Diagnosis and treatment strategies of traditional Chinese and Western medicine with abdominal pain
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摘要: 腹痛是一种常见的疾病表现形式，是门诊和急诊常见的症状之一。腹痛发病原因复杂，有内科腹痛、外科腹痛、妇科腹痛等，病情不典型和不易诊断是“腹痛”的特点。有些器质性腹痛，甚至可能危及患者生命。全科医生作为居民健康的“守门人”，特别是中西医结合的全科医生，对于腹痛的诊疗有一定的风险。本研究从中西医全科医学教学的角度，分析、总结腹痛的常见病因，并通过国内外相关文献梳理腹痛的诊治策略，以期帮助学习中西医全科医学的学生早期认识“腹痛”、了解“腹痛”、诊断“腹痛”，避免出现误诊、漏诊等不良后果。在诊治腹痛过程中，建议要通过“望闻问切查”五诊来评估病情。评估腹痛常见病因，鉴别危急重症，避免在腹痛的诊治过程中出现漏诊或者误诊的情况。对于以腹痛为表现的致命性疾病，需要在确保患者生命安全的基础上对症处理，第一时间转至上级医院诊治。建议根据腹痛患者的表现建立思维导图，按照中西医结合、中西医并用、中西医并重的思路对疾病进行诊疗。对于其所患腹痛的病因、诊疗方案、预后、调护等情况与患者进行沟通，以减少患者的担心，与患者建立信任、和谐的医患关系。Abstract: Abdominal pain is a common form of disease presentation and is one of the most common symptoms in outpatient and emergency. The causes of abdominal pain are complex and include medical abdominal pain, surgical abdominal pain, gynecological abdominal pain, etc. The atypical nature of the condition and the difficulty in diagnosing are the features of "abdominal pain". Some organic abdominal pains can even be life-threatening. As the gatekeeper to the health of the community, general practitioners, especially those who combine Chinese and Western medicine, are exposed to certain risks in the management of abdominal pain. This study is partly conducted to reduce the risks associated with medical treatment, analyzes and summarizes the common causes of abdominal pain from the perspective of a teacher teaching Chinese and Western general medicine, and sorts out strategies for the diagnosis and treatment of abdominal pain through relevant literature at domestic and international levels, so as to help students studying Chinese and Western general medicine to understand "abdominal pain", understand "abdominal pain", diagnose "abdominal pain", and diagnose abdominal pain at the early stage of their studies. The aim is to help students who study Chinese and Western general medicine understand "abdominal pain". In the diagnosis and treatment of abdominal pain, it is recommended that the condition be assessed through the five examinations of "Observation Auscultation and Olfaction, Inquiry, Pulse Feeling and Palpation and checking". It is important to assess the common causes of abdominal pain and to identify critical illnesses to avoid missing or misdiagnosing abdominal pain. In the case of fatal illnesses manifested by abdominal pain, symptomatic management is required to ensure the patients' safety and referral to a higher level hospital as soon as possible. It is recommended that a mind map be created based on the presentation of the patient with abdominal pain, and that the disease be diagnosed according to a combination of Chinese and Western medicine, with both Chinese and Western medicine, and with both Chinese and Western medicine. We should communicate with patients about the causes of their abdominal pain, treatment options, prognosis and care, in order to reduce patients ' worries and establish a trusting and harmonious doctor-patient relationship with them.
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Key words:
- Abdominal pain /
- Chinese and Western medicine /
- General medicine /
- Five diagnoses /
- Strategies
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图 1 急性腹痛患者诊断路径指南
Figure 1. Guidelines for the diagnostic pathway of acute abdominal pain patients
图 2 慢性腹痛基层诊疗指南
注：报警征象包括年龄>40岁、便血、粪便隐血阳性、贫血、腹部包块、腹腔积液、发热、体重下降、胃肠道肿瘤家族史等；生理事件包括进食、排便、月经等；初步筛查包括外周血常规、尿常规、粪便常规和隐血、肝肾功能、甲状腺功能、ESR或CRP、肿瘤标志物(CA19-9、CEA、CA125)以及腹部彩超。
Figure 2. Primary care guidelines for the diagnosis and treatment of vhronic abdominal pain
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