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16-September-2008 16:15:13 - pain Symptom/Sign: Abdominal pain Classifications and external resources ICD-10 R10. ICD-9 789.0 Abdominal pain can be one of the symptoms 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. Contents 1 Introduction 2 Types and mechanisms 3 Causes 4 Acute Abdomen 5 Recurrent Abdominal Pain in Children and Adolescents 6 Medical Assessment 7 See also 8 References Introduction Abdominal pain is traditionally described by its chronicity acute or chronic, its progression over time, its nature sharp, dull, colicky, 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 abdomen, abdominal pain is a concern of general practitioners/family physicians, surgeons, internists, emergency medicine doctors, pediatricians, gastroenterologists, urologists and 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 colicky, 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-in cholecystitis or cholelithiasis-is often referred to the shoulder. Causes The following is an incomplete list of possible causes of abdominal pain.1 Gastrointestinal 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 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, tumours Liver Inflammatory: hepatitis, liver abscess Pancreatic Inflammatory: pancreatitis Renal and urological Inflammation: pyelonephritis, bladder infection Obstruction: kidney stones, urolithiasis, tumours 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 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 Merranean 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 surgical intervention to treat its cause. The pain may frequently be associated with nausea and vomiting, abdominal distention, fever and signs of shock. 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 : Small bowel obstruction secondary to adhesions caused by previous surgeries, intussusception, hernias, benign or malignant neoplasms Large bowel obstruction caused by colorectal cancer, inflammatory bowel disease, volvulus, fecal impaction or hernia Vascular : occlusive 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 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 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 Apley J, Naish N: Recurrent abdominal pains: A field survey of 1,000 school children. Arch Dis Child 1958;33:165 - 170. 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. 1 Stomach ache or abdominal pain can be misdiagnosed.Consult a Gastroenterologist rather than ER doctor if Pain persists more than a day. ^ Cartwright SL, Knudson MP. Evaluation of Acute Abdominal Pain in Adults. Am Fam Physician. 2008;777:971-978. v d e Pain and nociception Head and neck Jaw and mouth pain Odynophagia , temporal arteritis Ear pain otalgia, otitis media, otitis externa Eye pain glaucoma Head pain headache, migraine, tension headache, cluster headache, cerebral aneurysm, sinusitis, meningitis Neck pain atypical myocardial infarction Thorax Back pain upper back pain, lower back pain, spinal disc herniation, degenerative disc disease, coccydynia Breast pain perimenstrual, breast cancer Chest pain myocardial infarction, gastroesophageal reflux disease, pancreatitis, hiatus hernia, aortic dissection, asymptomatic pulmonary embolism, Tietze's syndrome Shoulder pain right side - cholecystitis Abdominal pain Left and right upper quadrant peptic ulcer disease, gastroenteritis, hepatitis, pancreatitis, cholecystitis, atypical myocardial infarction, abdominal aortic aneurysm, asymptomatic gastric cancer Left and right lower quadrant appendicitis, ulcerative colitis, Crohn's disease, ectopic pregnancy, endometriosis, pelvic inflammatory disease, diverticulitis, urolithiasis, pyelonephritis, colorectal cancer Limbs Arms myocardial infarction, left arm Legs deep vein thrombosis, peripheral artery occlusive disease, claudication, spinal disc herniation, sciatica Joints Small joints osteoarthritis, rheumatoid arthritis, systemic lupus erythematosis, gout, pseudogout Large joints septic arthritis, hemarthrosis, osteonecrosis Back joints ankylosing spondylitis, inflammatory bowel disease Other psoriatic arthritis, Reiter's syndrome Musculoskeletal Delayed onset muscle soreness, Myalgia, Physical trauma Other/unspecified pain Allodynia, breakthrough pain, chronic pain, congenital insensitivity to pain, congenital insensitivity to pain with anhidrosis, hyperalgesia, hyperpathia, neuralgia, pain asymbolia, pain disorder, paroxysmal extreme pain disorder, phantom pain, referred pain Related concepts Anterolateral system, gate control theory of pain, pain management anesthesia, cordotomy, pain scale, pain threshold, posteromarginal nucleus, substance P, OPQRST v d e Digestive system - Digestive disease - Gastroenterology primarily K20-K93, 530-579 Upper GI tract Esophagus Esophagitis Candidal - Boerhaave syndrome - UES Zenker's diverticulum - LES Barrett's esophagus, Mallory-Weiss syndrome - Esophageal motility disorder Nutcracker esophagus, Achalasia, Diffuse esophageal spasm, GERD - Esophageal stricture Stomach Peptic gastric ulcer - Gastritis Atrophic, Ménétrier's disease - Gastroenteritis - Dyspepsia - Pyloric stenosis - Achlorhydria - Gastroparesis - Gastroptosis - Portal hypertensive gastropathy - Gastric antral vascular ectasia - Gastric dumping syndrome Intestinal Duodenum/ileum Peptic duodenal ulcer - Duodenitis - Ileitis Enteritis colitis/ enterocolitis noninfective: IBD Crohn's disease, Ulcerative colitis - noninfective gastroenteritis infective: Pseudomembranous colitis Vascular Abdominal angina - Mesenteric ischemia - Ischemic colitis - Angiodysplasia Malabsorption Coeliac - Tropical sprue - Blind loop syndrome - Whipple's - Short bowel syndrome - Steatorrhea Motility/ functional Ileus/Bowel obstruction Intussusception, Volvulus - Constipation - Diarrhea Functional colonic disease IBS, Intestinal pseudoobstruction/Ogilvie syndrome Rectum/anus Proctalgia fugax - Anal fissure/Anal fistula - Anal abscess - Rectal prolapse - Proctitis Radiation proctitis Other Diverticulitis/Diverticulosis - Megacolon/Toxic megacolon - Appendicitis Accessory Liver Hepatitis Viral hepatitis, Autoimmune hepatitis, Alcoholic hepatitis - Cirrhosis PBC - Fatty liver NASH - vascular Hepatic veno-occlusive disease, Portal hypertension, Nutmeg liver - Alcoholic liver disease - Liver failure Hepatic encephalopathy, Acute liver failure - Liver abscess - Hepatorenal syndrome - Peliosis hepatis Gallbladder Gallstones - common bile duct Choledocholithiasis, Biliary dyskinesia - Cholecystitis - Cholesterolosis - Rokitansky-Aschoff sinuses - Postcholecystectomy syndrome Biliary tree Cholangitis PSC, Ascending - Cholestasis/Mirizzi's syndrome - Biliary fistula - Haemobilia Pancreatic Pancreatitis Acute, Chronic, Herary - Pancreatic pseudocyst - Exocrine pancreatic insufficiency - Pancreatic fistula Hernia Diaphragmatic: Congenital diaphragmatic - Hiatus Abdominal hernia: Inguinal Indirect, Direct - Umbilical - Incisional - Femoral Obturator hernia Peritoneal Peritonitis Spontaneous bacterial peritonitis - Hemoperitoneum - Pneumoperitoneum GI bleeding Upper Hematemesis, Melena - Lower Hematochezia See also congenital, neoplasia v d e Symptoms and signs: digestive system and abdomen R10-R19, 787 Abdominal and pelvic pain Abdominal pain - Acute abdomen - Colic Other Nausea/Vomiting - Heartburn - Dysphagia Oropharyngeal, Esophageal flatulence and related Abdominal distension, Bloating, Burping, Tympanites Fecal incontinence Encopresis hepatosplenomegaly Hepatomegaly, Splenomegaly Jaundice - Ascites - Fecal occult blood - Halitosis see also noncongenital, congenital Retrieved from http://en..org/wiki/Abdominal_pain Categories: Pain | Nociception | Sensory system | Gynecology | Gastroenterology | Abdominal pain Views Article Discussion this page History Personal tools Log in / create account Navigation Main page Contents Featured content Current events Random article Search Go Search Interaction Community portal Recent changes Contact Donate to Help Toolbox What links here Related changes Upload file Special pages Printable version Permanent link Cite this page Languages العربية Deutsch Euskara Français í•œêµì–´ Nederlands Português РуÑ?Ñ?кий తెలà±?à°—à±? This page was last modified on 11 August 2008, at 23:12
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