Pathophysiology of pain in biliodigestif

Oleh : Aji Prabowo (JIP)

Pembimbing dr. Syaiful Mukhtar Sp.B (K) BD
What is pain ?!?
“PAIN” is defined as an unpleasant sensory and emotional experience arising from
actual or potential tissue damage or described bin terms of such damage (IASP)
(mersskey & bodguk,1994)

Pain is subjective, protective, and it is modified by developmental, behavioural,

personality and cultural factors.
 The pain threshold is the point at which a stimulus is
perceived as pain It does not vary significantly among
healthy people or in the same person over time.

The pain tolerance is expressed as duration of time

or the intensity of pain that an individual will endure
before initiation overt pain responses.
Physiology of Pain

 Nociceptors
 Tranduction
 Stimulus Transmission
 Modulation
 Perception
 Classification of Pain
2. Chronic
1. Acute
Non-malignant
- Injury, trauma, spasm or disease to skin,
- Pain persists beyond the precipitating injury
muscle, somatic structures or viscera;
-MRarely accompanied by autonomic
- Perceived and communicated via peripheral
symptoms
mechanisms (pathways) A delta and C fibers
- Sufferers often fail to demonstrate objective
- Usually subsides quickly as pain producing
evidence of underlying pathology.
stimuli decreases
- Characterized by location-visceral, myofacial,
- Associated with anxiety-(decreases rapidly
or neurologic causes

3.Chronic
Malignant
- Has characteristics of chronic pain as well as
symptoms of acute pain (breakthrough pain).
- Has a definable cause, e.g. tumor recurrence
In treatment, narcotic habituation is generally not a
6
concern.
 Nyeri Cepat
Nyeri lambat
 Terjadi pada stimulasi nosiseptor mekanis dan
 Terjadi pada stimulasi nosiseptor polimodal
suhu
 Disalurkan oleh serat C
 Disalurkan oleh serat A-delta
 Sensai yang ditimbulkan tumpul, panas dan
 Sensai yang ditimblkan menusuk dan tajam
pegal
 Lokasi mudah diketahui
 Lokasi tidak jelas
 Muncul pertama kali
 Menetap lebih lama dan lebih tidak
menyenangkan
 Intenisty Pain
behaviours

Aggravating
Timing Characteristics and

of pain alleviating
factors

Personal
Location Quality
meaning
INSTRUMENTS FOR ASSESSING PAIN
PERCEPTION
 Somatic Pain
• Aching, often constant
• May be dull or sharp
• Often worse with movement
• Well localized
• Skin, Muscle, Joints, superficial
or deep.
Eg:
– Bone & soft tissue
– chest wall

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 Visceral Pain
• Constant or crampy
• Aching, burning
• Poorly localized
• Referred
• Organs of Thorax & Abdominal
Cavity. Usually as a result of
stretching, infiltration and
compression
Eg/
– CA pancreas
– Liver capsule distension
– Bowel obstruction 14
Biliodigestif Pain

Nyeri persisten, bersifat

episodic, timbul tanpa pencetus
dan sering pada malam hari.

Kolik bilier mulai secara tiba-tiba dan

intensitasnya meningkat tajam dalam
interval 15 menit ke suatu plaeau
yang menetap selama 3-5 jam

Nyeri bersifat ber bertahan/menetap

dan tidak bergelombang.dan nyeri
mereda perlahan.
Biliary colic episodes are sporadic and unexpected. The
patient localizes in the epigastric or upper right quadrant
and may radiate to the right scapular end (Collins sign).

Biliary colic occurs when gallstones or deposits happen to have

an impact on the cystic duct during gallbladder contractions,
increasing tension in the gallbladder wall. In most cases, the
pain heals for more than 30 to 90 minutes because the bag of
relaxation and obstruction subsides.
Thank You