Stomach Pain

ABDOMINAL PAIN

abdominal pain

Abdominal pain is pain that is felt in the abdomen. The abdomen is an anatomical area that is bounded by the lower margin of the ribs and diaphragm above, the pelvic bone (pubic ramus) below, and the flanks on each side. Although abdominal pain can arise from the tissues of the abdominal wall that surround the abdominal cavity (such as the skin and abdominal wall muscles), the term abdominal pain generally is used to describe pain originating from organs within the abdominal cavity. Organs of the abdomen include the stomach, small intestine, colon, liver, gallbladder, spleen, and pancreas.

Technically, the lowermost portion of the area described previously, is the pelvis, which contains the urinary bladder and rectum, as well as the prostate gland in men, and the uterus, Fallopian tubes, and ovaries in women. Often, it can be difficult to know if lower abdominal pain is coming from the lower abdomen or pelvis.

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, conditions of the lower lungs, the kidneys, and the uterus or ovaries can cause abdominal pain. On the other hand, it also is possible for pain from organs within the abdomen to be felt outside of the abdomen. For example, the pain of pancreatic inflammation may be felt in the back. These latter types of pain are called "referred" pain because the pain does not originate in the location that it is felt. Rather, the cause of the pain is located away from where it is felt (i.e., it is referred to a different area).

What Are the Most Common Causes of Abdominal Pain?

Whether it's a mild stomach ache, sharp pain, or stomach cramps, abdominal pain can have numerous causes. Some of the more common causes include:

• Indigestion
• Constipation
• Stomach virus
• Menstrual cramps
• Irritable bowel syndrome (IBS)
• Food poisoning
• Food allergies
• Gas
• Lactose intolerance
• Ulcers
• Pelvic inflammatory disease
• Hernia
• Gallstones
• Kidney stones
• Endometriosis
• Crohn's disease
• Urinary tract infection
• Gastroesophageal reflux disease (GERD)
• Appendicitis

What Symptoms of Abdominal Pain Are Cause for Concern?

If your abdominal pain is severe or recurrent or if it is accompanied by any of the following symptoms, contact your health care provider as soon as possible:

• Fever
• Inability to keep food down for more than 2 days
• Any signs of dehydration
• Inability to pass stool, especially if you are also vomiting
• Painful or unusually frequent urination
• The abdomen is tender to the touch
• The pain is the result of an injury to the abdomen
• The pain lasts for more than a few hours

These symptoms can be an indication of an internal problem that requires treatment as soon as possible.

Seek immediate medical care for abdominal pain if you:

• Vomit blood
• Have bloody or black tarry stools
• Have difficulty breathing
• Have pain occurring during pregnancy

How Is the Cause of Abdominal Pain Determined?

Because there are so many potential causes of abdominal pain, your health care provider will perform a thorough physical exam, discuss with you the type of symptoms you are experiencing, and ask you several questions about the pain you are feeling. These questions may include:

• What type of pain are you experiencing? Is the pain throughout your abdomen or is it confined to a particular area?
• Where in your abdomen does the pain seem to be located?
• What type of pain are you experiencing? Is it stabbing and severe? Is it a dull ache?
• When does the pain occur? Always? More often in the morning or at night? If the pain comes and goes, about how long does it last each time? Does it occur after eating certain types of foods or after drinking alcohol? During menstruation
• How long have you had this pain?
• Does the pain also radiate into your lower back, shoulder, groin, or buttocks?
• Are you currently taking any medications or herbal supplements
• Are you pregnant?
• Does any activity such as eating or lying on one side relieve the pain?
• Have you been injured recently?

Once an initial evaluation has been completed, your health care provider may have you undergo some tests to help find the cause of your pain. These may include stool or urine tests, blood tests, barium swallows or enemas, an endoscopy, X-ray, ultrasound, or CT scan.

How Is Abdominal Pain Treated?

Treating abdominal pain depends on its cause. Treatments can range from medications for inflammation, GERD, or ulcers, to antibiotics for infections, to changes in personal behavior for abdominal pain caused by certain foods or beverages. In some cases, such as appendicitis and a hernia, surgery may be necessary.

When should I call my doctor about abdominal pain?

Some doctors suggest that if you have a "less serious" cause of abdominal pain (see above section on topic), especially if it is likely food poisoning (viral or bacterial) and you have had discomfort but are not dehydrated, you will likely not need medical care as the symptoms should resolve in about 24 to 48 hours. If you have a chronic problem that occasionally causes abdominal pain, most doctors suggest you contact the person treating you for the ailment for an appointment or prescription (refill). However, if you have any of the problems or symptoms listed in the "serious abdominal pain "section above, you should seek immediate medical care.

Signs and symptoms associated with abdominal pain

The following information, obtained by taking a patient's history, is important in helping doctors determine the cause of pain:

• The way the pain begins. Abdominal pain that comes on suddenly suggests an acute event, for example, the interruption of the supply of blood to the colon (ischemia) or obstruction of the bile duct by a gallstone (biliary colic).
• The location of the pain.
• Appendicitis typically causes pain in the middle of the abdomen, and then moves to the right lower abdomen, the usual location of the appendix.
• Diverticulitis typically causes pain in the left lower abdomen where most colonic diverticuli are located.
• Pain from the gallbladder (biliary colic or cholecystitis) typically is felt in the middle, upper abdomen or the right upper abdomen near where the gallbladder is located.
• The pattern of the pain.
• Obstruction of the intestine initially causes waves of crampy abdominal pain due to contractions of the intestinal muscles and distention of the intestine.
• True cramp-like pain suggests vigorous contractions of the intestines.
• Obstruction of the bile ducts by gallstones typically causes steady (constant) upper abdominal pain that lasts between 30 minutes and several hours.
• Acute pancreatitis typically causes severe, unrelenting, steady pain in the upper abdomen and upper back.
• The pain of acute appendicitis initially may start near the umbilicus, but as the inflammation progresses, the pain moves to the right lower abdomen.
• The character of pain may change over time. For example, obstruction of the bile ducts sometimes progresses to inflammation of the gallbladder with or without infection (acute cholecystitis). When this happens, the characteristics of the pain change to those of inflammatory pain. (See below.)
• The duration of the pain.
• The pain of IBS typically waxes and wanes over months or years and may last for years or decades.
• Biliary colic lasts no more than several hours.
• The pain of pancreatitis lasts one or more days.
• The pain of acid-related diseases - gastroesophageal reflux disease (GERD) or duodenal ulcers - typically show periodicity, that is, a period of weeks or months during which the pain is worse followed by periods of weeks or months during which the pain is better.
• Functional pain may show this same pattern of periodicity.
• What makes the pain worse. Pain due to inflammation (appendicitis, diverticulitis, 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.
• What relieves the pain.
• The pain of IBS and constipation often is relieved temporarily by bowel movements and may be associated with changes in bowel habit.
• Pain due to obstruction of the stomach or upper small intestine may be relieved temporarily by vomiting which reduces the distention that is caused by the obstruction.
• Eating or taking antacids may temporarily relieve the pain of ulcers of the stomach or duodenum because both food and antacids neutralize the acid that is responsible for irritating the ulcers and causing the pain.
• Pain that awakens patients from sleep is more likely to be due to non-functional causes and is more significant.

Other associated symptoms that accompany abdominal pain may suggest the following:

• The presence of fever suggests inflammation or infection.
• Diarrhea or rectal bleeding suggests an intestinal cause of the pain.

The presence of fever and diarrhea suggest inflammation of the intestines that may be infectious or non-infectious Physical examination to diagnose abdominal pain

PHYSICAL EXAMINATION

Examining the patient will provide the doctor with additional clues to the cause of abdominal pain. The doctor will determine:

1. The presence of sounds coming from the intestines that occur when there is obstruction of the intestines,
2. The presence of signs of inflammation (by special maneuvers during the examination),
3. The location of any tenderness
4. The presence of a mass within the abdomen that suggests a tumor, enlarged organ, or abscess (a collection of infected pus)
5. The presence of blood in the stool  that may signify an intestinal problem such as an ulcer, colon cancer, colitis, onr ischemia.