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PROF: Abdel Rahman A Mokhtar Internist - Gastroenterologist Mansoura University
PROF: Abdel Rahman A Mokhtar Internist - Gastroenterologist Mansoura University
PROF: Abdel Rahman A Mokhtar Internist - Gastroenterologist Mansoura University
However, CAWP is
commonly caused by
the entrapment of an
anterior cutaneous
branch of one or more
thoracic intercostal
nerves.
Locations where pain in the abdominal wall might originate:
Locations where pain in the
abdominal wall might originate.
ACNES-related pain is well localized and usually affects only one side.
However, the pain can occur on both sides at the same level .
or at different levels.
Pain radiating from T11 and T12 runs at an oblique angle and
follows the course of these nerves. Such pain can suggest urolithiasis;
however, patients with urolithiasis are usually seen writhing in pain,
where as patients with ACNES tend to lie quietly on the table with their
hand placed over the area of discomfort.
T11 involvement
on the right side may suggest appendicitis, and involvement
on either side may suggest ovarian involvement
or spigelian hernia; all these conditions should be identified
by proper physical examination.
Symptomatology of ACNES 4
•Chronic ACNES patients suffer considerable anxiety and worry that they
may have some horrible condition as yet undiscovered.
It is also not very useful to apply this test to individuals with wide spread abdominal pain
rather than localized area of pain to avoid misdiagnosis.
DIAGNOSIS OF CAWP
ACNES questionnaire
A VALIDATED QUESTIONNAIRE WITH THE ANSWER KEY.
A 10-POINT CUTOFF VALUE RESULTS IN AN OPTIMAL 94% SENSITIVITY AND 92% SPECIFICITY .
A highly suggested history can
be confirmed by :
In cases of mild pain, minimizing activities that aggravate the pain may be
sufficient.
An abdominal binder may be useful if gentle hand pressure helps ease
the pain.
Local nerve blocks or trigger point injections using anesthetic/steroid
injections are the treatment of choice for patients with moderate to severe
abdominal wall pain.
Drugs for neuralgic pain ?????
Conclusion
When patients present with persistent or recurrent abdominal pain it is all too easy to
consider a visceral source and overlook other origins for their symptoms.
Patients with chronic abdominal pain are often subjected to a variety of procedures in an
attempt to find a cause: simple investigations may give way to more complex
and invasive ones in the pursuit of ever more obscure diagnoses.
Then failure to find a visceral cause for the pain may prompt the physician to
apply a functional or psychosomatic label to the patient, with any treatment directed along
thoselines.
An awareness, however, that abdominal
pain may have a non-visceral origin' can forestall
a fruitless search for intra-abdominal pathology.