Abdominal pain

From Wikipedia, the free encyclopedia

Abdominal pain (or

stomach ache) is a
common symptom
associated with transient
disorders or serious
disease. Diagnosing the
cause of abdominal pain
can be dicult, because
many diseases can cause
this symptom. Most
frequently the cause is
benign and/or self-limiting,
but more serious causes
may require urgent
intervention.

Contents
1 Dierential
diagnosis
1.1 Acute
abdominal pain
1.2 By location
2 Diagnostic
approach
3 Management
4 References
5 Further reading

Abdominal pain

Abdominal pain can be characterized by the

region it aects.
ICD-10

R10 (http://apps.who.int
/classications/icd10/browse
/2010/en#/R10)

ICD-9

789.0
(http://www.icd9data.com
/getICD9Code.ashx?icd9=789.0)

MedlinePlus 003120
(http://www.nlm.nih.gov
/medlineplus/ency/article
/003120.htm)

Dierential diagnosis
Gastrointestinal
GI tract
Inammatory: gastroenteritis, appendicitis, gastritis,
esophagitis, diverticulitis, Crohn's disease, ulcerative
colitis, microscopic colitis
Obstruction: hernia, intussusception, volvulus,
post-surgical adhesions, tumours, superior mesenteric
artery syndrome, severe constipation, hemorrhoids

Vascular: embolism, thrombosis, hemorrhage, sickle cell

disease, abdominal angina, blood vessel compression
(such as celiac artery compression syndrome), Postural
orthostatic tachycardia syndrome
digestive: peptic ulcer, lactose intolerance, coeliac
disease, food allergies
Glands
Bile system
Inammatory: cholecystitis, cholangitis
Obstruction: cholelithiasis, tumours
Liver
Inammatory: hepatitis, liver abscess
Pancreatic
Inammatory: pancreatitis
Renal and urological
Inammation: pyelonephritis, bladder infection
Obstruction: kidney stones, urolithiasis, Urinary retention,
tumours
Vascular: left renal vein entrapment
Gynaecological or obstetric
Inammatory: pelvic inammatory disease
Mechanical: ovarian torsion
Endocrinological: menstruation, Mittelschmerz
Tumors: endometriosis, broids, ovarian cyst, ovarian cancer
Pregnancy: ruptured ectopic pregnancy, threatened abortion
Abdominal wall
muscle strain or trauma
muscular infection
neurogenic pain: herpes zoster, radiculitis in Lyme disease,
abdominal cutaneous nerve entrapment syndrome (ACNES),
tabes dorsalis
Referred pain
from the thorax: pneumonia, pulmonary embolism, ischemic
heart disease, pericarditis
from the spine: radiculitis
from the genitals: testicular torsion
Metabolic disturbance
uremia, diabetic ketoacidosis, porphyria, C1-esterase inhibitor
deciency, adrenal insuciency, lead poisoning, black widow
spider bite, narcotic withdrawal
Blood vessels
aortic dissection, abdominal aortic aneurysm

Immune system
sarcoidosis
vasculitis
familial Mediterranean fever
Idiopathic
irritable bowel syndrome (aecting up to 20% of the
population, IBS is the most common cause of recurrent,
intermittent abdominal pain)

Acute abdominal pain

Acute abdomen can be dened 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
Inammatory :
Infections such as appendicitis, cholecystitis, pancreatitis,
pyelonephritis, pelvic inammatory disease, hepatitis,
mesenteric adenitis, or a subdiaphragmatic abscess
Perforation of a peptic ulcer, a diverticulum, or the caecum
Complications of inammatory 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,
inammatory bowel disease, volvulus, fecal impaction or
hernia
Vascular : occlusive intestinal ischemia, usually caused by
thromboembolism of the superior mesenteric artery

By location
Location[1]
Upper middle abdominal pain
Stomach (gastritis, stomach ulcer, stomach cancer)

Pancreas pain [1] (http://www.pancreaspain.org/) (pancreatitis

or pancreatic cancer, can radiate to the left side of the waist,
back, and even shoulder)
Duodenal ulcer, diverticulitis
Appendicitis (starts here, after several times moves to lower
right abdomen)
Upper right abdominal pain
Liver (caused by hepatomegaly due to fatty liver, hepatitis, or
caused by liver cancer, abscess)
Gallbladder and biliary tract (gallstones, inammation,
roundworms)
Colon pain (below the area of liver - bowel obstruction,
functional disorders, gas accumulation, spasm, inammation,
colon cancer)
Upper left abdominal pain
Spleen pain (splenomegaly)
Pancreas
Colon pain (below the area of spleen - bowel obstruction,
functional disorders, gas accumulation, spasm, inammation,
colon cancer)
Middle abdominal pain (pain in the area around belly button)
Appendicitis (starts here)
Small intestine pain (inammation, intestinal spasm,
functional disorders)
Lower abdominal pain [2] (http://lower-abdominal-pain.net/)
Lower right abdominal pain
Cecum (intussusception, bowel obstruction)
Appendix point (Appendicitis location)
Lower left abdominal pain
Sigmoid colon (polyp), sigmoid volvulus, obstruction or gas
accumulation)
Pelvic pain
bladder (cystitis, may secondary to diverticulum and bladder
stone, bladder cancer)
pain in women (uterus, ovaries, fallopian tubes)
Right lumbago and back pain
liver pain (hepatomegaly)
right kidney pain (its location below the area of liver pain)
Left lumbago and back pain
less in spleen pain
left kidney pain
Low back pain

kidney pain (kidney stone, kidney cancer, hydronephrosis)

Ureteral stone pain

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 lms 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 cramping abdominal pain
with some success.[2]

References
1. ^ Richard F.LeBlond. Diagnostics. US: McGraw-Hill Companies, Inc.
ISBN 0-07-140923-8.
2. ^ Tytgat GN (2007). "Hyoscine butylbromide: a review of its use in the
treatment of abdominal cramping and pain". Drugs 67 (9): 134357.
doi:10.2165/00003495-200767090-00007 (http://dx.doi.org
/10.2165%2F00003495-200767090-00007). PMID 17547475
(//www.ncbi.nlm.nih.gov/pubmed/17547475).

Further reading
Boyle, J. T.; Hamel-Lambert, J. (2001). "Biopsychosocial issues in
functional abdominal pain". Pediatr Ann 30 (1): 3240.
PMID 11195732 (//www.ncbi.nlm.nih.gov/pubmed/11195732)..
Retrieved from "http://en.wikipedia.org
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Categories: Symptoms and signs: Digestive system and abdomen
Abdominal pain
This page was last modied on 16 July 2013 at 14:19.
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