Abdominal pain

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Abdominal pain
Gray1220.png
Abdominal pain can be characterized by the region it affects.
ICD-10 R10
ICD-9 789.0
MedlinePlus 003120

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.[1] Determining the cause can be difficult, because many diseases can cause this symptom.

Differential diagnosis[edit]

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%).[1] More common in those who are older, mesenteric ischemia and abdominal aortic aneurysms are other serious causes.[2]

A more extensive list includes the following:

Acute abdominal pain[edit]

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

By location[edit]

Location[3]

Diagnostic approach[edit]

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

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

Management[edit]

Butylscopolamine (Buscopan) is used to treat cramping abdominal pain with some success.[4]

Epidemiology[edit]

Abdominal pain is the reason about 3% of adults see their family physician.[1] 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%.[5]

References[edit]

  1. ^ a b c Viniol, A; Keunecke, C; Biroga, T; Stadje, R; Dornieden, K; Bösner, S; Donner-Banzhoff, N; Haasenritter, J; Becker, A (October 2014). "Studies of the symptom abdominal pain--a systematic review and meta-analysis.". Family practice 31 (5): 517–29. PMID 24987023. 
  2. ^ Spangler, R; Van Pham, T; Khoujah, D; Martinez, JP (2014). "Abdominal emergencies in the geriatric patient.". International journal of emergency medicine 7: 43. PMID 25635203. 
  3. ^ Richard F.LeBlond. Diagnostics. US: McGraw-Hill Companies, Inc. ISBN 0-07-140923-8. 
  4. ^ Tytgat GN (2007). "Hyoscine butylbromide: a review of its use in the treatment of abdominal cramping and pain". Drugs 67 (9): 1343–57. doi:10.2165/00003495-200767090-00007. PMID 17547475. 
  5. ^ Skiner HG, Blanchard J, Elixhauser A (September 2014). "Trends in Emergency Department Visits, 2006-2011". HCUP Statistical Brief #179. Rockville, MD: Agency for Healthcare Research and Quality.