10 COMMON DISEASES

CAUSES OF 10
COMMON SYMPTOMS

ABDOMINAL PAIN

 
Subject Contents

Abdominal pain diagnosis

 
Definition
This article discusses clues to diagnosing the cause and severity of abdominal pain.
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Alternative Names
Stomachache
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Information
Abdominal pain can represent many different types of problems besides a simple stomach ache. Some of the keys to diagnosing abdominal pain include aggravating factors, relieving factors, onset, duration, and quality of the pain. If abdominal pain is severe and is not improving quickly; if pain persists along with fever, persistent vomiting, vomiting blood, bloody diarrhea, nausea and lack of appetite, yellowing of eyes, burning with urination, weakness or dizziness; or if pregnancy is possible, a health provider should be contacted immediately. Appendicitis generally starts with pain in the center of the abdomen. This is usually followed by loss of appetite and nausea and then by fever. As a person's appendicitis worsens, pain generally migrates to the right lower abdomen. A health provider should check someone with persistent abdominal pain, nausea, and fever, as appendicitis is a medical emergency. Ulcers often produce pain in the upper, central abdomen (epigastrium), although some people with ulcers have no pain. Ulcers in the duodenum (the tube leaving the stomach) often produce pain 1 or 2 hours after eating and pain at night, which decreases with eating or antacids. Ulcers in the stomach (gastric ulcers) produce pain in the upper abdomen, which may or may not be related to food. Some patients with ulcers have stomach pain which travels to the mid-back. A bleeding ulcer can cause a person's stools to become black. Black stools can also be caused by medicines such as iron and Pepto Bismol, but in the absence of these medications, the passing of black stool, or melena, is a medical emergency. A physician should be contacted immediately.
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Abdominal pain

 
Definition
This symptom is pain in the abdominal area, stomach region, or belly (often referred to as stomach pain) or in the abdominal area.
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Alternative Names
Stomach pain; Pain - abdomen; Belly ache; Abdominal cramps; Acute abdomen
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Considerations
Abdominal pain is a nonspecific symptom that may be associated with a multitude of conditions. Some do not occur within the abdomen itself, but cause abdominal discomfort . An example would be the abdominal pain associated with strep throat . Some originate within the abdomen, but are not related to the gastrointestinal tract, such as a dissecting aortic aneurysm . Other pain is related directly to the gastrointestinal tract. The severity of the pain does not always reflect the severity of the condition causing the pain. Severe abdominal pain can be associated with mild conditions, such as gas or the cramping of viral gastroenteritis , while relatively mild pain (or no pain) may be present with severe and life-threatening conditions, such as cancer of the colon or early appendicitis . Abdominal pain can be caused by toxins , infection, biliary tract disease, liver disease , renal disease , bladder infections, menstruation, ovulation, female and male genitourinary disease, vascular problems, malignancy , ulcers , perforation, pancreatic disease, hernias, trauma, and metabolic diseases. The list is so extensive that it would be impossible to name all the possible diseases in each of the above groups. Because abdominal pain is nonspecific, the health care provider will require much more information regarding the time of onset, duration of pain (minutes, hours, days, or even months), location of pain, nature of pain (dull, sharp, steady, crampy, off and on), severity of pain, and relationship to normal functions (such as menstruation and ovulation). The location of pain and its time pattern may be helpful in suggesting its cause. During physical examination , the health care provider will try to determine if the pain is localized to a single area ( point tenderness ) or diffuse, and if the pain is related to inflammation of the peritoneum or of the abdomen. If the health care provider finds evidence of peritoneal inflammation, the abdominal pain may be classified as an " acute abdomen", which often requires prompt surgical intervention. In addition, the health care provider will try to relate the abdominal tenderness to other general symptoms, such as fever , fatigue , general ill feeling ( malaise ), nausea , vomiting , or changes in stool. Then, the provider will ask about increasingly specific symptoms as the diagnostic considerations are narrowed. In infants, prolonged unexplained crying (often called "colic") may be caused by abdominal pain that often ends with the passage of gas or stool. Colic is often worse in the evening. Cuddling and rocking the child may bring some relief. Severe abdominal pain that occurs during menstruation may indicate a problem in a reproductive organ. This includes conditions, such as endometriosis , uterine fibroids , ovarian cysts , ovarian cancer (rare), or pelvic inflammatory disease (PID) .
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Common Causes
The following is a list of the most common causes of abdominal pain. It is important to note that among this list there are relatively few serious diseases.
  • Bladder infections
  • Cholecystitis
  • and/or
  • gallstones
  • Colic in infants
  • (infants to 4 months)
  • Excessive gas
  • Endometriosis
  • Food allergy
  • Food poisoning
  • (salmonella, shigella)
  • Hernia
  • Indigestion
  • Kidney stones
  • Lactose intolerance
  • (
  • milk intolerance )
  • Menstrual cramping
  • Ovarian cysts
  • Pelvic inflammatory disease (PID)
  • Pneumonia
  • (in children)
  • Recurrent abdominal pain (usually in children and adolescents -- a type of
  • somatization disorder where emotional upset is reflected as physical discomfort)
  • Streptococcal pharyngitis
  • (
  • strep throat , in children this can cause abdominal pain)
  • Ulcers
  • Uterine fibroids
  • Viral gastroenteritis
  • (stomach
  • flu ) Common causes in children:
  • Gastroesophageal reflux
  • Chronic constipation
  • Parasite infections (Giardia)
  • Excess fructose or sorbitol ingestion
  • Sickle cell crisis
  • Crohn's disease
  • Less common, but serious causes:
  • Ovarian cancer
  • Colon cancer
  • or other
  • abdominal cancer Abdominal pain that may indicate a potential emergency:
  • Severe abdominal pain with nausea and fever may indicate
  • appendicitis '>appendicitis , Cholecystitis '>Cholecystitis (infected gall bladder), or complications of diverticulitis .
  • Abdominal pain, nausea, and bloating or constipation may indicate a
  • bowel obstruction .
  • Abdominal pain that is accompanies by a stiff, "board like" abdomen may indicate
  • peritonitis due to an infection spreading in the abdominal cavity or to a hole in the stomach or intestine.
  • Abdominal pain is accompanied by bloody stools,
  • vomiting blood , or gastrointestinal bleeding from any cause can be dangerous.
  • Persistent upper abdominal pain and vomiting may indicate pancreatitis (inflammation of the pancreas).
  • Abdominal pain followed by nausea/ vomiting and fever may indicate
  • appendicitis '>appendicitis .
  • Intermittent abdominal pain manifested in an infant by drawing knees to chest, with crying, could be
  • intussusception (telescoping intestines).
  • Dissecting abdominal aortic aneurysm.
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    Home Care
    For mild pains, sip water or other clear fluids. Avoid solid food. Antacids may provide some relief. AVOID narcotic pain medications , aspirin, and NSAIDs unless the health care provider prescribes them.
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    Call your health care provider if
  • The pain is very severe
  • An abdominal injury was sustained in the last 2 or 3 days
  • Pain develops during
  • pregnancy (or possible pregnancy)
  • The pain persists for a prolonged period of time.
  • Pain is accompanied by
  • fever , nausea , or an inability to keep down food or liquids for several days
  • Nausea, fever, and
  • bloating or constipation accompanies the pain
  • The abdomen is tender to touch, or it feels rigid or hard
  • The patient has been
  • vomiting blood or there are bloody stools
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    What to expect at your health care provider's office
    The medical history will be obtained and a physical examination performed. Medical history questions documenting abdominal pain in detail include:
  • Type
  • Is the pain all over (diffuse or generalized) or in a specific location?
  • Location (What part of the abdomen is affected?)
  • Lower abdomen
  • Right-lower quadrant
  • Left-lower quadrant
  • Upper abdomen
  • Left-upper quadrant
  • Right-upper quadrant
  • Upper-middle of abdomen (epigastric)
  • Around the navel (periumbilical)
  • Initially around the navel, later shifted to the right lower quadrant (this is highly indicative of
  • appendicitis )
  • Quality
  • Severe
  • Sharp or cramping
  • Persistent or constant
  • Periodic and changing intensity over minutes (colicky)
  • Time pattern
  • Does the pain awaken you at night?
  • Is the pain recurrent -- has there been similar pain in past?
  • How long does each episode last (how many hours)?
  • How often does the pain appear (at how many days interval)?
  • How long have you been having these pains (how many months in duration?)
  • Does it occur within minutes following meals?
  • Does it occur within 2 to 3 hours after meals?
  • Is it getting increasingly more severe?
  • Did it begin suddenly?
  • Does it occur during menstruation (
  • dysmenorrhea )?
  • How long has the pain been present?
  • Radiation
  • Does the pain go into your back?
  • Does the pain go below the right shoulder blade (right scapular area)?
  • Does the pain go through to the middle of the back?
  • Does the pain go into your groin, buttocks, or legs?
  • Aggravating factors
  • Does the pain get worse after lying on the back (supine position)?
  • Does the pain get worse after eating or drinking?
  • Does the pain get worse after greasy foods?
  • Does the pain get worse after milk products?
  • Does the pain get worse after alcohol?
  • Does the pain get worse after fasting?
  • Does the pain get worse after
  • stress ?
  • Does the pain get worse after straining efforts?
  • Relieving factors
  • Does the pain get better after you eat food?
  • Does the pain get better after bowel movement?
  • Does the pain get better after milk or antacids? Does this relieve the pain in a few minutes?
  • Does the pain get better after withdrawal of milk products?
  • Medications
  • What medications are you taking?
  • Have you changed medications recently?
  • Other
  • Has there been a recent injury?
  • Are you
  • pregnant ?
  • What other symptoms are occurring at the same time?
  • Is there a
  • fever ?
  • Is there
  • vomiting ?
  • Is there
  • diarrhea ?
  • Are there
  • hives ?
  • Is there
  • difficulty breathing ?
  • Is there
  • blood in the stools ?
  • Are you
  • vomiting blood ? A physical examination with a focus on the abdomen will be performed. Observation in the hospital may be required in severe cases. If pain persists, re-evaluation will be necessary. Diagnostic tests that may be performed include:
  • Barium enema
  • Upper GI and small bowel series
  • Blood, urine, and stool tests
  • Endoscopy
  • of upper GI (gastrointestinal) tract (
  • EGD '>EGD )
  • Ultrasound of the abdomen
  • X-rays of the abdomen
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