Abdominal Pain

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Contents

  • 1 Diagnosis
    • 1.1 Exams and tests
  • 2 Signs and Symptoms
  • 3 What Abdominal Pain Could Mean

Diagnosis

As for other body systems, the evaluation of abdominal pain consists of taking a careful history, followed by a diligent exam and the selective ordering of lab tests and imaging studies. The history section must include the location of the pain, the duration of the symptoms, whether the pain radiates and which factors worsen or lighten the symptoms. It helps the clinician to remember the important points of the history of present illness of an acute abdominal pain to use the mnemonic PQRST:

1. P- refers to pain as symptom.

2. Q- refers to the character of the pain. The pain can be sharp, dull, diffuse or burning.

3. R- refers to the issue if the abdominal pain has any radiation pattern.

4. S- refers to the symptoms associated with the pain. Such as nausea, vomiting, diarrhea, constipation, obstipation, melena or fever.

5. T- refers to the time elapsed since the abdominal pain started.

Exams and tests

A cohort study concluded "Although CT is the most sensitive imaging investigation for detecting urgent conditions in patients with abdominal pain, using ultrasonography first and CT only in those with negative or inconclusive ultrasonography results in the best sensitivity and lowers exposure to radiation."[1]

Signs and Symptoms

Associated symptoms must be searched out, such as nausea, fever, diarrhea, changes in stool consistency and color, urinary symptoms and any skin manifestations. The combination of bloody diarrhea with mucus, fever and intermittent abdominal cramps would suggest a form of dysentery; if there were no fever but the person were older (say, over 50), this might be diverticulitis or ischemic colitis. The more symptoms that are present, the easier it is, in general, to pinpoint the cause.

What Abdominal Pain Could Mean

Oliver Cope, in his classic text,The Acute Abdomen, carefully delineates this investigative process, beginning with location in the abdomen. Since the abdomen is more of a regional category rather than a monofunctional one, pain can be due to any of the organs present in it. In the right upper quadrant, we have the liver, the gall bladder and the large and small bowel. Common syndromes of right upper quadrant (RUQ) pain include hepatitis, hepatic abscess, liver parasites, gallstones, problems of the sphincter of Oddi and common bile duct problems.

A high-riding appendix might also generate pain there. The base of the right lower lung and its parietal pleura might also cause problems there. When there is an inflammatory process elsewhere in the abdomen, a sub-phrenic abscess is yet another condition to consider.

Vascular problems, primarily arterial, can also be a source of pain in the abdomen. The arteries feeding the right colon and the small intestine on that side can occlude and cause tissue infarction.

In the LUQ, we have the descending colon, additional small bowel, the inferior aspect of the left lung and its parietal pleura, the inferior part of the heart, and the associated arteries. The pancreas, situated posterior to the lower stomach, can be a source of acute or chronic, sing-ular or recurrent pain, based on attacks of pancreatitis or blockage of the pancreatic duct. Need-less to say, the symptoms of pancreatitis may mimic esophagitis or gastritis.

Spleens can infarct, as they might with infectious disease or lymphoproliferative disease or hematologic abnormalities, such as sickle cell. The stomach occupies a large part of this region and can manifest problems of erosion, inflammation, hyperacidity and abnormal blood flow. The gas-troesophageal area can have its own differential diagnosis, apart from the fundus, the antrum and the gastroduodenal outlet.

In general, abdominal pain is most often visceral pain, poorly localized and often giving the feeling of an ache. When it involves a hollow viscus, it might attain a crescendo-decrescendo pattern, giving the sense of increasing intensity which lets off after some time, only to repeat itself. It is similar to the cycle of labor pains and can be found this way in obstruction or partial obstruction of a hollow viscus or a series of contractions associated with phenomena like diarrhea.

By contrast, kidney stones, although presenting with a cyclic pain quality, tend to be much sharper. As the stone descends in the ureter, the person experiences the pain at the upper flank area, then the lateral midabdomen, then the groin, before it passes through the urethra and the patient is symptom-free.

The RLQ, well-known as the general home of the appendix, may also have symptoms associated with the right adnexa (ovary and tube). There is addition colon and small bowel present, as well as associated arteries and veins. Lymph nodes, when enlarged, can be a source of pain, whether as a result of infectious disease or carcinogenesis.

The LLQ is comparable to the RLQ, except that it is also the home of the descending colon, the sigmoid and the rectum. Both lower quadrants contain a ureter, most often symptomatic from a kidney stone. The kidneys, being retroperitoneal, tend to localize their pain to the posterior flanks.

A thorough patient history should be obtained. Details regarding when, where and how long the pains lasted, and the quality of the pain (burning, cutting, stabbing, continuous vs cyclic or inter-mittent). The patient should be asked about any similar problems in the past, as well as prior surgeries or traumas.

Not all abdominal pain arises in the abdomen, as the prior mention of pulmonary conditions and heart conditions attests.

Source: Medpedia content in it's entirety (http://wiki.medpedia.com/Clinical:Abdominal_Pain).

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