Abdominal Pain

Abdominal pain

The term abdominal pain generally is used to describe pain originating from organs within the abdominal cavity. These organs include the stomach, small intestine, colon, liver, gall bladder, and pancreas. Occasionally, pain may be felt in the abdomen even though it is arising from organs that are close to but not within the abdominal cavity, for example the lower lungs, the kidneys, and the uterus or ovaries. This latter type of pain is called 'referred' pain because the pain, though originating outside the abdomen, is being referred to (felt) in the abdominal area. The following information is important in determining the cause of abdominal pain :

Onset of the Pain : For example, sudden onset of abdominal pain may be due to appendicitis or obstruction of the bile duct by a gallstone (biliary colic).

Character of Pain : Obstruction of the intestine initially causes spasmodic abdominal pain. Obstruction of the bile ducts by gall stones causes constant upper abdominal pain. 

Aggravating and reliving factors : Pain due to inflammation (appendicitis, cholecystitis, pancreatitis) typically is aggravated by sneezing, coughing or any jarring motion. Patients with inflammation as the cause of their pain prefer to lie still. The pain of IBS is often relieved temporarily by bowel movements. Pain due to obstruction of the stomach or upper small intestine may be relieved temporarily by vomiting. Eating may temporarily relieve the pain of ulcers of the stomach or duodenum. 

Location of Pain : The location of the pain can help in finding out the cause of pain. 

Navel area : Pain near the navel can be related to a small intestine disorder or an inflammation of the appendix ( appendicitis). The appendix is a small finger-shaped organ that lies in the lower right side of the abdomen. If it gets clogged or obstructed, it may become inflamed and filled with pus.

Upper middle abdomen : This area is known as the epigastric area. It lies directly above the navel in the upper middle part of the abdomen. Pain of stomach disorders is felt in this area. Persistent pain in this area may also signal a problem with the upper part of the small intestine (duodenum), pancreas or gall bladder. 

Upper left abdomen : Pain in this area may suggest problem in the colon, stomach, spleen or pancreas. 

Upper right abdomen : Intense pain in the upper right abdomen is often related to inflammation f the gall bladder. The pain may extend to the centre of the abdomen and penetrate to the back. Occasionally, an inflamed pancreas or duodenum can cause pain in this area as well. 

Lower left abdomen : Pain here most often suggest in the lower colon. Possible causes include inflammatory bowel disease or an infection in the colon known as diverticulitis.

Lower right abdomen : Inflammation of the first part of the colon may cause pain in the lower right abdomen. The pain of acute appendicitis initially may start near the umbilicus and then shift to the right lower abdomen. 

Though most cases of abdominal pain aren't serious, sometimes medical treatment is essential. Consult the doctor if: 

• The pain is severe, recurrent or persistent.
  The pain gets worse.
  The pain is accompanied by shortness of breathe, dizziness, bleeding, vomiting or high fever. 

Seek emergency help if : 

• The abdominal pain is sudden and sharp. 
  The pain radiates to the chest, neck or shoulder. 
  Blood is vomited. 
  If there is blood in the stool or the stool turns black.
  Abdomen is swollen and tender. 

Diagnosis

Investigations are often necessary to determine the cause .

Laboratory tests that are frequently performed in the evaluation of abdominal pain are : 

• Complete blood count (CBC)
  Liver enzymes (SGOT, SGPT, alkaline phosphatase)
  Pancreatic enzymes (amylase and lipase)
  Urinalysis 

Radiographic studies include : 

1. X-rays of the abdomen are helpful in the diagnosis of intestinal obstruction, perforated duodenal or peptic ulcer and kidney stone. 

2. Barium X-rays of the stomach and the intestines (upper gastrointestinal series or UGI with a small bowel follow-through) can be helpful in diagnosing ulcers, inflammation and blockage in the intestines. This procedure is rarely used these days as endoscopy is more convenient. 

3. Ultrasound is useful in diagnosing gallstones, cholecystitis, appendicitis or ruptured ovarian cysts as the cause of the pain. 

4. Computerised Tomography (CT) of the abdomen is useful in diagnosing pancreatitis, pancreatic cancer, appendicitis and diverticulitis, as well as in diagnosing abscesses in the abdomen.

5. Magnetic resonance Imaging (MRI) is useful in diagnosing gallstones that have passed out of the gall bladder and are obstructing the bile ducts. 

Stomach Bloating or Abdominal Distension.
Abdominal pain
Endoscopic procedures
Constipation
Diagnosis and Treatment of Constipation
Medications and Complications
Indigestion