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成人腹痛的鉴别诊断

Authors
Mary B Fishman, MD
Mark D Aronson, MD
Section Editor
Robert H Fletcher, MD, MSc
Deputy Editor
Lee Park, MD, MPH
Translators
高茹, 主任医师，副教授

引言

对于腹痛的评估，需要了解导致腹痛的可能机制、常见病因的普遍差别，并能够识别不同腹痛的典型模式和临床表现。并非所有的腹痛患者都有典型的临床表现。因此，必须要考虑到引起腹痛的不常见原因，特别是对于年龄较大成人和免疫功能受损的患者。

一项急性腹痛的流行病学评估发现，以腹痛为主诉而到初级保健医生门诊进行首诊的患者可以分为10个诊断组：全腹痛、上腹痛、右肋下痛、左肋下痛、右侧腰痛、左侧腰痛、脐周痛、右下腹痛、中下腹痛和左下腹痛(表 1)[1]。采集病史及体格检查的总体敏感性较差。胃十二指肠疾病引起的上腹痛、肝胆疾病引起的右肋下痛，以及妇科疾病引起的中下腹痛患者中的特异性最高。

本专题将概述腹痛患者的发病机制和鉴别诊断。腹痛特定病因和初始治疗的详细讨论参见其他专题。成人腹痛患者的详细病史和体格检查也将单独讨论。

许多腹痛患者都会出现某种功能异常，如肠易激综合征(irritable bowel syndrome, IBS)或功能性消化不良。对大多数腹痛患者及旨在从更多的有着严重病因的腹痛中鉴别出功能异常的恰当诊断方法也参见其他专题。 (参见“成年人腹痛的诊断方法”)

腹痛的神经病学基础

腹部的疼痛感受器会对机械和化学刺激产生应答。牵张是参与内脏伤害性感受的主要机械刺激，但膨胀、挛缩、牵引、压缩和扭转也可被感知[2]。接受这些感觉的内脏感受器位于浆膜表层、肠系膜内和空腔脏器壁内(存在于黏膜肌层和黏膜下层之间)。

                                                    

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Literature review current through: 2017-06 . | This topic last updated: 2016-02-22.
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