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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