Tag Archives: Pain

What Are the Symptoms of Refractory Wounds?

A refractory (hard-to-heal) wound is defined as any break in skin or mucosa that fails to move through an orderly reparative sequence and remains open beyond 4–6 weeks despite standard care. The wound itself and the surrounding tissues display a characteristic set of changes.

Persistent open wound bed
Granulation tissue is pale, flat or “pocket-like” instead of beefy red and raised; epithelial margins fail to advance and may become rolled or calloused .
Excessive moisture or oozing
Continuous serous or purulent discharge macerates perilesional skin, increases odour and demands frequent dressing changes .
Pain and malodour
Deep, throbbing pain is common; an unpleasant smell develops when bacterial load rises or necrotic slough is present, often leading to social isolation .
Recurrent bleeding & fragile tissue
Minimal trauma causes pinpoint bleeding; capillaries in the wound bed are fragile and rupture easily during debridement .
Peri-wound changes
Surrounding skin becomes indurated, hyperkeratotic or shows brown haemosiderin staining (venous disease) or shiny hairless atrophy (arterial disease) .
Signs of critical colonisation / infection
Increase in exudate, change to grey-yellow slough, spreading erythema, new satellite lesions, low-grade fever or leucocytosis herald bacterial biofilm formation .
Functional limitation
Location on foot, sacrum or leg can restrict walking, sitting or sleep; chronic inflammation and malnutrition produce fatigue and weight loss .

Early recognition allows correction of underlying causes (ischaemia, diabetes, oedema, malnutrition) and adoption of advanced therapies before complications such as cellulitis, osteomyelitis or sepsis develop.

Symptom / Sign	Typical Features
Non-healing bed	Pale, flat granulation; rolled edges
Heavy exudate	Serous / purulent; macerates skin
Pain & odour	Throbbing; foul smell when infected
Easy bleeding	Fragile capillaries, pinpoint spots
Peri-wound skin	Induration, staining, atrophy
Colonisation clues	Grey slough, redness, satellite lesions
Functional loss	Limits mobility, disturbs sleep

What Are the Symptoms of Abdominal Trauma?

Abdominal trauma is any blunt or penetrating injury that damages structures within the abdominal cavity. Clinical pictures range from subtle discomfort to life-threatening hemorrhage or peritonitis; key pointers are listed below.

Abdominal pain and tenderness
Pain is present in almost every case, but its intensity can mislead: severe organ injury may cause only mild ache, while apparently trivial wounds sometimes produce marked discomfort. Localized tenderness on palpation, guarding, or rebound pain suggests peritoneal irritation .
External marks
Bruises, abrasions, seat-belt imprints, stab wounds or bullet holes over the abdomen, flank or back provide visible evidence of impact and raise suspicion for deeper damage .
Swelling and distension
Progressive abdominal distension may indicate accumulating blood, bile, urine or intestinal contents. A rigid, board-like abdomen implies significant intraperitoneal bleeding or spillage of enteric contents .
Shoulder-tip pain
Irritation of the diaphragm by free blood or fluid can produce referred pain at the tip of either shoulder, especially when the patient lies supine .
Hypovolaemic and haemorrhagic signs
Tachycardia, hypotension, cool peripheries, pallor and narrowing pulse pressure follow major solid-organ (spleen, liver, major vessel) laceration. Delayed shock may appear hours after the initial event as contained haematomas rupture .
Gastro-intestinal symptoms
Nausea, vomiting and absent bowel sounds are common with bowel perforation or mesenteric injury. Subsequent fever and leukocytosis herald peritonitis.
Urinary changes
Haematuria, flank pain or inability to void suggests renal, ureteric or bladder trauma. Penetrating wounds at any level between the nipples and the perineum can injure intra-abdominal organs.
Neurological overlay
Head injury, intoxication or distracting fractures may mask abdominal findings; repeated examination is mandatory.

Because clinical signs can be subtle in the early phase, any patient with a suggestive mechanism plus pain, tenderness or unexplained hypotension requires urgent imaging and surgical review.

Symptom / Sign	Typical Meaning
Abdominal pain ± guarding	Peritoneal irritation, organ injury
Bruises, seat-belt sign	External evidence of force
Distension / rigidity	Haemoperitoneum, bowel spillage
Shoulder-tip pain	Diaphragmatic irritation from free fluid
Tachycardia, hypotension	Significant haemorrhage
Nausea, vomiting, ileus	Bowel or mesenteric damage
Haematuria / flank pain	Genito-urinary tract injury
Delayed shock	Expanding or ruptured haematoma

What Are the Symptoms of Retroperitoneal Fibrosis?

Retroperitoneal fibrosis is a rare disorder in which fibrous tissue proliferates in the retroperitoneal space, gradually encasing the abdominal aorta, ureters, and adjacent structures. Onset is insidious and early complaints are non-specific, so diagnosis is often delayed.

Dull, persistent pain
Deep, aching discomfort is the most frequent first symptom. Pain is usually felt in the flank, lower back, or iliac fossa, may radiate to the groin or anterior thigh, and is characteristically unrelieved by rest or change of posture; NSAIDs give only temporary relief.
Constitutional symptoms
Low-grade fever, fatigue, anorexia, weight loss, and general malaise accompany the inflammatory phase in more than half of patients.
Urinary manifestations
Encasement of the ureters leads to obstructive uropathy: flank colic, frequency, urgency, oliguria, or anuria. Painless bilateral hydronephrosis is common and, if untreated, may progress to azotaemia and renal failure.
Genital-oedematous signs
Males often note testicular or scrotal pain, hydrocele, or varicocele, while compression of iliac veins can produce unilateral or bilateral leg oedema, superficial thrombophlebitis, or even deep-vein thrombosis.
Vascular sequelae
Involvement of the aortic wall or renal arteries may cause renovascular hypertension; lower-limb claudication or intestinal angina appear when iliac or mesenteric vessels are narrowed.
Gastro-intestinal upset
Constipation, vague abdominal fullness, or, less often, sub-occlusive episodes occur if duodenal or mesenteric encasement develops. Rarely, bile-duct compression presents as obstructive jaundice.

Because findings are initially subtle, any combination of unexplained back/flank pain, constitutional decline, and urinary or oedematous changes should raise suspicion and prompt imaging to prevent irreversible renal damage.

Key Symptom / Sign	Typical Features
Pain	Dull, deep, flank/back → groin/thigh; nocturnal accentuation
Constitutional	Low-grade fever, fatigue, weight loss, anorexia
Urinary obstruction	Colic, frequency, oliguria, bilateral hydronephrosis
Genital / limb oedema	Testicular pain, hydrocele, leg swelling, thrombophlebitis
Vascular compromise	New hypertension, claudication, intestinal ischaemia
Gastro-intestinal	Constipation, sub-occlusion, rarely obstructive jaundice

What Are the Symptoms of Psoas Abscess

Psoas abscess is a purulent collection within the psoas muscle, usually spreading from spinal, urinary, or gastrointestinal infections. Clinical presentation is often insidious and easily missed:

“Flank” or lower-back pain
Dull, persistent ache that radiates to the anterior hip or groin; movement, walking, or hip extension markedly worsens the pain.
Flexion contracture of the hip
Involuntary flexion and external rotation relieve tension on the psoas sheath, so patients walk with a limp or cannot fully straighten the leg.
Palpable or visible mass
A tender, sausage-shaped swelling may be felt below the inguinal ligament or in the lateral flank, especially if the abscess is large.
Fever and night sweats
Low-grade or spiking pyrexia, chills, and drenching sweats are common; elderly or immunosuppressed patients may be afebrile.
Leukocytosis and raised inflammatory markers
Blood tests usually show neutrophilia, elevated CRP and ESR; these indices help monitor treatment response.
Compressive neuropathy
Extension into the iliac fossa can compress the femoral or obturator nerve, causing thigh numbness, weakness, or referred knee pain.
Systemic toxicity
Persistent bacteraemia may lead to tachycardia, hypotension, and multi-organ dysfunction if drainage is delayed.

Because pain is referred to the hip, the diagnosis is often confused with arthritis, disc herniation, or appendicitis. Any patient with back/hip pain, flexed hip posture, and fever merits urgent spinal/abdomen CT or MRI to confirm the collection and guide percutaneous or surgical drainage.

Symptom	Typical Pattern	Complication Flags
Pain	Flank → groin, hip flexion relieves	Severe, bilateral, sciatica
Hip	Fixed flexion, limp	Contracture, nerve palsy
Mass	Tender “sausage” in groin	Rapid enlargement
Fever	Spiking, night sweats	Rigors, hypotension
Labs	↑WCC, ↑CRP, ↑ESR	Rising despite antibiotics
Systemic	Malaise, weight loss	Sepsis, multi-organ failure

What Are the Symptoms of Pancreatic Cysts

Pancreatic cysts are fluid-filled sacs that form within or on the surface of the pancreas. Most small cysts cause no complaints and are found incidentally during scans for other problems. When symptoms occur they usually reflect cyst size, location, or complications such as infection, bleeding, or malignant change:

Persistent upper-abdominal pain
Dull ache or pressure that may radiate straight through to the back; often worse after fatty meals and sometimes steadily increasing over weeks.
Early satiety and bloating
A feeling of fullness after a few bites, belching, and visible abdominal distension when the cyst compresses the stomach or duodenum.
Nausea and vomiting
Intermittent queasiness or frank vomiting, especially if the cyst obstructes the gastric outlet or pancreatic duct.
Unintended weight loss
Fear of pain or true malabsorption from associated pancreatic exocrine insufficiency leads to gradual weight decline.
Jaundice
Yellow sclerae, dark urine and pale stools appear when a cyst in the pancreatic head compresses the common bile duct .
Palpable mass
A large cyst may be felt as a smooth, non-tender upper-abdominal swelling that moves little with respiration.
Acute complications
Sudden severe pain, fever, or shock suggest rupture, infection, or bleeding into the cyst; this is a surgical emergency.

Any new upper-abdominal pain accompanied by fullness, weight loss, or jaundice warrants contrast-enhanced CT or MRI to characterise the cyst and guide further management.

Symptom	Typical Pattern	Alarm for Complication
Pain	Upper abdomen → back, persistent	Sudden increase ± fever
Fullness	Early satiety, bloating	Vomiting, obstruction
Weight	Gradual loss	Rapid decline
Jaundice	Painless, progressive	Itching, dark urine
Mass	Smooth, non-tender	Rapid enlargement
Systemic	Well between meals	Fever, hypotension

What Are the Symptoms of Gallbladder Stones

Gallbladder stones (cholelithiasis) can remain silent for years, but when they obstruct the cystic duct or migrate into the bile duct they produce a characteristic symptom cluster:

Biliary colic
Sudden, steady pain in the right upper quadrant or epigastrium builds over 15–30 minutes, lasts 30 min – several hours, and may radiate to the right shoulder or back; it is not relieved by positional change, bowel movement, or antacids .
Post-prandial trigger
Pain typically follows a fatty or large meal as gall-bladder contraction forces a stone against the duct opening .
Nausea and vomiting
Gastric stasis and vagal stimulation produce pronounced nausea with occasional bilious vomiting that accompanies rather than precedes the pain .
Epigastric bloating and belching
Patients describe a tight, gassy sensation and frequent sour eructation that mimics dyspepsia.
Intolerance to fatty foods
Fear of post-meal pain leads to voluntary fat avoidance and sometimes weight loss.
Complication signs
Persistent pain >6 h, high fever, jaundice, dark urine and pale stools suggest stone migration into the common bile duct with possible cholangitis or pancreatitis and require urgent care .

Any recurrent upper-abdominal pain related to meals should prompt abdominal ultrasound and liver-function tests to confirm the diagnosis and plan early cholecystectomy.

Symptom	Typical Pattern	Alarm for Complication
Pain	RUQ/epigastric, 30 min–hours, radiates to shoulder	>6 h, constant, severe
Nausea/vomiting	Follows onset of pain	Persistent with fever
Food trigger	Fatty meal, large dinner	—
Bowel	Bloating, belching	Pale stool, dark urine
Fever	Absent in simple colic	Present with jaundice
Systemic	Well between attacks	Rigors, hypotension

What Are the Symptoms of Femoral Hernia

A femoral hernia occurs when tissue bulges through the femoral canal below the inguinal ligament, most often in women. Because the canal opening is narrow, symptoms can be subtle at first but may progress rapidly.

Visible or palpable lump
A small, round swelling appears in the upper thigh or groin crease; it usually emerges on standing, coughing, or lifting and may disappear when lying down .
Groin or thigh discomfort
Aching, burning, or a heavy “pulling” sensation that worsens with prolonged standing, lifting, or straining at stool .
Pain radiating down the leg
Pressure on nearby nerves can shoot pain into the inner thigh or downward toward the knee .
Bowel / urinary pressure symptoms
Feeling of fullness, early satiety, or slight difficulty voiding if the hernia compresses the bladder or rectum .
Irreducibility
Unlike inguinal hernias, femoral hernias are often difficult to push back manually and may remain out, predisposing to incarceration .
Incarceration & strangulation flags
Sudden severe pain, nausea, vomiting, constipation, and a firm, tender, non-reducible mass with overlying skin redness or purple discoloration indicate vascular compromise and demand emergency surgery .

Any new groin lump in a woman, especially if painful or irreducible, should be evaluated promptly with ultrasound or CT.

Symptom	Typical Pattern	Alarm for Strangulation
Lump	Upper thigh/groin, small, appears on standing	Red, hard, non-reducible
Pain	Aching, worse with lift/strain	Sudden, severe, constant
Radiation	Inner thigh, knee	—
Bowel	Fullness, constipation	Obstruction, no flatus
Systemic	None	Nausea, vomiting, fever

What Are the Symptoms of Intestinal Volvulus

Intestinal volvulus is a complete twisting of a loop of bowel around its mesenteric axis, producing sudden obstruction and rapid vascular compromise. Symptoms are dramatic and progress quickly:

Explosive colicky pain
Severe, continuous abdominal pain starts abruptly and escalates; patients often writhe and cannot find relief .
Projectile vomiting
Gastric and then bilious vomiting occurs early, is profuse, and may eject a meter from the mouth as obstruction becomes high-grade .
Abdominal distension
The affected loop fills with gas and fluid, producing tense, tympanic distension that is tender to palpation.
Absent flatus and stool
Passage of gas and stool ceases; complete obstruction is the rule once the twist exceeds 360°.
Rebound tenderness and guarding
Localised peritonitis signs appear when mural ischemia develops; pain becomes constant and sharper.
Fever and tachycardia
Temperature may remain normal early, but rises quickly with bowel necrosis; pulse >120 beats/min and hypotension herald hypovolemic or septic shock .
Perforation and peritonitis
Sudden diffuse pain, board-like rigidity, and shock indicate perforation—an operative emergency.

Any patient with abrupt severe colic plus bilious vomiting and obstipation should be assumed to have a volvulus until proven otherwise; urgent imaging (CT or bedside ultrasound) and laparotomy are required.

Symptom	Typical Pattern	Alarm for Gangrene/Perforation
Pain	Sudden, severe, colicky → constant	Diffuse, rebound, board-like
Vomiting	Early, bilious, projectile	Feculent if ileus
Distension	Rapid, tympanic	Increasing tenderness
Bowel	No flatus/stool	Absolute obstruction
Vitals	Tachycardia, later fever	Hypotension, shock
Imaging	Twisted loop, free fluid	Free air, pneumatosis

What Are the Symptoms of Intussusception

Intussusception is the telescoping of one segment of bowel into the adjacent distal segment, creating obstruction and potential ischemia. Symptoms differ between infants and adults but share a core pattern:

Paroxysmal abdominal pain
Sudden, severe colic lasting 15–20 minutes recurs with increasing frequency; the infant screams, draws up the knees, or an adult doubles over in pain .
Vomiting
Initially gastric fluid, later bilious, as small-bowel obstruction develops .
“Currant-jelly” stool
Blood mixed with mucus appears after venous congestion of the intussusceptum; it is more common in infants but can occur in adults .
Palpable sausage-shaped mass
The intussuscepted segment may be felt in the right upper or mid-abdomen, especially between spasms in infants .
Lethargy or shock-like state
Infants may become pale, floppy, and apathetic between attacks; adults report fatigue when pain persists for days .
Abdominal distension and guarding
Progressive bloating, hyper-resonance, and localized rebound indicate developing obstruction or peritonitis.
Fever and systemic toxicity
Temperature remains normal early on; high fever, tachycardia, and hypotension suggest bowel necrosis or perforation .

Any infant with intermittent screaming attacks and any adult with unexplained intermittent colic plus vomiting should be imaged urgently with ultrasound or CT to confirm the diagnosis and guide reduction or surgery.

Symptom	Infants (typical)	Adults (often subtle)
Pain	15-20 min colic, knees drawn up	Intermittent cramp, weeks
Vomiting	Early, becomes bilious	Nausea ± bilious
Stool	Currant-jelly blood	Occult or bloody
Mass	Sausage-shaped RUQ	Often impalpable
Consciousness	Lethargy between spasms	Fatigue, weight loss
Fever	Absent early	Late if necrosis
Imaging	US target/doughnut	CT target/pseudokidney

What Are the Symptoms of Linea Alba Hernia (White-Line Hernia)

A linea alba hernia occurs when tissue protrudes through a defect in the midline tendinous seam of the abdominal wall, most commonly at or just above the umbilicus. Because the defect is small and lies between the rectus muscles, symptoms are often subtle but may include:

Midline bulge
A soft, round or fusiform swelling appears along the midline when standing, coughing, or performing sit-ups; it reduces spontaneously when supine.
Local discomfort or ache
A dull, pulling pain is felt precisely at the defect, especially after prolonged standing, lifting, or core exercise; it is relieved by rest and manual pressure.
Tenderness on palpation
Pressure over the linea alba reproduces pain even when the hernia is reduced; fingertip may feel a small slit-like gap (usually 0.5–2 cm).
Heaviness after meals
Some patients note increased fullness or tension in the epigastrium after large meals or carbonated drinks, probably due to raised intra-abdominal pressure.
Absence of skin changes
Overlying skin remains normal; redness, warmth, or rapid enlargement are unusual unless incarceration occurs.
Incarceration/strangulation flags
Sudden sharp pain, nausea, vomiting, and a firm, tender, non-reducible midline mass with skin discoloration indicate compromised contents and mandate emergency evaluation.

Because the bulge is small and may be hidden between rectus muscles, diagnosis often requires ultrasound or dynamic MRI during Valsalva manoeuvre. Any persistent midline swelling or exercise-related epigastric pain should prompt imaging.

Symptom	Typical Pattern	Alarm for Complication
Bulge	Midline, 0.5–2 cm, reduces supine	Non-reducible, enlarging
Pain	Dull ache after exertion	Sudden severe, constant
Tenderness	Localised to defect	Diffuse, rebound
Skin	Normal colour	Red/dusky, edematous
Systemic	Well, no fever	Nausea, vomiting, fever

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Tag Archives: Pain

What Are the Symptoms of Refractory Wounds?

What Are the Symptoms of Abdominal Trauma?

What Are the Symptoms of Retroperitoneal Fibrosis?

What Are the Symptoms of Psoas Abscess

What Are the Symptoms of Pancreatic Cysts

What Are the Symptoms of Gallbladder Stones

What Are the Symptoms of Femoral Hernia

What Are the Symptoms of Intestinal Volvulus

What Are the Symptoms of Intussusception

What Are the Symptoms of Linea Alba Hernia (White-Line Hernia)

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