patofisiologi nyeri pada kelainan biliodigestif.pptx

8/10/2019 PATOFISIOLOGI NYERI PADA KELAINAN BILIODIGESTIF.pptx

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Oleh :Radityo Budi Leksono (DIT)

Pembimbing

dr. Syaiful Mukhtar Sp.B (K) BD


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The definition of painaccording to the

International Association for the Study ofPain (IASP, 1979) is an unpleasant sensory

and emotional experience associated withactual or potential tissue damage, ordescribed in terms of such damage

Painis not always associated with thedegree of the damaged tissue

Painis an unpleasant phenomenonthat isuniquely experienced by each individual, itcannot be adequately defined, identified, ormeasured by an observer


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Pain threshold and pain tolerance

The pain threshold is the point at which a stimulus is perceived

as painIt does not vary significantly among healthy people or in the sameperson over time

Perceptual dominance-intense pain at one location may cause

an increase in the pain threshold in another location

The pain toleranceis expressed asduration 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


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Age and perception of pain

Children and the elderlymay experience or express paindifferently than adults

Infantsin the first 1 to 2 days of life are less sensitiveto 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


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Pain categories

1. Somatogenic painis pain with cause (usually known)

localised in the body tissuea/ nociceptive painb/ neuropatic pain

2. Psychogenic painis pain for which there is no knownphysical cause but processing of sensitive informationin CNS is dysturbed

Acute and chronic pain

Acute painis a protective mechanism that alerts the

individual to a condition or experience that is immediately

harmful to the body

Onset- usually sudden


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Relief -after the chemical mediators that stimulate thenociceptors, 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


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Psychological and behavioural response to acute pain

- fear

- general sense of unpleasantness or unease

- anxiety

Chronic painis 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


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Psychological response to chronic pain

Intermittent painproduces a physiologic response similar to

acute pain.

Persistent painallows 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


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Acute Pain or Nociceptive Pain is pain thatelicited by activation of nociceptors

There are 4 distinct process involved:

1. Transduction

2. Transmission

3. Modulation and

4. Perception


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Pain PerceptionBrain

Dorsal RootGanglion

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.


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1. Transduction Conversion of noxious stimuli

(mechanical, thermal, chemical intoelectrical activation

2 Transmission Communication of the nerve impulsefrom the periphery to the spinal cord,

up to spinothalamic track to thethalamus and cerebral cortex

3 Modulation Process by which impulse travel fromthe brain back down to the spinal cordto selectiveley inhibit (or sometimesamlpify) pain impulse

4 Perception Net result of three events thesubjective experience of pain


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An alarm protection tell us that something wrong in ourbody

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


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Ulcer

IntestinalColic

Biliary Colic,Pancreatic


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The Result from stimulation of the autonomicnerve in the visceral peritoneum surrounding theinternal organs.

The Pain/noxius stimuli will be transferred to thespinal cord through the symphatetic route.

The pain is hard to localize

Intermittent, cramp dan colicy pain

Usually accompanied with nausea, vomitting,and diaphoresis


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Stimuli occur from the iritation of the parietalperitoneum.

Somatic pain impulses is conducted through

the peripheral nerve system, therefore it couldbe better localized.

The somatic pain characteristic are continous,constant, and usually worsen by cough orchanging of the body position. Nyeri terusmenerus, konstan, memburuk denganperubahan posisi, batuk


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It is elicited by firmly placing a hand at the costalmargin in the right upper abdominal quadrant andasking the patient to breathe deeply. If the gallbladderis inflamed, the patient will experience pain and catchtheir breath as the gallbladder descends and contactsthe 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 agallstone. Subsequently, this inflammation causes the

release of prostaglandins, which cause moreinflammation of the gallbladder. Patients with acutecholecystitis experience discomfort with the Murphyssign maneuver because the inflamed gallbladderdescends toward the examiners fingers, whichirritates the peritoneum, thereby causing pain.


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TERIMA KASIH

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