نسخوږی

**نسخوږی** (يا **نس دردي**) د يوې يا څو وژونکو او يا هم د يوې عادي ناروغې نښه کېدای شي. د نسخوږي څرگنده پېژندنه او تشخيص يو گران کار کېدای شي، دا ځکه چې ډېرې داسې ناروغۍ شته چې د نسخوږي سبب گرځي. په اکثرو ناروغيو کې نسخوږی د عادي او محدوده رنځونو سره راولاړېږي، خو ډېرې داسې خطرناکې ناروغۍ هم شته چې جراحي درملنې ته اړتيا پکې پېښېږي او پداسې وخت کې بايد د ناروغ د درملنې په پروسه کې چټک گام پورته شي.

## توپيري پېژندنه يا تشخيص
*د نس او کولمو اړونده
**التهابي: گاسټرواېنټېرايټس, اپېنډيسايټس, گاسټرايټس, اېسوفيگايټس, ډايورټيکولايټس, د کروهن ناروغي, السېرېټيف کولايټس, مايکروسکوپيک کولايټس
**د بندېدنې اړونده: هرنيا, انټوسوسېپشن, ولوولوس, د جراحۍ وروسته اډهيشنز, تومورونه, د پورتني مېسېنټېرېک آرټري ساينډروم, سخت قبض, بواسير
**د رگونو اړونده: اېمبوليزم, ترومبوسېز, ويندېدنه, د سېکل ژونکې ناروغي, د نس انجاينا, blood vessel compression (such as celiac artery compression syndrome), Postural orthostatic tachycardia syndrome
**هظمي: د معدې زخم, د لکټوز نازغمل, د سېلياک ناروغي, د خوړو الرژي
*د تريخې د غونډال اړونده 
**التهابي: کوليسيسټايټس, کولانجايټس
**بندېدنه: کوليلېتياسېز, تومورونه
*د ځيگر اړونده
**التهابي: هېپټايټس, د ځيگر ابسېس
*د پانکرياس اړونده
**التهابي: پانکرياتايټس
*د پښتورگو او د متيازاړې اړونده
**التهابي: پايلونېفرايټس, د سپوخسې التهاب
**د بندېدنې اړونده: د پښتورگو ډبره, يوروليتياسېس, متيازبندي, تومورونه
**د رگونو اړونده: د پښتورگي د کيڼ رگ راگيرېدنه
*د ښځو د ناروغيو او د زېږون د ناروغيو اړونده
**التهابي: pelvic inflammatory disease
**Mechanical: ovarian torsion
**د اېنډوکراين اړونده: menstruation, Mittelschmerz
**د تومورونو اړونده: اېنډومېټريوسېز, فېبرويډز, اوېري سيسټ, د اوېري سرطان
**د بلاربښت اړونده: څيرېدلی اېکټوپيک بلاربښت, سقط
*د گېډې دېوال
**د عظلي فشار او 
**عظلي انتان
**د عصبي سېگنالونو اړوند دردونو: هرپېس زوسټر, راډيکولايټس په لايم ناروغي کې, د گېډې د جلدي وژي د راگيرېدنې ناروغي (ACNES), ټابېز ډورسالېس
*Referred pain
**from the ټټر: نېمونيا, سږيز اېمبوليزم, د زړه اسکېميکه ناروغي, پيريکارډايټس
**د شمزۍ اړونده: راډيکولايټس
**د جنسي برخو اړونده: testicular torsion
*مېټابوليکي اختلال
**يورېميا, diabetic ketoacidosis, پورفېريا, C1-esterase inhibitor deficiency, adrenal insufficiency, lead poisoning, black widow spider bite, narcotic withdrawal
*د وينې د رگونو اړونده
**aortic dissection, abdominal aortic aneurysm
*د معافيتي غونډال اړونده
**سرکويډوسېز
**واسکولايټس
**familial Mediterranean fever
*ناپېژندلي 
**irritable bowel syndrome (affecting up to 20% of the population, IBS is the most common cause of recurrent, intermittent abdominal pain)

### Acute abdominal pain
Acute abdomen can be defined as severe, persistent abdominal pain of sudden onset that is likely to require surgical intervention to treat its cause. The pain may frequently be associated with nausea and vomiting, abdominal distention, fever and signs of shock. One of the most common conditions associated with acute abdominal pain is acute appendicitis.

**Selected causes of acute abdomen**

*Traumatic : blunt or perforating trauma to the stomach, bowel, spleen, liver, or kidney
*Inflammatory :
** Infections such as appendicitis, cholecystitis, pancreatitis, pyelonephritis, pelvic inflammatory disease, hepatitis, mesenteric adenitis, or a subdiaphragmatic abscess
** Perforation of a peptic ulcer, a diverticulum, or the caecum
** Complications of inflammatory bowel disease such as Crohn's disease or ulcerative colitis
*Mechanical :
**Small bowel obstruction secondary to adhesions caused by previous surgeries, intussusception, hernias, benign or malignant neoplasms
**Large bowel obstruction caused by colorectal cancer, inflammatory bowel disease, volvulus, fecal impaction or hernia
*Vascular : occlusive intestinal ischemia, usually caused by thromboembolism of the superior mesenteric artery

### Recurrent abdominal pain
Recurrent abdominal pain (RAP) occurs in 5–15% of children 6–19 years old. In a community-based study of middle and high school students, 13–17% had weekly abdominal pain. Using criteria for irritable bowel syndrome (IBS), 14% of high school students and 6% of middle school students fit the criteria for adult IBS. As with other difficult to diagnose chronic medical problems, patients with RAP account for a very large number of office visits and medical resources in proportion to their actual numbers.  Most patients with RAP benefit from reassurance and techniques to manage anxiety and stress, which are frequently associated with episodes.

## Diagnostic approach
When a physician assesses a patient to determine the etiology and subsequent treatment for abdominal pain the patient's history of the presenting complaint and physical examination should derive a diagnosis in over 90% of cases.

It is important also for a physician to remember that abdominal pain can be caused by problems outside the abdomen, especially heart attacks and pneumonias which can occasionally present as abdominal pain.

Investigations that would aid diagnosis include
*Blood tests including full blood count, electrolytes, urea, creatinine, liver function tests, pregnancy test, amylase and lipase.
*Urinalysis
*Imaging including erect chest X-ray and plain films of the abdomen
*An electrocardiograph to rule out a heart attack which can occasionally present as abdominal pain

If diagnosis remains unclear after history, examination and basic investigations as above then more advanced investigations may reveal a diagnosis.  These as such would include
*Computed Tomography of the abdomen/pelvis
*Abdominal or pelvic ultrasound
*Endoscopy and colonoscopy (not used for diagnosing acute pain)

## Management
Butylscopolamine (Buscopan) is used to treat crampy abdominal pain with some success.

## References

* Apley J, Naish N: Recurrent abdominal pains: A field survey of 1,000 school children. *Arch Dis Child* 1958;33:165 - 170.
* Chronic Pelvic Pain and Recurrent Abdominal Pain in Female Adolescents
* Boyle JT, Hamel-Lambert J: Biopsychosocial issues in functional abdominal pain. *Pediatr Ann* 2001;30:1.
*http://www.suburbanchicagonews.com/beaconnews/lifestyles/438133,2_5_AU22_DUNCAN_S1.article Stomach ache or abdominal pain can be misdiagnosed.Consult a Gastroenterologist rather than ER doctor if Pain persists more than a day.
*http://a-stomach-pain.com/acute-appedicitis/  Stomach Pain and Conditions.

وېشنيزه:خوږ
وېشنيزه:نس خوږی