Abdominal pain can be characterized by the region it affects.
Abdominal pain (or stomach ache) is a common symptom associated with both temporary non serious disorders and more serious conditions.
Common causes include: gastroenteritis and irritable bowel syndrome. In a third of cases the exact cause is unclear. About 10% of people have a more serious underlying condition such as: appendicitis or diverticulitis. Determining the cause can be difficult, because many diseases can cause this symptom.
The most frequent cause of abdominal pain is gastroenteritis (13%), irritable bowel syndrome (8%), urinary tract problems (5%), inflammation of the stomach (5%) and constipation (5%). About 30% of cases the cause is not determined. About 10% of cases have a more serious cause including: gallbladder or pancreas problems (4%), diverticulitis (3%), appendicitis (2%) and cancer (1%). More common in those who are older, mesenteric ischemia and abdominal aortic aneurysms are other serious causes.
A more extensive list includes the following:
- GI tract
- Inflammatory: 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
- GI tract
- Renal and urological
- Gynaecological or obstetric
- Abdominal wall
- Referred pain
- Metabolic disturbance
- Blood vessels
- Immune system
- irritable bowel syndrome (affecting up to 20% of the population, IBS is the most common cause of recurrent, intermittent abdominal pain)
Acute abdominal pain
Acute abdomen can be defined 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
- Inflammatory :
- Infections such as appendicitis, cholecystitis, pancreatitis, pyelonephritis, pelvic inflammatory disease, hepatitis, mesenteric adenitis, or a subdiaphragmatic abscess
- Perforation of a peptic ulcer, a diverticulum, or the caecum
- Complications of inflammatory bowel disease such as Crohn's disease or ulcerative colitis
- Mechanical :
- Vascular : occlusive intestinal ischemia, usually caused by thromboembolism of the superior mesenteric artery
- Upper middle abdominal pain
- Upper right abdominal pain
- Upper left abdominal pain
- Spleen pain (splenomegaly)
- Colon pain (below the area of spleen - bowel obstruction, functional disorders, gas accumulation, spasm, inflammation, colon cancer)
- Middle abdominal pain (pain in the area around belly button)
- Appendicitis (starts here)
- Small intestine pain (inflammation, intestinal spasm, functional disorders)
- Lower abdominal pain (diarrhea, colitis and dysentery)
- Lower right abdominal pain
- Lower left abdominal pain
- Sigmoid colon (polyp), sigmoid volvulus, obstruction or gas accumulation)
- Pelvic pain
- 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
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.
- Imaging including erect chest X-ray and plain films 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)
Abdominal pain is the reason about 3% of adults see their family physician. Rates of ED visits in the United States for abdominal pain increased 18% from 2006 through 2011. This was the largest increase out of 20 common conditions seen in the ED. The rate of ED use for nausea and vomiting also increased 18%.
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