ray examination. Pressing the non-fracture site of the sternum or rib (thoracic compression test) and causing pain at the fracture (indirect tenderness), or direct compression of the rib fracture, direct tenderness or simultaneous hearing of bone rubbing, hand feeling bone friction and Abnormal rib movement is very diagnostic. X-ray chest radiographs can mostly show rib fractures, but for costal cartilage fractures, "willow branch fractures", fractures without dislocations, or middle rib fractures on the chest radiograph because the ribs on both sides overlap each other, it is not easy to find, should be combined with clinical Performance to judge to avoid missed diagnosis. A rib fracture without a combined injury is called a simple rib fracture.

In addition to pleural and lung injury and the resulting hemothorax or (and) pneumothorax, often combined with other chest damage or damage outside the chest, especially in the diagnosis. The first or second rib fracture often combined with clavicle or scapular fracture, and may be associated with intrathoracic organ and large vessel injury, bronchial or tracheal rupture, or cardiac contusion, often combined with craniocerebral injury; lower thoracic rib fracture may be associated with intra-abdominal organ injury In particular, the liver, spleen and kidney rupture, should also pay attention to the spinal and pelvic fractures.

Differential diagnosis

Differential diagnosis of conductive abdominal pain:

1, paroxysmal abdominal pain: abdominal pain, accompanied by diarrhea and other conditions, the symptoms are not like dysentery. Such abdominal pain and diarrhea symptoms can also be called summer paroxysmal abdominal pain. Also common in intestinal fistula, is the most common case of acute abdominal pain in children.

2, acute abdominal pain: acute abdominal pain (abdominal pain) refers to the patient's sudden abdominal pain, often caused by intra-abdominal or extra-abdominal organ diseases, the former is called visceral abdominal pain, often paroxysmal with nausea, A series of related symptoms such as vomiting and sweating, abdominal pain is transmitted by the splanchnic nerve; while the latter abdominal pain is transmitted by the somatic nerves, so it is called somatic abdominal pain, which is often persistent, and is often accompanied by nausea and vomiting.

3, chronic abdominal pain: chronic abdominal pain is a relatively slow onset, long course of disease, or abdominal pain secondary to acute abdominal pain, its positioning is more accurate.

4, extensive and non-localized abdominal pain: abdominal pain, abdominal pain, cramps, drill-like pain, dull pain and burning pain are all in the category of abdominal pain, is a common clinical symptom. According to the degree of onset of the disease, it can be divided into acute abdominal pain and chronic abdominal pain. Chronic extensive and non-localized abdominal pain: common in tuberculous peritonitis, intestinal adhesions, intestinal ascariasis and neurosis.

The diagnosis of rib fractures is based on injury history, clinical presentation, and chest X-ray examination. Pressing the non-fracture site of the sternum or rib (thoracic compression test) and causing pain at the fracture (indirect tenderness), or direct compression of the rib fracture, direct tenderness or simultaneous hearing of bone rubbing, hand feeling bone friction and Abnormal rib movement is very diagnostic. X-ray chest radiographs can mostly show rib fractures, but for costal cartilage fractures, "willow branch fractures", fractures without dislocations, or middle rib fractures on the chest radiograph because the ribs on both sides overlap each other, it is not easy to find, should be combined with clinical Performance to judge to avoid missed diagnosis. A rib fracture without a combined injury is called a simple rib fracture.

In addition to pleural and lung injury and the resulting hemothorax or (and) pneumothorax, often combined with other chest damage or damage outside the chest, especially in the diagnosis. The first or second rib fracture often combined with clavicle or scapular fracture, and may be associated with intrathoracic organ and large vessel injury, bronchial or tracheal rupture, or cardiac contusion, often combined with craniocerebral injury; lower thoracic rib fracture may be associated with intra-abdominal organ injury In particular, the liver, spleen and kidney rupture, should also pay attention to the spinal and pelvic fractures.

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