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					著：横江正道（名古屋第二赤十字病院第二総合内科部長）
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				<ul class="property"><li class="disc">A5判・288頁・2色刷</li><li class="disc">ISBN&nbsp;978-4-8306-1030-1</li><li class="disc">2020年11月25日発行</li></ul>

				
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		<div class="headers"><h3 class="current content">内容</h3><h3 class="preface">序文</h3><h3 class="indexes">主要目次</h3></div><section class="current content">いろいろと多くの鑑別疾患をあげながらも最終的に確定診断がつかず，謎に包まれたままになることも多い「腹痛」について，診療の基本から，リスキーなものからコモンなものまで含めた鑑別疾患，病歴からのアプローチ法，身体所見からのアプローチ法，検査の組み立てと評価，ケーススタディと，腹痛の診断に至るまでの考え方や知識をすみずみまで解説．腹痛への苦手意識を減らすためのガイドブック．</section><section class="preface">序　文<br><br>　医師になって，研修医として救急外来に立つとき，今夜はどんな患者が来るのだろうかと不安と期待が入り混じった妙な気持ちに苛まれたことを今でも覚えている．そもそも腹痛は，胸痛ほどにすぐに生死にかかわるリスクは低いものの，最終的に確定診断がつかず，謎に包まれたままになることも多く，わからない腹痛はどこまでも怖かった記憶がある．<br>　前著である『この1冊で極める胸痛の診断学』でも論じたが，胸痛の患者を担当するときは，死ぬかもしれない胸痛，いわゆる5 killer chest painが真っ先に頭に浮かび，どんな医師でもひたすらに除外診断を進めていくことが鉄板である．しかし，実は5つの疾患を否定できたとしても，診断が確定できるかといえばそうではなく，「はて？　この患者の診断は一体，何なのだろうか？」となることは実際にはよくある．同様に，腹痛においてもいろいろと多くの疾患を鑑別にあげながらも，いずれも空振りに終わった経験は誰にもあることであろう．ただし，患者の痛みが続き，診断が未確定となれば，やはり帰宅させることは困難である．慎重な対応をするのであれば，経過観察入院であったり，ときには試験開腹といったケースもあるであろう．<br>　著者もすでに，20年ほど医師をやっているが，腹痛の診断は思うほど簡単ではない．もっと言えば，「100％大丈夫だ！」などと自信をもって患者に言える状況は皆無である．不明熱の患者は，たとえ熱が高く出ていても，熱だけでは死なないが，腹痛はそれこそ，後になって腸が破れたり，血管が破れたり，大量出血などが起こって患者を失うリスクがあり，熱だけの患者より本当は怖い．しかも，時間経過が診断の大きなカギになっていることは間違いなく，「後医は名医」という言葉は腹痛のためにあるようなものだ．無論，自分だけはぜひ後から診る医者になりたいと言ってもそうは問屋が卸さない．だからこそ腹痛の診断学は，研修医のうちから多くの知識を身につけて，漫然と対応せず，ひとつひとつの病歴や身体所見に謙虚に向き合って，検査前確率を意識して適切な検査計画を立案しなくてはならない．CTを撮れば診断は簡単だなんて思っているといつかしっぺ返しをくらう．歴史的名著であるCope’s early diagnosis of acute abdomenと考えは同じである．そこで本書では随所にDr. Copeの考えをちりばめることにした．<br>　本書は，初学者・研修医を主にターゲットにし，少しでも腹痛の苦手意識を減らすとともに，自分のお腹が痛くならないようにするための本である．患者に真正面から接していくことができるようになれば著者冥利につきる．<br><br>2020年6月<br>横江正道</section><section class="indexes">第Ⅰ章　腹痛診療の5ヵ条<br>　　①女性の腹痛は覚悟すべし<br>　　②意識レベルだけは確実に評価すべし<br>　　③お腹が痛くても呼吸の評価を最初にすべし<br>　　④お腹を触る前に脈を触れるべし<br>　　⑤のたうち回るのではなく，うずくまっている方がヤバいと感じるべし<br><br>第Ⅱ章　見逃すわけにはいかないリスキーな腹痛<br>　　　　“7 killer abdominal pain”<br>　A　ショックを伴う汎発性腹膜炎<br>　　①概論／②病態／③好発年齢／④リスクファクター／⑤身体所見／⑥検査所見／⑦治療／⑧合併症　<br>　B　急性腸閉塞（特に絞扼性腸閉塞）<br>　　①概論／②病態／③好発年齢／④リスクファクター／⑤身体所見／⑥検査所見／⑦治療／⑧合併症　<br>　C　腹部大動脈瘤破裂<br>　　①概論／②病態／③好発年齢／④リスクファクター／⑤身体所見／⑥検査所見／⑦治療／⑧合併症<br>　D　急性腸間膜虚血（上腸間膜動静脈閉塞症，NOMI）<br>　　①概論／②病態／③好発年齢／④リスクファクター／⑤身体所見／⑥検査所見／⑦治療／⑧合併症<br>　E　異所性妊娠破裂<br>　　①概論／②病態／③好発年齢／④リスクファクター／⑤身体所見／⑥検査所見／⑦治療／⑧合併症　<br>　F　常位胎盤早期剥離・妊娠合併症<br>　　①概論／②病態／③好発年齢／④リスクファクター／⑤身体所見／⑥検査所見／⑦治療／⑧合併症<br>　G　トキシックショック症候群<br>　　①概論／②病態／③好発年齢／④リスクファクター／⑤身体所見／⑥検査所見／⑦治療／⑧合併症<br><br>第Ⅲ章　知っておくと役に立つ腹痛の鑑別疾患<br>　■消化管関連<br>　A　食道<br>　　①食道炎（感染性，好酸球性）／②特発性食道破裂（Boerhaave症候群）<br>　B　胃<br>　　①胃潰瘍（穿孔）／②急性胃粘膜病変／③胃アニサキス症　<br>　C　十二指腸<br>　　①十二指腸潰瘍（穿孔）<br>　D　小腸<br>　　①腸閉塞（絞扼性腸閉塞以外）<br>　E　大腸<br>　　①感染性腸炎／②虫垂炎／③大腸憩室炎／④虚血性大腸炎<br>　■肝胆膵関連<br>　F　肝臓<br>　　①肝膿瘍／②Fitz-Hugh-Curtis症候群／③肝細胞癌破裂／④肝エキノコックス症<br>　G　胆囊・胆管<br>　　①胆石発作／②急性胆囊炎／③急性胆管炎<br>　H　膵臓<br>　　①急性膵炎<br>　Ｉ　脾臓<br>　　①脾梗塞／②脾膿瘍<br>　■腹部大血管関連<br>　J　腹部大動脈<br>　　①大動脈解離<br>　K　上腸間膜動脈<br>　　①上腸間膜動脈塞栓症／②上腸間膜動脈血栓症<br>　■泌尿器科関連<br>　L　腎臓<br>　　①腎盂腎炎／②腎梗塞<br>　M　尿管<br>　　①尿管結石<br>　N　前立腺<br>　　①前立腺炎（急性細菌性前立腺炎）<br>　O　精巣・精巣上体<br>　　①精巣捻転／②精巣上体炎<br>　■婦人科関連<br>　P　子宮<br>　　①子宮内膜症・卵巣チョコレート囊胞破裂<br>　Q　卵巣<br>　　①卵巣腫瘍茎捻転<br>　R　その他<br>　　①骨盤腹膜炎<br>　■代謝性疾患関連<br>　S　代謝性疾患関連<br>　　①急性ポルフィリン症／②糖尿病性ケトアシドーシス／③IgA血管炎（Henoch-Schönlein症候群）<br>　■その他<br>　T　その他（腹壁・皮膚など）<br>　　①非外傷性腹直筋血腫／②鉛中毒／③家族性地中海熱　<br><br>第Ⅳ章　病歴からのアプローチ<br>　　　　〜主訴「腹痛」からの病歴への展開〜<br>　A　発症時間・経過<br>　B　腹痛の部位・放散痛<br>　C　痛みの性状<br>　D　痛みの強さ<br>　E　随伴症状<br>　F　増悪因子<br>　G　寛解因子<br>　H　危険因子<br>　Ｉ　既往歴・治療歴<br><br>第Ⅴ章　身体所見からのアプローチ<br>　A　腹痛の鑑別に有用な診察所見<br>　　①視診／②聴診／③触診／④圧痛／⑤叩打痛／⑥特異的な身体所見<br><br>第Ⅵ章　検査の組み立てとその評価<br>　A　検査の流れ<br>　B　各検査<br>　　①血液生化学検査／②尿検査／③心電図検査／④CT／⑤エコー／⑥MRI・MRCP／<br>　　⑦上部消化管内視鏡検査⑧大腸ファイバー検査／⑨血液培養　<br><br>第Ⅶ章　ケーススタディで学ぼう<br>　　　　〜腹痛患者でぜひとも押さえておきたい15症例ファイル〜<br>　［症例1］汎発性腹膜炎（消化管穿孔）<br>　［症例1］絞扼性腸閉塞<br>　［症例1］腹部大動脈瘤破裂<br>　［症例1］非閉塞性腸間膜虚血：NOMI<br>　［症例5］異所性妊娠<br>　［症例6］常位胎盤早期剥離<br>　［症例7］トキシックショック症候群<br>　［症例8］急性胆囊炎<br>　［症例9］急性膵炎<br>　［症例10］Fitz-Hugh-Curtis症候群<br>　［症例11］左腎梗塞・脾梗塞<br>　［症例12］上腸間膜動脈血栓症<br>　［症例13］アニサキス症<br>　［症例14］非外傷性腹直筋血腫<br>　［症例15］急性虫垂炎<br><br>索　引</section></article>
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