Боль в животе

Парфенов А.И. Боль в животе. Терапевтический архив. 2023;95(2):113–119.
DOI: 10.26442/00403660.2023.02.202055

© ООО «КОНСИЛИУМ МЕДИКУМ», 2023 г.

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Parfenov AI. Abdominal pain. Terapevticheskii Arkhiv (Ter. Arkh.). 2023;95(2):113–119.
DOI: 10.26442/00403660.2023.02.202055

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Аннотация

Боль в животе является симптомом, от качества оценки которого зависят точность и своевременность диагноза, лечения и прогноз. В статье описаны причины острой и хронической боли в животе, в частности брюшной стенке, и сложности в их распознавании. Показаны особенности патогенеза висцеральной, париетальной, рефлекторной, психогенной боли и принципы симптоматической терапии. Подчеркивается, что сложные инвазивные исследования органов брюшной полости особенно необходимы при обследовании пожилых пациентов, чаще имеющих заболевания, требующие компьютерной томографии, в том числе с внутривенным контрастированием. Не уменьшая значимости современных методов исследования, применяемых в клинической практике, автор напоминает, что подробный анамнез болезни и тщательный физический осмотр могут значительно сузить объем исследований. Эндоскопические и другие инструментальные инвазивные исследования должны быть строго обоснованы и применяться в рамках рационального экономически эффективного подхода.

Ключевые слова: боль в брюшной стенке, боль в животе, висцеральная боль, париетальная боль, рефлекторная боль, психогенная боль, диагноз, дифференциальный диагноз, лечение

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Abdominal pain is a symptom that determines the accuracy and timeliness of diagnosis, treatment, and prognosis. The article describes the causes of acute and chronic abdominal pain, particularly the pain in the abdominal wall, and the challenges in recognizing them. The pathogenetic features of visceral, parietal, referred, and psychogenic pain and the principles of symptomatic therapy are addressed. It is emphasized that complex invasive examinations of the abdominal organs are especially relevant for elderly patients who often have conditions that require computed tomography, including contrast-enhanced scans. Without losing the importance of modern examination methods used in clinical practice, the author states that a detailed medical history and a thorough physical examination can significantly narrow the work-up. Endoscopic and other instrumental invasive examinations should be strictly justified and applied with a cost-effective rational approach.

Keywords: abdominal wall pain, abdominal pain, visceral pain, parietal pain, reflex pain, psychogenic pain, diagnosis, differential diagnosis, treatment

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Список литературы

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22. Dong WZ, Zou DW, Li ZS, et al. Study of visceral hypersensitivity in irritable bowel syndrome. Chin J Dig Dis. 2004;5(3):103-9. DOI:10.1111/j.1443-9573.2004.00168.x
23. Макарова А.А., Дюкова Г.М., Ручкина И.Н., и др. Висцеральная чувствительность в диагностике и лечении синдрома раздраженного кишечника тяжелого течения. Терапевтический архив. 2022;94(2S):356-61 [Makarova AA, Dyukova GM, Ruchkina IN, et al. Visceral sensitivity in the diagnosis and treatment of severe irritable bowel syndrome. Terapevticheskii Arkhiv (Ter. Arkh.). 2022;94(2S):356-61 (in Russian)]. DOI:10.26442/00403660.2022.02.201394
24. Laird KT, Tanner-Smith EE, Russell AC, et al. Comparative efficacy of psychological therapies for improving mental health and daily functioning in irritable bowel syndrome: A systematic review and metaanalysis. Clin Psychol Rev. 2017;51:142-52. DOI:10.1016/j.cpr.2016.11.001
25. Salehian R, Mokhtare M, Ghanbari Jolfaei A, Noorian R. Investigation the Effectiveness of Duloxetine in Quality of Life and Symptoms of Patients with Irritable Bowel Syndrome. Adv Biomed Res. 2021;10:14. DOI:10.4103/abr.abr_247_20

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1. Parfenov AI. Pain in the abdomen in the practice of a therapist. Terapevticheskii Arkhiv (Ter. Arkh.). 2008;80(8):38-42 (in Russian).
2. McGarrity TJ, Peters DJ, Thompson C, McGarrity SJ. Outcome of patients with chronic abdominal pain referred to chеnic pain clinic. Am J Gastroenterol. 2000;95(7):1812-6. DOI:10.1111/j.1572-0241.2000.02170.x
3. Costanza CD, Longstreth GF, Liu AL. Chronic abdominal wall pain: clinical features, health care costs, and long-term outcome. Clin Gastroenterol Hepatol. 2004;2(5):395-9. DOI:10.1016/s1542-3565(04)00124-7
4. Mui J, Allaire C, Williams C, Yong PJ. Abdominal wall pain in women with chronic pelvic pain. J Obstet Gynaecol Can. 2016;38(2):154-9. DOI:10.1016/j.jogc.2015.11.003
5. Clarke S, Kanakarajan S. Abdominal cutaneous nerve entrapment syndrome. Contin Educ Anaesth Crit Care Pain. 2015;15(2):60-3.
6. Sippo WC, Gomez AC. Nerve-entrapment syndromes from lower abdominal surgery. J Fam Pract. 1987;25(6):585-7.
7. Shian B, Larson ST. Abdominal Wall Pain: Clinical Evaluation, Differential Diagnosis, and Treatment. Am Fam Physician. 2018;98(7):429-36.
8. Towfigh S, Anderson S, Walker A. When it is not a Spigelian hernia: abdominal cutaneous nerve entrapment syndrome. Am Surg. 2013;79(10):1111-4.
9. Khan Z, Zanfagnin V, El-Nashar SA, et al. Risk factors, clinical presentation, and outcomes for abdominal wall endometriosis. J Minim Invasive Gynecol. 2017;24(3):478-84. DOI:10.1016/j.jmig.2017.01.005
10. Karaca B, Tarakci H, Tumer E, et al. Primary abdominal wall actinomycosis. Hernia. 2015;19(6):1015-8. DOI:10.1007/s10029-013-1208-2
11. Maev IV, Cheremushkin SV, Kucheryavyy YA, Cheremushkina NV. Biomarkers In The Diagnosis Of Irritable Bowel Syndrome, What Is The Reality? Experimental and Clinical Gastroenterology. 2018;10:86-91 (in Russian). DOI:10.31146/1682-8658-ecg-158-10-86-91
12. Katsumata R, Shiotani A, Murao T, et al. The TPH1 rs211105 gene polymorphism affects abdominal symptoms and quality of life of diarrhea-predominant irritable bowel syndrome. J Clin Biochem Nutr. 2018;62(3):270-6. DOI:10.3164/jcbn.17-76
13. Drossman DA. Functional Gastrointestinal Disorders: History, Pathophysiology, Clinical Features and Rome IV. Gastroenterology. 2016: S0016-5085(16)00223-7. DOI:10.1053/j.gastro.2016.02.032
14. Meerveld BG, Johnson AC. Mechanisms of Stress-induced Visceral Pain. J Neurogastroenterol Motil. 2018;24(1):7-18. DOI:10.5056/jnm17137
15. Szymaszkiewicz A, Włodarczyk J, Wasilewski A, et al. Desensitization of transient receptor potential vanilloid type-1 (TRPV1) channel as promising therapy of irritable bowel syndrome: characterization of the action of palvanil in the mouse gastrointestinal tract. Naunyn Schmiedebergs Arch Pharmacol. 2020;393(8):1357-64.
DOI:10.1007/s00210-020-01829-x
16. Balemans D, Boeckxstaens GE, Talavera K, Wouters MM. Transient receptor potential ion channel function in sensory transduction and cellular signaling cascades underlying visceral hypersensitivity. Am J Physiol Gastrointest Liver Physiol. 2017;312(6):G635-48. DOI:10.1152/ajpgi.00401.2016
17. Szymaszkiewicz A, Włodarczyk J, Wasilewski A, et al. Desensitization of transient receptor potential vanilloid type-1 (TRPV1) channel as promising therapy of irritable bowel syndrome: characterization of the action of palvanil in the mouse gastrointestinal tract. Naunyn Schmiedebergs Arch Pharmacol. 2020;393(8):1357-64.
DOI:10.1007/s00210-020-01829-x
18. Parfenov AI. Bolezni ileotsekal'noi oblasti. Moscow: Anacharsis, 2005 (in Russian).
19. Loginov AS, Parfenov AI. Bolezni kishechnika. Rukovodstvo dlia vrachei. Moscow: Meditsina, 2000 (in Russian).
20. Parfenov AI. Enteropatiia s narusheniiem membrannogo pishchevareniia. 2-e izd. Moscow: Medkongress, 2022; p. 244 (in Russian).
21. Magidson PD, Martinez JP. Abdominal pain in the geriatric patient. Emerg Med Clin North Am. 2016;34(3):559-74. DOI:10.1016/j.emc.2016.04.008
22. Dong WZ, Zou DW, Li ZS, et al. Study of visceral hypersensitivity in irritable bowel syndrome. Chin J Dig Dis. 2004;5(3):103-9. DOI:10.1111/j.1443-9573.2004.00168.x
23. Makarova AA, Dyukova GM, Ruchkina IN, et al. Visceral sensitivity in the diagnosis and treatment of severe irritable bowel syndrome. Terapevticheskii Arkhiv (Ter. Arkh.). 2022;94(2S):356-61 (in Russian). DOI:10.26442/00403660.2022.02.201394
24. Laird KT, Tanner-Smith EE, Russell AC, et al. Comparative efficacy of psychological therapies for improving mental health and daily functioning in irritable bowel syndrome: A systematic review and metaanalysis. Clin Psychol Rev. 2017;51:142-52. DOI:10.1016/j.cpr.2016.11.001
25. Salehian R, Mokhtare M, Ghanbari Jolfaei A, Noorian R. Investigation the Effectiveness of Duloxetine in Quality of Life and Symptoms of Patients with Irritable Bowel Syndrome. Adv Biomed Res. 2021;10:14. DOI:10.4103/abr.abr_247_20

Авторы

А.И. Парфенов*

ГБУЗ «Московский клинический научно-практический центр им. А.С. Логинова» Департамента здравоохранения г. Москвы, Москва, Россия
*asfold@mail.ru

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Asfold I. Parfenov*

Loginov Moscow Clinical Scientific Center, Moscow, Russia
*asfold@mail.ru

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