Abdominal Pain

Nadine Z. Villarin
Acute Abdominal Pain

It is important to understand the

physiology of pain specific to each
organ and site in the abdomen.
For instance, distention of the bowel
produces pain, whereas mechanical
laceration does not.
 pain arising in the viscera

vagal visceral afferent nerves

and sympathetic afferent nerves

sensations:
• Deep
• Boring
• poorly localized
– frequently accompanied by autonomic features
such as nausea, vomiting, and diaphoresis.
 Pain transmitted via the spinal somatic
afferent nerves

innervating the body wall and peritoneum

generally described as:

• sharp
• well localized to the anatomic site of the
inflammation or injury.
knowledge of the innervation of each
abdominal organ will help the
examiner understand the nature
and pattern of the
patient's pain history.
Severe, acute abdominal pain can lead to a
variety of disorders from the benign to the
Immanently life-threatening.
The specific diagnosis must be sought with
a sense of urgency, because early surgical
intervention may be lifesaving in some
disorders:
• leaking abdominal aortic aneurysm
• appendicitis
and contraindicated in others:
• acute intermittent porphyria
• sickle cell crisis.
Some assistance is obtained from
Imaging examinations, while laboratory tests
are less important. A careful history and
personally repeated examinations over a few
hours are mandatory.
Important in Examination:
– Location of pain
– Tenderness
– Variations in quality
– Severity of symptoms
Fig. 9-19 Common Locations of Acute Abdominal Pain. In general, the painful
spot is also tender, but not always. Note especially that the pain of acute appendicitis
is in the epigastrium early and later in the right lower quadrant. Pain in the spleen
commonly radiates to the top of the left shoulder. These pains are ordinarily constant,
in contrast to the intermittent pain of colic.
Chronic and Recurrent
Abdominal Pain
• Chronic pain is physiologically different
from acute pain.
• The pattern of pain and associated
symptoms will help to make inferences
about the possible pathophysiology, while
the location of the pain suggests the
organs involved.
Pain that is vague in onset but steadily
worsens over time suggests a progressive
anatomically advancing obstructive lesion
or mass effect.

Intermittent pain separated by periods free

of pain suggests painful smooth-muscle
contraction or dynamic obstruction,
recurrent inflammation or ulceration, and
relapsing infection.
 Careful history is required to identify:

• precipitating factors
• Timing
• previous surgeries
• symptoms, or illnesses that could help
explain the current problem
It is important to recognize that
nonspecific abdominal and pelvic pain is a
common symptom in persons with
histories of current or previous abuse.
If the history and physical exam do not
suggest specific leads for further
investigation, a barrage of laboratory and
imaging tests are extremely unlikely to be
helpful.
There is a tendency to project pain inward
to intraabdominal structures when it
actually arises from the abdominal wall.