Viszerale Pathologie als Ursache für diffuse Schmerzen bei einem komplexen Schmerzgeschehen

Zusammenfassung

Eine 75-jährige Patientin, die bereits seit 2 Monaten wegen fortgeschrittener, symptomatischer Hüftarthrose links und Lendenwirbelsäulenschmerzen in regelmäßiger physiotherapeutischer Behandlung ist, muss einen Termin absagen, da sie wegen starker Übelkeit und Erbrechen ins Krankenhaus eingeliefert wurde. Die Patientin gibt an, in der letzten Woche eigenständig vermehrt Schmerztabletten ohne zusätzlichen Magenschutz genommen zu haben. Sie wird im Krankenhaus internistisch abgeklärt und auch eine zusätzlich durchgeführte Magnetresonanztomografie an der Lendenwirbelsäule zeigt keine relevanten Befunde. Einige Tage später ruft die Patientin den Therapeuten erneut an und beschreibt, dass sie seit 2 Tagen an akuten, diffusen, krampfartigen und bewegungsunabhängigen Schmerzen oberhalb der linken Leiste leidet. Da der Therapeut einen viszeralen Schmerzmechanismus vermutet, rät er der Patientin zur dringenden ärztlichen Abklärung. Eine noch am selben Tag durchgeführte Untersuchung bei einem Facharzt für Viszeralchirurgie ergibt die Diagnose Divertikulitis.

Abstract

A 75-year-old female patient has already received regular physiotherapy treatment for 2 months due to advanced symptomatic osteoarthritis of the left hip and lower back pain, when she has to cancel a treatment session because she was admitted into hospital for severe nausea and vomiting. The patient states that she has been self-medicating with analgesics more frequently over the last week, without using additional stomach protection. Internalist evaluation at the hospital and an additional MRI of the lumbar spine yield no relevant findings. A few days later, the patient calls her therapist again and describes that, for the last 2 days, she has also been suffering from acute, diffuse, spasmodic and motion-independent pains above the left groin. Suspecting a visceral pain mechanism, the therapist advises the patient to urgently seek medical evaluation. An examination carried out by a specialist for visceral surgery on the same day results in the patient being diagnosed with diverticulitis.

Schlüsselwörter

Red Flags - Differenzialdiagnose - klinische Entscheidungsprozesse - Physiotherapie

Key words

Red Flags - differential diagnosis - clinical reasoning - physiotherapy

Publication History

Received: 07 July 2022

Accepted: 24 August 2022

Article published online:
13 February 2023

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