Abdominal pain 593703 225704061 2008-07-15T00:09:09Z 64.81.18.202 /* External links */ {{SignSymptom infobox | Name = Abdominal pain | ICD10 = {{ICD10|R|10||r|10}} | ICD9 = {{ICD9|789.0}} | }} '''Abdominal pain''' can be one of the [[symptom]]s associated with transient disorders or serious disease. Making a definitive diagnosis of the cause of abdominal pain can be difficult, because many diseases can result in this symptom. Abdominal pain is a common problem. Most frequently the cause is benign and/or self-limited, but more serious causes may require urgent intervention. ==Introduction==<!-- This section is linked from [[List of medical abbreviations]] --> Abdominal pain is traditionally described by its chronicity (acute or chronic), its progression over time, its nature (sharp, dull, [[colic]]ky), its distribution (by various methods, such as abdominal quadrant (left upper quadrant, left lower quadrant, right upper quadrant, right lower quadrant) or other methods that divide the abdomen into nine sections), and by characterization of the factors that make it worse, or alleviate it. Due to the many organ systems in the [[human abdomen|abdomen]], abdominal pain is a concern of [[general practitioner]]s/[[family physician]]s, [[surgery|surgeons]], [[internal medicine|internist]]s, [[emergency medicine]] doctors, [[pediatrics|pediatricians]], [[gastroenterology|gastroenterologists]], [[urology|urologists]] and [[gynecology|gynecologists]]. Occasionally, patients with rare causes can see a number of specialists before being diagnosed adequately (''e.g.'', [[chronic functional abdominal pain]]) ==Types and mechanisms== #The pain associated with the abdomen of inflammation of the [[parietal]] [[peritoneum]] (the part of the peritoneum lining the abdominal wall) is steady and aching, and worsened by changes in the tension of peritoneum caused by pressure or positional change. It is often accompanied by tension of the abdominal muscles contracting to relieve such tension. #The pain associated with obstruction of a hollow viscus (as opposed to peritoneal and solid organ pain) is often intermittent or "[[colic]]ky", coinciding with the peristaltic waves of the organ. Such cramps are exactly what is experienced with early acute [[appendicitis]] and [[gastroenteritis]] and are somewhat relieved by writhing and massage. #The pain associated with abdominal vascular disturbances ([[thrombosis]] or [[embolism]]) can be sudden or gradual in onset, and can be severe or mild. Pain associated with the rupture of an [[abdominal aortic aneurysm]] may radiate to the back, flank, or genitals. #Pain that is felt in the abdomen may be "referred" from elsewhere (''e.g.'', a disease process in the chest may cause pain in the abdomen), and abdominal processes can cause radiated pain elsewhere (''e.g.'', [[gall bladder]] pain&mdash;in [[cholecystitis]] or [[cholelithiasis]]&mdash;is often referred to the [[shoulder]]). ==Causes== The following is an incomplete list of possible causes of abdominal pain.<ref name="AAFP">Cartwright SL, Knudson MP. [http://www.aafp.org/afp/20080401/971.html Evaluation of Acute Abdominal Pain in Adults]. Am Fam Physician. 2008;77(7):971-978.</ref> *Gastrointestinal **Inflammatory: [[gastroenteritis]], [[appendicitis]], [[gastritis]], [[esophagitis]], [[diverticulitis]], [[Crohn's disease]], [[ulcerative colitis]], [[microscopic colitis]] **Obstruction: [[hernia]], [[intussusception]], [[volvulus]], post-surgical [[adhesions]], [[tumour]]s, [[superior mesenteric artery syndrome]], severe [[constipation]] **Vascular: [[embolism]], [[thrombosis]], [[hemorrhage]], [[sickle cell disease]], [[abdominal angina]], blood vessel compression (such as celiac artery compression syndrome) **[[digestive]]: [[peptic ulcer]], [[lactose intolerance]], [[celiac sprue]], Jasohnstritis *Bile system **Inflammatory: [[cholecystitis]], [[cholangitis]] **Obstruction: [[cholelithiasis]], [[tumour]]s *Liver **Inflammatory: [[hepatitis]], [[liver abscess]] *Pancreatic **Inflammatory: [[pancreatitis]] *Renal and urological **Inflammation: [[pyelonephritis]], [[cystitis|bladder infection]] **Obstruction: [[nephrolithiasis|kidney stones]], [[urolithiasis]], [[tumour]]s **Vascular: [[left renal vein entrapment]] *Gynecological or obstetric **Inflammatory: [[pelvic inflammatory disease]] **Mechanical: ovarian torsion **Endocrinological: [[menstruation]], [[Mittelschmerz]] **Tumors: [[endometriosis]], [[fibroids]], [[ovarian cyst]], [[ovarian cancer]] **Pregnancy: ruptured [[ectopic pregnancy]], [[threatened abortion]] *[[Abdominal wall]] **muscle strain or trauma **muscular infection **[[neurogenic]] pain: [[herpes zoster]], [[radiculitis]] in [[Lyme disease]], [[abdominal cutaneous nerve entrapment syndrome]] (ACNES), [[tabes dorsalis]] *[[Referred pain]] **from the [[thorax]]: [[pneumonia]], [[pulmonary embolism]], [[ischemic heart disease]], [[pericarditis]] **from the [[vertebral column|spine]]: [[radiculitis]] **from the [[genitals]]: [[testicular torsion]] *[[Metabolic disturbance]] **[[uremia]], [[diabetic ketoacidosis]], [[porphyria]], [[C1-esterase inhibitor deficiency]], adrenal insufficiency,[[lead poisoning]], [[black widow spider]] bite, [[narcotic]] [[withdrawal]] *Blood vessels **[[aortic dissection]], [[abdominal aortic aneurysm]] *Immune system **[[sarcoidosis]] **[[vasculitis]] **[[familial Mediterranean fever]] *Idiopathic **[[irritable bowel syndrome]] (affecting up to 20% of the population, IBS is the most common cause of recurrent, intermittent abdominal pain) ==Acute Abdomen== [[Acute abdomen]] can be defined as severe, persistent abdominal pain of sudden onset that is likely to require [[surgery|surgical intervention]] to treat its cause. The pain may frequently be associated with [[nausea]] and [[vomiting]], [[abdominal distention]], [[fever]] and signs of [[Shock (medical)|shock]]. '''Selected causes of acute abdomen''' *Traumatic : [[Blunt force trauma|blunt]] or perforating [[physical trauma|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]] ** [[Gastrointestinal perforation|Perforation]] of a [[peptic ulcer]], a [[diverticulitis|diverticulum]], or the [[caecum]] ** Complications of [[inflammatory bowel disease]] such as [[Crohn's disease]] or [[ulcerative colitis]] *Mechanical : **[[Small bowel]] [[bowel obstruction|obstruction]] secondary to adhesions caused by previous surgeries, [[intussusception]], [[hernia]]s, benign or malignant [[neoplasia|neoplasm]]s **[[Large bowel]] [[bowel obstruction|obstruction]] caused by [[colorectal cancer]], [[inflammatory bowel disease]], [[volvulus]], [[fecal impaction]] or [[hernia]] *Vascular : occlusive [[ischemic colitis|intestinal ischemia]], usually caused by [[thromboembolism]] of the [[superior mesenteric artery]] ==Recurrent Abdominal Pain in Children and Adolescents== Recurrent abdominal pain (RAP) occurs in 5–15% of children 6–19 years old. In a community-based study of middle and high school students, 13–17% had weekly abdominal pain. Using criteria for [[irritable bowel syndrome]] (IBS), 14% of high school students and 6% of middle school students fit the criteria for adult IBS. As with other difficult to diagnose chronic medical problems, patients with RAP account for a very large number of office visits and medical resources in proportion to their actual numbers. Most patients with RAP benefit from reassurance and techniques to manage anxiety and stress, which are frequently associated with episodes. ==Medical Assessment== When a physician assesses a patient to determine the etiology and subsequent treatment for abdominal pain the patients 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 [[pneumonia]]s 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]] and [[lipase]]. *[[Urinalysis]] *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) ==See also== *[[Abdominal exam]] *[[Chronic functional abdominal pain]] *[[Irritable bowel syndrome]] *[[Bowelgina]] ==References== <small> * Apley J, Naish N: Recurrent abdominal pains: A field survey of 1,000 school children. ''Arch Dis Child'' 1958;33:165 - 170. * [http://www.health.am/gyneco/chronic-pelvic-pain/ Chronic Pelvic Pain and Recurrent Abdominal Pain in Female Adolescents] * Boyle JT, Hamel-Lambert J: Biopsychosocial issues in functional abdominal pain. ''Pediatr Ann'' 2001;30:1. *[http://www.suburbanchicagonews.com/beaconnews/lifestyles/438133,2_5_AU22_DUNCAN_S1.article] Stomach ache or abdominal pain can be misdiagnosed.Consult a Gastroenterologist rather than ER doctor if Pain persists more than a day. </small> <references/> ==External links== * [http://www.undiag.com/symptoms/abdominalpain.php Abdominal pain details] * [http://www.nethealthbook.com/gastrointestinaldisease_abdominalpain.html Abdominal pain differential diagnosis according to pain location] * [http://www.wellsphere.com/wellmix360/Acute-abdominal-pain Acute abdominal pain overview] {{Pain}} {{Gastroenterology}} {{Digestive system and abdomen symptoms and signs}} [[Category:Gynecology]] [[Category:Gastroenterology]] [[Category:Pain]] [[Category:Abdominal pain]] [[ar:مغص]] [[de:Schmerz#Bauchschmerzen]] [[eu:Tripako min]] [[fr:Douleur abdominale]] [[ko:복통]] [[ja:腹痛]] [[nl:Buikpijn]] [[pt:Dor abdominal]] [[te:కడుపునొప్పి]]