0 évaluation0% ont trouvé ce document utile (0 vote)
213 vues25 pages
Pain is an unpleasant phenomenon that is uniquely experienced by each individual. Pain is not always associated with the degree of the damaged tissue. Infants in the first 1 to 2 days of life are less sensitive to pain. A full behavioural response to pain is apparent at 3 to 12 month of life. Older children, between the ages of 15 and 18 years, tend to have a lower pain threshold than do adults.
Description originale:
Titre original
PATOFISIOLOGI NYERI PADA KELAINAN BILIODIGESTIF.pptx
Pain is an unpleasant phenomenon that is uniquely experienced by each individual. Pain is not always associated with the degree of the damaged tissue. Infants in the first 1 to 2 days of life are less sensitive to pain. A full behavioural response to pain is apparent at 3 to 12 month of life. Older children, between the ages of 15 and 18 years, tend to have a lower pain threshold than do adults.
Pain is an unpleasant phenomenon that is uniquely experienced by each individual. Pain is not always associated with the degree of the damaged tissue. Infants in the first 1 to 2 days of life are less sensitive to pain. A full behavioural response to pain is apparent at 3 to 12 month of life. Older children, between the ages of 15 and 18 years, tend to have a lower pain threshold than do adults.
The definition of pain according to the International Association for the Study of Pain (IASP, 1979) is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage Pain is not always associated with the degree of the damaged tissue Pain is an unpleasant phenomenon that is uniquely experienced by each individual, it cannot be adequately defined, identified, or measured by an observer Pain threshold and pain tolerance The pain threshold is the point at which a stimulus is perceived as pain It does not vary significantly among healthy people or in the same person over time Perceptual dominance- intense pain at one location may cause an increase in the pain threshold in another location The pain tolerance is expressed as duration of time or the intensity of pain that an individual will endure before initiation overt pain responses. It is influenced by - persons cultural prescriptions - expectations - role behaviours - physical and mental health Pain tolerance is generally decreased: - with repeated exposure to pain, - by fatigue, anger, boredom, apprehension, - sleep deprivation
Tolerance to pain may be increased: - by alcohol consumption, - medication, hypnosis, - warmth, distracting activities, - strong beliefs or faith Pain tolerance varies greatly among people and in the same person over time A decrease in pain tolerance is also evident in the elderly, and women appear to be more tolerant to pain than men Age and perception of pain
Children and the elderly may experience or express pain differently than adults Infants in the first 1 to 2 days of life are less sensitive to pain (or they simply lack the ability to verbalise the pain experience). A full behavioural response to pain is apparent at 3 to 12 month of life Older children, between the ages of 15 and 18 years, tend to have a lower pain threshold than do adults Pain threshold tends to increase with ageing This change is probably caused by peripheral neuropathies and changes in the thickness of the skin Pain categories
1. Somatogenic pain is pain with cause (usually known) localised in the body tissue a/ nociceptive pain b/ neuropatic pain
2. Psychogenic pain is pain for which there is no known physical cause but processing of sensitive information in CNS is dysturbed Acute and chronic pain
Acute pain is a protective mechanism that alerts the individual to a condition or experience that is immediately harmful to the body Onset - usually sudden Relief - after the chemical mediators that stimulate the nociceptors, are removed This type of pain mobilises the individual to prompt action to relief it Stimulation of autonomic nervous system can be observed during this type of pain (mydriasis, tachycardia, tachypnoe, sweating, vasoconstriction) Responses to acute pain - increased heart rate - diaphoresis - increased respiratory rate - blood sugar - elevated blood pressure - gastric acid secretion - pallor or flushing, - gastric motility dilated pupils - blood flow to the viscera, kidney and skin - nausea occasionally occurs Psychological and behavioural response to acute pain - fear - general sense of unpleasantness or unease - anxiety Chronic pain is persistent or intermittent usually defined as lasting at least 6 months The cause is often unknown, often develops insidiously, very often is associated with a sense of hopelessness and helplessness. Depression often results Psychological response to chronic pain Intermittent pain produces a physiologic response similar to acute pain. Persistent pain allows for adaptation (functions of the body are normal but the pain is not reliefed) Chronic pain produces significant behavioural and psychological changes The main changes are: - depression - an attempt to keep pain - related behaviour to a minimum - sleeping disorders - preoccupation with the pain - tendency to deny pain Acute Pain or Nociceptive Pain is pain that elicited by activation of nociceptors
There are 4 distinct process involved: 1. Transduction 2. Transmission 3. Modulation and 4. Perception
Pain Perception Brain Dorsal Root Ganglion Dorsal Horn Nociceptor Spinal Cord Gottschalk A et al. Am Fam Physician. 2001;63:1979-84. Fields HL et al. Harrisons Principles of Internal Medicine. 1998:53-8. 1. Transduction Conversion of noxious stimuli (mechanical, thermal, chemical into electrical activation 2 Transmission Communication of the nerve impulse from the periphery to the spinal cord, up to spinothalamic track to the thalamus and cerebral cortex 3 Modulation Process by which impulse travel from the brain back down to the spinal cord to selectiveley inhibit (or sometimes amlpify) pain impulse 4 Perception Net result of three events the subjective experience of pain An alarm protection tell us that something wrong in our body Accompanied by emotional reaction like nausea, fear, anxiety, and discomfort There is an urgency feeling for relieving the pain in the right upper abdominal area The Location of pain The quality and intensivity of pain Duration of pain What time did the pain appear Refered pain Accompanying symptoms Symptom yang menyertai Physical examination Pemeriksaan fisik Laboratorium valuesLaboratorium
Ulcer Intestinal Colic Biliary Colic, Pancreatic The Result from stimulation of the autonomic nerve in the visceral peritoneum surrounding the internal organs. The Pain/noxius stimuli will be transferred to the spinal cord through the symphatetic route. The pain is hard to localize Intermittent, cramp dan colicy pain Usually accompanied with nausea, vomitting, and diaphoresis Stimuli occur from the iritation of the parietal peritoneum. Somatic pain impulses is conducted through the peripheral nerve system, therefore it could be better localized. The somatic pain characteristic are continous, constant, and usually worsen by cough or changing of the body position. Nyeri terus menerus, konstan, memburuk dengan perubahan posisi, batuk
It is elicited by firmly placing a hand at the costal margin in the right upper abdominal quadrant and asking the patient to breathe deeply. If the gallbladder is inflamed, the patient will experience pain and catch their breath as the gallbladder descends and contacts the palpating hand. A positive Murphy's sign is seen in acute cholecystitis. In cholecystitis, the gallbladder becomes inflamed secondary to blockage of the cystic duct, usually by a gallstone. Subsequently, this inflammation causes the release of prostaglandins, which cause more inflammation of the gallbladder. Patients with acute cholecystitis experience discomfort with the Murphys sign maneuver because the inflamed gallbladder descends toward the examiners fingers, which irritates the peritoneum, thereby causing pain.