WordNet
- a pain that is felt (as when the area is touched); "the best results are generally obtained by inserting the needle into the point of maximum tenderness"; "after taking a cold, rawness of the larynx and trachea come on" (同)soreness, rawness
- a tendency to express warm and affectionate feeling
- warm compassionate feelings (同)tenderheartedness
- a reaction to a crisis or setback or frustration; "he is still on the rebound from his wifes death"
- the act of securing possession of the rebounding basketball after a missed shot
PrepTutorEJDIC
- 柔らかさ;か弱さ / 感じやすさ,敏感 / 《時に a ~》優しさ,親切,慈愛
- (…から)〈物体が〉はね返る《+『from』+『名』》 / (自分に)〈したこと[の報]が〉はね返る《『on』(『upon』)one『self』》 / はね返り
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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2013/12/02 15:55:12」(JST)
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- 1. Causes of abdominal pain in adults
- 2. Evaluation of the adult with abdominal pain
- 3. 救急外来における成人の腹痛の評価 evaluation of the adult with abdominal pain in the emergency department
- 4. 小児における急性虫垂炎：臨床症状および診断 acute appendicitis in children clinical manifestations and diagnosis
- 5. 腹膜透析における腹膜炎の臨床症状および診断 clinical manifestations and diagnosis of peritonitis in peritoneal dialysis
English Journal
- Early endovascular treatment of superior mesenteric occlusion secondary to thromboemboli.
- Jia Z1, Jiang G2, Tian F1, Zhao J1, Li S1, Wang K1, Wang Y1, Jiang L1, Wang W3.Author information 1Department of Interventional Radiography, The Second Hospital of Changzhou Affiliated to Nanjing Medical University, Jiangsu Province, China.2Department of Interventional Radiography, The Second Hospital of Changzhou Affiliated to Nanjing Medical University, Jiangsu Province, China. Electronic address: 747094035@qq.com.3Imaging Institute, Section of Interventional Radiology, Cleveland Clinic, Cleveland, OH, USA.AbstractOBJECTIVE: To evaluate our early experience with endovascular revascularization in patients with acute thromboembolic occlusion of the superior mesenteric artery (SMA).
- European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery.Eur J Vasc Endovasc Surg.2014 Feb;47(2):196-203. doi: 10.1016/j.ejvs.2013.09.025. Epub 2013 Oct 2.
- OBJECTIVE: To evaluate our early experience with endovascular revascularization in patients with acute thromboembolic occlusion of the superior mesenteric artery (SMA).METHODS: A retrospective review was conducted of all patients who underwent endovascular revascularization for acute thromboembolic
- PMID 24183620
- Does usage of peritonism tests in an emergency department have any benefit?
- Akdur O1, Durukan P, Ozkan S, M Sozuer E, Avsarogullari L, Ikizceli I.Author information 11Department of Emergency Medicine, Canakkale Onsekiz Mart University Medical School, Canakkale, 2Erciyes University Medical School, Departments of Emergency Medicine, Kayseri, Turkey, 3Department of Emergency Medicine,Istanbul University Cerrahpasa Medical School; Istanbul, Turkey.AbstractAim To evaluate the usage of inspiration, expiration, cough, and heel drop jarring tests that are applied for determination of peritonism in cases with acute abdominal pain. Methods A prospective study based on observation of patients between 16-65 years of age and presented to the Emergency Department within a 3-month period starting from June 2007, was conducted. The patients were asked to rate their pain level between "0" and "10". Following the measurement of the vital signs, 4 tests were conducted by an emergency medicine resident. The medical records of all the patients were reviewed after 3 months. Data concerning clinical diagnosis, hospital admission and discharge processes, and surgical results, were all recorded. Results Seventy-seven patients had peritonism tests performed. Inspiration test was positive in 29 (of 51, 56.9%) patients admitted to the hospital. However, there was no correlation between the cases admitted to the hospital and the other 3 tests (p more than 0.05). Twenty-one (of 34, 61.8%) patients which have been subjected to surgical treatment, showed positive inspiration test results. Surgical treatment was performed on nine (of 11, 81.8%) patients who showed positive results for all 4 tests. Conclusion The applied tests are helpful in determining a serious abdominal disease, particularly alongside findings of rebound, tenderness, and laboratory results.
- Medicinski glasnik : official publication of the Medical Association of Zenica-Doboj Canton, Bosnia and Herzegovina.Med Glas (Zenica).2014 Feb;11(1):105-9.
- Aim To evaluate the usage of inspiration, expiration, cough, and heel drop jarring tests that are applied for determination of peritonism in cases with acute abdominal pain. Methods A prospective study based on observation of patients between 16-65 years of age and presented to the Emergency Departm
- PMID 24496349
Japanese Journal
- 尿膜管癌より発生した腹膜偽粘液腫の1例
- 中村 健治,寺田 直樹,清水 洋祐,小林 恭,杉野 善雄,山崎 俊成,松井 喜之,今村 正明,大久保 和俊,神波 大己,吉村 耕治,小川 修
- 泌尿器科紀要 59(10), 657-662, 2013-10-00
- … Peritonitis was suspected because of the existence of free air and abdominal rebound tenderness, and emergent surgery was performed. …
- NAID 120005347155
- 急性腹症で発症した小児Meckel憩室茎捻転の1例
- 三谷 泰之,瀧藤 克也,渡邉 高士 [他],中森 幹人,山上 裕機
- 日本小児外科学会雑誌 48(7), 1051-1054, 2012-12-20
- 症例は4歳,男児.腹痛と嘔吐を主訴に近医を受診し,腸炎の診断で点滴治療が行われた.その後も症状が持続し,右下腹部を中心とした強い圧痛を認めるようになり,当院に緊急紹介となった.感染性腸炎によるイレウスの診断で入院となり保存的治療を行った.入院翌日の朝になり腹膜刺激症状が出現し,腹部CTで小腸の拡張と右下腹部に嚢胞性の病変を認めた.急性虫垂炎の穿孔による膿瘍形成や小腸重複症の感染などを考え緊急手術を …
- NAID 110009562252
- Omental Infarction Triggered by Tight Pants
- Ishimaru Naoto,Maeno Tetsuhiro
- Internal Medicine 51(16), 2235-2237, 2012
- … A 75-year-old woman presented with acute lower abdominal and left flank pain with rebound tenderness. …
- NAID 130002062309
Related Links
- tenderness /ten·der·ness/ (ten´der-nes) a state of unusual sensitivity to touch or pressure. rebound tenderness a state in which pain is felt on the release of pressure over a part. rebound tenderness n. Pain or tenderness that occurs ...
- 2008年9月18日 ... 腹膜刺激症状を見る一つの手段として「 Rebound tenderness （反跳痛or反跳圧痛）」 があります。聞いたことのない学生はいないのではないかと思われるほど広く知れた もので、これがあったら一大事。腹膜炎だ！
Related Pictures
★リンクテーブル★
| リンク元 | 「急性虫垂炎」「腹膜炎」「ブルンベルグ徴候」 |
| 関連記事 | 「tenderness」「rebound」 |
「急性虫垂炎」
身体所見
- 圧痛点：
- ローゼンシュタイン徴候 Rosenstein徴候：左側臥位でMcBurney点を圧迫すると仰臥位よりも疼痛が増強する。
- ロブシング徴候 Rovsing徴候：仰臥位で下行結腸を下部より上方に押し上げるように手掌で圧迫し回盲部を充満させると回盲部に痛みが誘発される。
- ブルンベルグ徴候 Blumberg徴候：反跳痛。腹膜炎
- obturator sign：骨盤内炎症。右股関節を内転時に疼痛誘発。
- psoas sign：腸腰筋の炎症。右大腿の伸展で右下腹部痛誘発。
- Dunphy's sign：咳き込んで右下腹部痛誘発。
- tapping pain：腹膜刺激症状
- heel drop sign：腹膜刺激症状
虫垂炎、身体診察のの感度、特異度
- SEN、SPE
- psoas sign ：16％、95％
- ブルンベルグ徴候：63％、69％ (*1)
- heel drop sign：93％
症状
- 先駆症状：腹痛、悪心・嘔吐
- 腹痛：心窩部・臍部の鈍い間欠的疼痛(内臓痛) → 右下腹部に限局する持続的疼痛(体性痛)
- 発熱
- 嘔吐
合併症
検査
- 血液検査
- 腹部単純X線検査
- 腹部超音波検査
- 腹部CT検査
鑑別疾患
- 消化器系：憩室炎、クローン病、大腸癌、stump appendicitis、結腸垂捻転・結腸垂炎
- 泌尿器系：尿路結石(膀胱尿管移行部の右尿管結石)、精巣捻転
- 婦人科系：骨盤内炎症疾患、卵巣出血、子宮外妊娠、付属器炎、子宮内膜症、(妊婦)切迫流産、絨毛膜羊膜炎、常位胎盤早期剥離
診断
- Alvaradoスコア「MANTRELS」：7点以上で虫垂炎疑い
| M | migration of pain | 心窩部・臍傍部から右下腹部への痛みの移動 | 1 |
| A | anorexia | 食欲不振 | 1 |
| N | nausea | 嘔気嘔吐 | 1 |
| T | tenderness in RLQ | 右下腹部圧痛 | 1 |
| R | rebound tenderness | 反跳痛 | 2 |
| E | elevated temperature | 37.3℃以上の発熱 | 1 |
| L | leukocytosis | WBC>1万/μl, 白血球増多 | 2 |
| S | shift of WBC | 白血球の左方移動 | 1 |
治療
- カタル性、化膿性・蜂窩織炎性、壊疽性それぞれに合わせた治療を行う。
- 腹膜刺激症状があればほぼ緊急開腹手術となる。
国試
参考
- 1. 虫垂炎の診断
「腹膜炎」
- 英
- peritonitis
- 関
- 腹膜
| sensitivity(%) | specificity(%) | positive likehood ratio | |
| garding | 13～69 | 56～97 | 2.6 |
| rigidity | 6～31 | 96～100 | 5.1 |
| rebound tenderness | 40～95 | 20～89 | 2.1 |
| rectal tenderness | 20～53 | 41～96 | n.s. |
| positive abdominal wall tenderness test | 1～5 | 32～72 | 0.1 |
国試
「ブルンベルグ徴候」
- 英
- Blumberg sign, Blumberg's sign
- 同
- Blumberg徴候
- 反跳圧痛 反跳痛 rebound tenderness
- 関
- [[]]
- 同
- Blumberg Sign
- 腹膜刺激症状
- 腹膜炎を示唆
-Blumberg徴候
「tenderness」
- n
- 柔らかさ
- 敏感。扱いにくさ
- 優しさ、愛情
- 圧痛
「rebound」
- 関
- recoil