Karın Ağrısına Yaklaşım
Özet
Karın ağrısı, geniş bir ayırıcı tanı yelpazesi olması ve detaylı inceleme gerektirmesi nedeniyle hekimler için zorlu bir şikayettir. Hekimin ağrı oluşturma mekanizmalarını anlaması, karın ağrısına neden olan yaygın hastalıkların kliniklerine aşina olması hayati önem taşır. Bunu yaparken sistematik bir plana bağlı kalmak sürecin iyi yönetilmesi için gereklidir. Anamnez, fizik muayene, laboratuvar ve ilk görüntüleme bulgularındaki verileri tanımak, hekimin hangi hastaların karın ağrısı şikayetinde altta yatan ciddi bir hastalık süreci olabileceğini belirlemesine yardımcı olur ve bu nedenle hekime daha hızlı değerlendirme ve tedavi imkanı sunar. Bu bölümde aile hekimlerinin karın ağrısı şikayetiyle gelen bir hastanın değerlendirilmesinde kullanabilecekleri sistematik yöntem planını sunmaya odaklanılacaktır.
Referanslar
Merskey HJP. Pain terms: a list with definitions and notes on usage. Recommended by the IASP Subcommittee on Taxonomy. 1979;6:249-52.
Kamin RA, Nowicki TA, Courtney DS, Powers RDJEMC. Pearls and pitfalls in the emergency department evaluation of abdominal pain. 2003;21(1):61-72.
Laméris W, Van Randen A, Van Es HW, van Heesewijk JP, van Ramshorst B, Bouma WH, et al. Imaging strategies for detection of urgent conditions in patients with acute abdominal pain: diagnostic accuracy study. 2009;338.
De Dombal F. Diagnosis of acute abdominal pain: Churchill Livingstone; 1991.
Hyams JS, Burke G, Davis PM, Rzepski B, Andrulonis PAJTJop. Abdominal pain and irritable bowel syndrome in adolescents: a community-based study. 1996;129(2):220-6.
Heading RJSjogS. Prevalence of upper gastrointestinal symptoms in the general population: a systematic review. 1999;231:3-8.
Brewer B, Golden GT, Hitch DC, Rudolf LE, Wangensteen SLJAjos. Abdominal pain. An analysis of 1,000 consecutive cases in a University Hospital emergency room. 1976;131(2):219-23.
Powers RD, Guertler ATJTAjoem. Abdominal pain in the ED: stability and change over 20 years. 1995;13(3):301-3.
An G, West MAJCcm. Abdominal compartment syndrome: a concise clinical review. 2008;36(4):1304-10.
Purcell TBJEMCoNA. Nonsurgical and extraperitoneal causes of abdominal pain. 1989;7(3):721-40.
Flasar MH, Cross R, Goldberg EJPCCiOP. Acute abdominal pain. 2006;33(3):659-84.
De Dombal F, Dallos V, McAdam WJBMJ. Can computer aided teaching packages improve clinical care in patients with acute abdominal pain? 1991;302(6791):1495-7.
Körner H, Söndenaa K, Söreide J, Andersen E, Nysted A, Lende TJBJoS. Structured data collection improves the diagnosis of acute appendicitis. 1998;85(3):341-4.
Stollman N, Raskin JBJTL. Diverticular disease of the colon. 2004;363(9409):631-9.
Mattson B, Dulaimy K, editors. The 4 quadrants: acute pathology in the abdomen and current imaging guidelines. Seminars in Ultrasound, CT and MRI; 2017: Elsevier.
Lukens TW, Emerman C, Effron DJAoem. The natural history and clinical findings in undifferentiated abdominal pain. 1993;22(4):690-6.
De Dombal FJSjogS. The OMGE acute abdominal pain survey. Progress report, 1986. 1988;144:35-42.
McFadden D, Zinner M. Manifestations of gastrointestinal disease. Principles of Surgery, Schwartz SI, Shires GT, Spencer FC, Eds. McGraw-Hill, New York; 1994.
Sabo CM, Grad S, Dumitrascu DLJDD. Chronic abdominal pain in general practice. 2021;39(6):606-14.
Jaschinski T, Mosch C, Eikermann M, Neugebauer EAJBg. Laparoscopic versus open appendectomy in patients with suspected appendicitis: a systematic review of meta-analyses of randomised controlled trials. 2015;15(1):1-10.
Zingone F, Sultan AA, Humes DJ, West JJAos. Risk of acute appendicitis in and around pregnancy: a population-based cohort study from England. 2015;261(2):332-7.
Mandeville K, Monuteaux M, Pottker T, Bulloch BJPec. Effects of timing to diagnosis and appendectomy in pediatric appendicitis. 2015;31(11):753-8.
Bhangu A, Søreide K, Di Saverio S, Assarsson JH, Drake FTJTL. Acute appendicitis: modern understanding of pathogenesis, diagnosis, and management. 2015;386(10000):1278-87.
Tazuma SJBp, gastroenterology rC. Epidemiology, pathogenesis, and classification of biliary stones (common bile duct and intrahepatic). 2006;20(6):1075-83.
Indar AA, Beckingham IJJB. Acute cholecystitis. 2002;325(7365):639-43.
Yamashita Y, Takada T, Strasberg SM, Pitt HA, Gouma DJ, Garden OJ, et al. TG13 surgical management of acute cholecystitis. 2013;20:89-96.
Silva AC, Pimenta M, Guimaraes LSJR. Small bowel obstruction: what to look for. 2009;29(2):423-39.
Diaz Jr JJ, Bokhari F, Mowery NT, Acosta JA, Block EF, Bromberg WJ, et al. Guidelines for management of small bowel obstruction. 2008;64(6):1651-64.
Miller G, Boman J, Shrier I, Gordon PHJTAJoS. Etiology of small bowel obstruction. 2000;180(1):33-6.
Iraha Y, Okada M, Iraha R, Azama K, Yamashiro T, Tsubakimoto M, et al. CT and MR imaging of gynecologic emergencies. 2017;37(5):1569-86.
Drukker L, Noble J, Papageorghiou AJUiO, Gynecology. Introduction to artificial intelligence in ultrasound imaging in obstetrics and gynecology. 2020;56(4):498-505.
Yang H, Wang R, Zhao L, Ye J, Li N, Kong LJC, et al. Diagnosis and analysis of transabdominal and intracavitary ultrasound in gynecological acute abdomen. 2021;2021.
Talha M, Sohail M, Tariq R, Ahmad MTJCdE. Impact of oil prices, energy consumption and economic growth on the inflation rate in Malaysia. 2021;44(124):26-32.
Alrahmani L, Codsi E, Borowski KSJJoUiM. The current state of ultrasound training in obstetrics and gynecology residency programs. 2018;37(9):2201-7.
Mc Kay C, Buter AJP. Natural history of organ failure in acute pancreatitis. 2003;3(2):111-4.
Uhl W, Warshaw A, Imrie C, Bassi C, McKay CJ, Lankisch PG, et al. IAP guidelines for the surgical management of acute pancreatitis. 2002;2(6):565-73.
Forsmark CE, Baillie JJRdgdM. AGA Institute technical review on acute pancreatitis. 2007;72(3):257-81.
Bhatia M, Wong FL, Cao Y, Lau HY, Huang J, Puneet P, et al. Pathophysiology of acute pancreatitis. 2005;5(2-3):132-44.
Kwon RS, Banks PAJCPFPG, Surgeons. How should acute pancreatitis be diagnosed in clinical practice? 2004:34-9.
Brizi MG, Perillo F, Cannone F, Tuzza L, Manfredi RJLrm. The role of imaging in acute pancreatitis. 2021;126(8):1017-29.
Heidenreich A, Desgrandschamps F, Terrier FJEu. Modern approach of diagnosis and management of acute flank pain: review of all imaging modalities. 2002;41(4):351-62.
Dawson C, Whitfield HJB. ABC of urology: urological emergencies in general practice. 1996;312(7034):838-40.
Kessler CS, Bauml JJWJoEM. Non-traumatic urologic emergencies in men: a clinical review. 2009;10(4):281.
Hamza BK, Ahmed M, Tolani MA, Awaisu M, Lawal AT, Oyelowo N, et al. Spectrum of urological emergencies and surgical interventions in a single tertiary health center. 2021;11(2):223-6.
Jones RS, Claridge JAJSToStBboMSPtePE. Acute abdomen. 2004:1219-38.
Fecteau G, Desrochers A, Francoz D, Nichols SJVCFAP. Diagnostic approach to the acute abdomen. 2018;34(1):19-33.
Panebianco NL, Jahnes K, Mills AMJEMC. Imaging and laboratory testing in acute abdominal pain. 2011;29(2):175-93.
Marasco G, Verardi FM, Eusebi LH, Guarino S, Romiti A, Vestito A, et al. Diagnostic imaging for acute abdominal pain in an Emergency Department in Italy. 2019;14(7):1147-53.
van Randen A, Laméris W, van Es HW, van Heesewijk HP, van Ramshorst B, Ten Hove W, et al. A comparison of the accuracy of ultrasound and computed tomography in common diagnoses causing acute abdominal pain. 2011;21:1535-45.
Shuman W, Ralls P, Balfe D, Bree R, DiSantis D, Glick S, et al. Imaging evaluation of patients with acute abdominal pain and fever. American College of Radiology. ACR Appropriateness Criteria. 2000;215:209-12.
Puylaert JBJRC. Ultrasonography of the acute abdomen: gastrointestinal conditions. 2003;41(6):1227-42.
Valentin J. The 2007 recommendations of the international commission on radiological protection: Elsevier Oxford; 2007.
Deshmukh S, Kishan AMJISJ. Diagnostic accuracy of ultrasound in common acute abdominal conditions. 2019;6(12):4460-4.
Referanslar
Merskey HJP. Pain terms: a list with definitions and notes on usage. Recommended by the IASP Subcommittee on Taxonomy. 1979;6:249-52.
Kamin RA, Nowicki TA, Courtney DS, Powers RDJEMC. Pearls and pitfalls in the emergency department evaluation of abdominal pain. 2003;21(1):61-72.
Laméris W, Van Randen A, Van Es HW, van Heesewijk JP, van Ramshorst B, Bouma WH, et al. Imaging strategies for detection of urgent conditions in patients with acute abdominal pain: diagnostic accuracy study. 2009;338.
De Dombal F. Diagnosis of acute abdominal pain: Churchill Livingstone; 1991.
Hyams JS, Burke G, Davis PM, Rzepski B, Andrulonis PAJTJop. Abdominal pain and irritable bowel syndrome in adolescents: a community-based study. 1996;129(2):220-6.
Heading RJSjogS. Prevalence of upper gastrointestinal symptoms in the general population: a systematic review. 1999;231:3-8.
Brewer B, Golden GT, Hitch DC, Rudolf LE, Wangensteen SLJAjos. Abdominal pain. An analysis of 1,000 consecutive cases in a University Hospital emergency room. 1976;131(2):219-23.
Powers RD, Guertler ATJTAjoem. Abdominal pain in the ED: stability and change over 20 years. 1995;13(3):301-3.
An G, West MAJCcm. Abdominal compartment syndrome: a concise clinical review. 2008;36(4):1304-10.
Purcell TBJEMCoNA. Nonsurgical and extraperitoneal causes of abdominal pain. 1989;7(3):721-40.
Flasar MH, Cross R, Goldberg EJPCCiOP. Acute abdominal pain. 2006;33(3):659-84.
De Dombal F, Dallos V, McAdam WJBMJ. Can computer aided teaching packages improve clinical care in patients with acute abdominal pain? 1991;302(6791):1495-7.
Körner H, Söndenaa K, Söreide J, Andersen E, Nysted A, Lende TJBJoS. Structured data collection improves the diagnosis of acute appendicitis. 1998;85(3):341-4.
Stollman N, Raskin JBJTL. Diverticular disease of the colon. 2004;363(9409):631-9.
Mattson B, Dulaimy K, editors. The 4 quadrants: acute pathology in the abdomen and current imaging guidelines. Seminars in Ultrasound, CT and MRI; 2017: Elsevier.
Lukens TW, Emerman C, Effron DJAoem. The natural history and clinical findings in undifferentiated abdominal pain. 1993;22(4):690-6.
De Dombal FJSjogS. The OMGE acute abdominal pain survey. Progress report, 1986. 1988;144:35-42.
McFadden D, Zinner M. Manifestations of gastrointestinal disease. Principles of Surgery, Schwartz SI, Shires GT, Spencer FC, Eds. McGraw-Hill, New York; 1994.
Sabo CM, Grad S, Dumitrascu DLJDD. Chronic abdominal pain in general practice. 2021;39(6):606-14.
Jaschinski T, Mosch C, Eikermann M, Neugebauer EAJBg. Laparoscopic versus open appendectomy in patients with suspected appendicitis: a systematic review of meta-analyses of randomised controlled trials. 2015;15(1):1-10.
Zingone F, Sultan AA, Humes DJ, West JJAos. Risk of acute appendicitis in and around pregnancy: a population-based cohort study from England. 2015;261(2):332-7.
Mandeville K, Monuteaux M, Pottker T, Bulloch BJPec. Effects of timing to diagnosis and appendectomy in pediatric appendicitis. 2015;31(11):753-8.
Bhangu A, Søreide K, Di Saverio S, Assarsson JH, Drake FTJTL. Acute appendicitis: modern understanding of pathogenesis, diagnosis, and management. 2015;386(10000):1278-87.
Tazuma SJBp, gastroenterology rC. Epidemiology, pathogenesis, and classification of biliary stones (common bile duct and intrahepatic). 2006;20(6):1075-83.
Indar AA, Beckingham IJJB. Acute cholecystitis. 2002;325(7365):639-43.
Yamashita Y, Takada T, Strasberg SM, Pitt HA, Gouma DJ, Garden OJ, et al. TG13 surgical management of acute cholecystitis. 2013;20:89-96.
Silva AC, Pimenta M, Guimaraes LSJR. Small bowel obstruction: what to look for. 2009;29(2):423-39.
Diaz Jr JJ, Bokhari F, Mowery NT, Acosta JA, Block EF, Bromberg WJ, et al. Guidelines for management of small bowel obstruction. 2008;64(6):1651-64.
Miller G, Boman J, Shrier I, Gordon PHJTAJoS. Etiology of small bowel obstruction. 2000;180(1):33-6.
Iraha Y, Okada M, Iraha R, Azama K, Yamashiro T, Tsubakimoto M, et al. CT and MR imaging of gynecologic emergencies. 2017;37(5):1569-86.
Drukker L, Noble J, Papageorghiou AJUiO, Gynecology. Introduction to artificial intelligence in ultrasound imaging in obstetrics and gynecology. 2020;56(4):498-505.
Yang H, Wang R, Zhao L, Ye J, Li N, Kong LJC, et al. Diagnosis and analysis of transabdominal and intracavitary ultrasound in gynecological acute abdomen. 2021;2021.
Talha M, Sohail M, Tariq R, Ahmad MTJCdE. Impact of oil prices, energy consumption and economic growth on the inflation rate in Malaysia. 2021;44(124):26-32.
Alrahmani L, Codsi E, Borowski KSJJoUiM. The current state of ultrasound training in obstetrics and gynecology residency programs. 2018;37(9):2201-7.
Mc Kay C, Buter AJP. Natural history of organ failure in acute pancreatitis. 2003;3(2):111-4.
Uhl W, Warshaw A, Imrie C, Bassi C, McKay CJ, Lankisch PG, et al. IAP guidelines for the surgical management of acute pancreatitis. 2002;2(6):565-73.
Forsmark CE, Baillie JJRdgdM. AGA Institute technical review on acute pancreatitis. 2007;72(3):257-81.
Bhatia M, Wong FL, Cao Y, Lau HY, Huang J, Puneet P, et al. Pathophysiology of acute pancreatitis. 2005;5(2-3):132-44.
Kwon RS, Banks PAJCPFPG, Surgeons. How should acute pancreatitis be diagnosed in clinical practice? 2004:34-9.
Brizi MG, Perillo F, Cannone F, Tuzza L, Manfredi RJLrm. The role of imaging in acute pancreatitis. 2021;126(8):1017-29.
Heidenreich A, Desgrandschamps F, Terrier FJEu. Modern approach of diagnosis and management of acute flank pain: review of all imaging modalities. 2002;41(4):351-62.
Dawson C, Whitfield HJB. ABC of urology: urological emergencies in general practice. 1996;312(7034):838-40.
Kessler CS, Bauml JJWJoEM. Non-traumatic urologic emergencies in men: a clinical review. 2009;10(4):281.
Hamza BK, Ahmed M, Tolani MA, Awaisu M, Lawal AT, Oyelowo N, et al. Spectrum of urological emergencies and surgical interventions in a single tertiary health center. 2021;11(2):223-6.
Jones RS, Claridge JAJSToStBboMSPtePE. Acute abdomen. 2004:1219-38.
Fecteau G, Desrochers A, Francoz D, Nichols SJVCFAP. Diagnostic approach to the acute abdomen. 2018;34(1):19-33.
Panebianco NL, Jahnes K, Mills AMJEMC. Imaging and laboratory testing in acute abdominal pain. 2011;29(2):175-93.
Marasco G, Verardi FM, Eusebi LH, Guarino S, Romiti A, Vestito A, et al. Diagnostic imaging for acute abdominal pain in an Emergency Department in Italy. 2019;14(7):1147-53.
van Randen A, Laméris W, van Es HW, van Heesewijk HP, van Ramshorst B, Ten Hove W, et al. A comparison of the accuracy of ultrasound and computed tomography in common diagnoses causing acute abdominal pain. 2011;21:1535-45.
Shuman W, Ralls P, Balfe D, Bree R, DiSantis D, Glick S, et al. Imaging evaluation of patients with acute abdominal pain and fever. American College of Radiology. ACR Appropriateness Criteria. 2000;215:209-12.
Puylaert JBJRC. Ultrasonography of the acute abdomen: gastrointestinal conditions. 2003;41(6):1227-42.
Valentin J. The 2007 recommendations of the international commission on radiological protection: Elsevier Oxford; 2007.
Deshmukh S, Kishan AMJISJ. Diagnostic accuracy of ultrasound in common acute abdominal conditions. 2019;6(12):4460-4.
