New Trio – Abdominal Pain (Jan Smoczyński)
Mateusz Smoczyński – violin
Jan Smoczyński – hammond organ
Alex Zinger – drums
http://myspace.com/newtrio
Duration : 0:9:51
Enviado por ” CONSULTORIO MÉDICO FLORES BUISSON ” MÁNCORA- PERÚ…
URL: http://consultoriomedicofloresmancora.es.tl/ …
PALPACION ABDOMINAL: Es el cuarto paso de un examen abdominal y a su vez es el paso más informativo del examen. No obstante Stanilad et al (13) apuntan que solo 1/3 de casos presentan dolor sobre la zona correspondiente al órgano lesionado. Aunque son muchos los datos que se pueden obtener en una palpación correcta del abdomen, hemos de prestar atención a:
Iniciar la exploración en la zona distante a la localización del dolor y acercarse a este de forma progresiva. La intensidad de la sensibilidad es muy poco útil dado su extrema subjetividad.
Presencia de dolor de rebote o Signo de Blumberg: Es indicativo de inflamación del peritoneo. Para que sea significativo, debe realizarse de forma correcta así ha de palparse con la palma de la mano extendida, manteniendo una presión constante, si esta no es dolorosa raramente habrá rebote; debe mantenerse la presión unos 30-60 segundos de esta manera el dolor originado por la presión irá disminuyendo, cuando esté desprevenido el enfermo se soltará bruscamente la mano del abdomen, bajo estas circunstancias una simple muesca es indicativo de rebote positivo. No podemos olvidar que el hecho de tener signo de rebote positivo, no indica indefectiblemente patología quirúrgica, dado que hasta un 20% de procesos patológicos intrabdominales no quirúrgicos presentan signo de rebote positivo (3, 5, 6, 7).
Presencia de defensa muscular y contractura. Lo más importante de este apartado es diferenciar la contractura voluntaria que realiza el enfermo por la simple palpación de aquella otra involuntaria que está presente por muy minuciosa que sea la exploración. La presencia de contractura involuntaria indica peritonitis y necesidad de cirugía (6, 7).
Signo de Murphy: Es un signo clásicamente descrito como guía del diagnóstico de colecistitis. Consiste en realizar la palpación por debajo del reborde costal derecho, esto produce un aumento del dolor cuando el paciente realiza una inspiración profunda al chocar la vesícula inflamada con la mano.
Hemos de explorar también los movimientos de la pared abdominal para descartar patología a este nivel. Se apoya la palma de la mano sobre la parte superior del abdomen y se invita al enfermo a que realice una inspiración profunda intentando que su estómago choque con nuestra mano, si con esta maniobra el dolor no aumenta la movilidad de la pared es normal.
Abdominal palpation
Examination of the abdomen is often forgotten in today’s world of advanced diagnostic technology. Yet, it is very revealing when performed in a systematic and thorough manner. The following guidelines will be helpful.
*** Auscultation is relatively less important in the abdomen than in the thorax. It seldom yields meaningful information in a routine examination, but it is of extreme importance in evaluation of abdominal pain.
*** Percussion of the abdomen usually does not play an important role in the assessment of abdominal pain. It is primarily used to establish the presence of distention, tumors, fluid, and enlargement of solid viscera.
*** Therefore, palpation takes on great importance for examining the abdomen. It is rather difficult to actually palpate the abdominal organs because they are separated from the examining hand by a relatively thick, muscular wall. But this is exactly what we are searching for, i.e., muscle contraction or stress points that share the same spinal innervation as the underlying organ.
*** Remember that the only time these stress points can be found is when the organ is stressed and unable to perform its responsibilities for maintaining homeostasis. Once the stress passes, the muscle contraction disappears.
The most important point to bear in mind as we discuss abdominal palpation is distinguishing between deep pain found in the viscera, and superficial pain found in the muscular abdominal wall.
*** Myofascial trigger points in an abdominal muscle may produce referred abdominal pain and symptoms such as projectile vomiting, anorexia and nausea, intestinal colic, diarrhea, urinary bladder and sphincter spasms, and dysmenorrhea. When such visceral symptoms occur with abdominal pain and tenderness, the combination can strongly mimic acute visceral disease, especially appendicitis and cholelithiasis (Travell).
*** In addition, abdominal trigger points may be secondary to visceral disorders such as, peptic ulcer, intestinal parasites, dysentery, ulcerative colitis, diverticulosis, diverticulitis, and cholelithiasis. Abdominal trigger points may also accompany such vague complaints as burning, fullness, bloating, swelling and gas
Duration : 0:0:54
Attorney Deborah Maliver is also a board certified physician. When a patient presents to an emergency room with abdominal pain, it cannot be ignore. Attorney Maliver has seen many cases where catastrophic injury has occured because abdominal pain has been ignored. Attorney Maliver handles all type of medical malpractice cases from across Pennsylvania and West Virginia from places like Pittsburgh, Erie, New Castle, Sharon, Indiana, Johnstown, Altoona, Bedford, Uniontown, Morgantown, Wheeling, Charleston and surrounding areas. Please call for a free consultation.
Duration : 0:1:13
Duration : 0:4:14
Patient from out of state Utah with history of ulcerative colitis and constipation was initially skeptical of the NBE treatment. After his first NBE treatment, his bowels were normalized and patient now returns periodically for maintenance. Patient’s son, who is a track and field runner, suffered from stunted growth and was worked up by world renowned hospitals. After NBE treatments, he grew significantly in height and his leg cramps from running were also cured, allowing him to compete and win competitions.
Duration : 0:6:6
Simon RAbinowitz PhD MD Ped GI Chairman Department of Pediatric Richmond University Medical Center
Duration : 1 min 42 sec
Stephen Dolgin, MD, FACS, FAAP Chief, Pediatric Surgery Schneider Children’s Hospital
Post Graduate Training:
The Brigham and Women’s Hospital
Harvard Medical School
General Surgical Residency
Children’s Memorial Hospital
Northwestern University School of Medicine
Fellowship in Pediatric Surgery
DrMDK.com
Duration : 0:2:36