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Abdominal Pain Overview
Abdominal pain has many different sources. The abdomen is located at the level of the diaphragm and extends down to the area of the pelvic bone. There are many organ systems that can be the cause of abdominal pain and it is the goal of the physician to determine the cause. The abdominal wall itself can be the cause as well as the stomach, liver, small intestine, colon, gallbladder, pancreas and spleen.
Pain may be felt in the abdomen that is not related to actual disease in the abdomen. For example, the lower lungs, kidneys and uterus or ovaries can yield abdominal pain. Disease related to the abdomen can also be felt in non-abdominal areas. For example pancreatic pain can be felt in the back. These are all types of pain that must be considered.
Abdominal pain can be caused by inflammation of an organ such as appendicitis or diverticulitis. It can occur due to stretching of an organ, such as with distension of the colon due to blockage or blockage of the common bile duct due to a gall stone. The liver can swell from hepatitis causing pain and there can be pain if an area of the abdomen loses its blood supply, such as with ischaemic colitis. You can have inflammation of the colon as in Crohn's colitis. In irritable bowel syndrome, there is no inflammation but abnormal contractions of the colon are believed to be the cause.
Doctors can look at the abdominal pain and diagnose its cause by looking at the physical examination, characteristics of the pain, surgery or lab tests, radiological testing and endoscopic testing. Abdominal pain can begin suddenly or gradually and can be located in different areas, depending on the location of the disease. For example, appendicitis causes pain in the right lower quadrant pain, whereas diverticulitis usually causes left lower quadrant abdominal pain. Stomach pain is located in the upper central area. The pain may be crampy and is a result of contractions of the abdominal viscus. This suggests colon or intestinal sources of the pain. Gallstone blockage causes a steady right upper quadrant abdominal pain. Acute pancreatitis causes a severe steady pain in the upper abdomen radiating to the mid back region.
The duration of the pain is important. If you have IBS, the pain can wax and wane over several months or years. Biliary colic usually lasts no more than a few hours. Pancreatitis pain lasts around one or more days. GE reflux usually is periodical, worse after eating or on an empty stomach. You need to determine what makes the pain worse and what makes it better. Some types of pain are associated with coughing or sneezing, while others are made worse with any kind of movement at all.
The pain is relieved by several different kinds of things. IBS with constipation is improved by having a bowel movement. Obstructive pain is often relieved somewhat by vomiting. Antacids make the pain of indigestion and stomach inflammation better. Pain that wakes you up is more likely than not to be non-functional.
Related signs and symptoms need to be paid attention to. This includes fever, which means you have infection or inflammation. Rectal bleeding or diarrhoea means there is intestinal causes of the disease. Fever and diarrhoea suggest that you might have Crohn's disease or ulcerative colitis.
In the physical exam of abdominal pain, the doctor will listen for bowel sounds and will do a number of tests that determine the degree of the pain such as pushing on the stomach and lifting up suddenly, a sign of a surgical abdomen and peritonitis. The location of the tenderness is determined. Masses in the abdomen are looked at carefully. The doctor will look at evidence of blood in the stool.
Tests are done to see if the cause of the abdominal pain is severe or not. This can include lab tests looking for inflammation, infection and damage to the kidneys or liver. Amylase and lipase levels are made by the pancreas and are increased in pancreatitis. Liver enzymes can also be high in gallbladder attacks and white blood cells in the stool means there may be intestinal inflammatory disease.
X-rays of the abdomen can show the kidneys, intestines and liver. If there are enlarged loops of bowel, there may be an ileus or an obstruction. An abdominal ultrasound is good for diagnosis of gall bladder disease, gall stones and appendicitis. Ruptured ovarian cysts can be seen on ultrasound. A CT scan of the abdomen can be done to define the structures of the abdomen and can help diagnose pancreatitis, pancreatic cancer and diseases like diverticulitis and appendicitis. An MRI can diagnose the same things as a CT scan of the abdomen. Barium studies will show problems with the intestinal and stomach lumen. A newer test, capsular enteroscopy uses a capsule with a camera that you swallow and it takes pictures of the inside of the colon. An ERCP is a test that looks at the biliary tract system. Doctors can also do a colonoscopy or a scope of the stomach and duodenum. Sometimes only a laparotomy, looking at the inside of the abdomen, takes care of diagnosing the cause of the abdominal pain.
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The author of the substantive medical writing on this website is Dr. Christine Traxler MD whose biography can be read here