ABDOMINAL PAIN

Abdominal pain usually results from a GI disorder, but it can be caused by a reproductive,
genitourinary (GU),musculoskeletal, or vascular disorder; drug use; or ingestion
of toxins. At times, such pain signals life-threatening complications.
Abdominal pain arises from the abdominopelvic viscera, the parietal peritoneum,
or the capsules of the liver, kidney, or spleen. It may be acute or chronic, diffuse
or localized.Visceral pain develops slowly into a deep, dull, aching pain that’s
poorly localized in the epigastric, periumbilical, or lower midabdominal (hypogastric)
region. In contrast, somatic (parietal, peritoneal) pain produces a sharp, more
intense, and well-localized discomfort that rapidly follows the insult.Movement or
coughing aggravates this pain. (See Abdominal pain: Types and locations.)
Pain may also be referred to the abdomen from another site with the same or
similar nerve supply. This sharp, well-localized, referred pain is felt in skin or deeper
tissues and may coexist with skin hyperesthesia and muscle hyperalgesia.
Mechanisms that produce abdominal pain include stretching or tension of the
gut wall, traction on the peritoneum or mesentery, vigorous intestinal contraction,
inflammation, ischemia, and sensory nerve irritation.
EMERGENCY ACTIONS If the patient is experiencing sudden and severe
abdominal pain, quickly take his vital signs and palpate pulses below the
waist. Be alert for signs of hypovolemic shock, such as tachycardia and
hypotension. Obtain I.V. access. Emergency surgery may be required if the patient
also has mottled skin below the waist and a pulsating epigastric mass or rebound
tenderness and rigidity.