Abdominal Pain

What is Abdominal pain ?

Abdominal pain (or stomach ache) 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.

Causes :

Most of the time, it's difficult to determine where abdominal pain originates from. And though you may feel pain in one area of your abdomen, it may actually be caused by something in another area of your body — what doctors call referred pain. Few causes of abdominal pain are specific to one area of your abdomen.

Some abdominal pain isn't focused in one area of the abdomen. This type of pain can be caused by:

• Aortic aneurysm
• Appendicitis
• Crohn's disease
• Diabetic ketoacidosis (high levels of ketones in the blood)
• Diverticulitis
• Injury
• Intestinal obstruction
• Intussusception (in children)
• Irritable bowel syndrome
• Lead poisoning
• Mesenteric lymphadenitis (swollen lymph nodes in the folds of membrane that hold the abdominal organs in place)
• Pancreatitis (pancreas inflammation)
• Pelvic inflammatory disease (PID) (infection of the female reproductive organs)
• Peritonitis (infection of the abdominal lining)
• Sickle cell anemia
• Strained or pulled abdominal muscle
• Ulcerative colitis
• Uremia (buildup of waste products in your blood)
• Urinary tract infection
• Viral gastroenteritis (stomach flu) (stomach inflammation)

Causes of lower abdominal pain, sometimes described as pelvic pain, include:

• Appendicitis
• Cystitis (bladder inflammation)
• Diverticulitis
• Ectopic pregnancy
• Endometriosis
• Intestinal obstruction
• Mittelschmerz (pain associated with ovulation)
• Ovarian cysts
• Pelvic inflammatory disease (PID) (infection of the female reproductive organs)
• Salpingitis (inflammation of the fallopian tubes)

Causes of upper abdominal pain include:

• Angina (reduced blood flow to the heart)
• Aortic aneurysm
• Appendicitis
• Cholangitis (bile duct inflammation)
• Cholecystitis (gallbladder inflammation)
• Duodenitis (inflammation of the initial portion of the small intestine)
• Gallstones
• GERD (gastroesophageal reflux disease)
• Heart attack
• Hepatitis (liver inflammation)
• Intestinal obstruction
• Mesenteric ischemia (decreased blood flow to the intestines)
• Non-Hodgkin's lymphoma
• Nonulcer stomach pain
• Pancreatitis (pancreas inflammation)
• Peptic ulcer
• Pericarditis (inflammation of the tissue around the heart)
• Pleurisy (inflammation of the membrane surrounding the lungs)
• Pneumonia
• Pneumothorax (lung collapse caused by air that leaks inside chest wall)
• Pyloric stenosis (in infants)

Causes of pain in the center of the abdomen include:

• Aortic aneurysm
• Appendicitis
• Diabetic ketoacidosis (high levels of ketones in the blood)
• Injury
• Intestinal obstruction
• Mesenteric thrombosis (blood clot in a vein carrying blood away from your intestines)
• Pancreatitis (pancreas inflammation)
• Uremia (buildup of waste products in your blood)

Causes of lower left abdominal pain include:

• Aortic aneurysm
• Appendicitis
• Cancer
• Crohn's disease
• Diverticulitis
• Ectopic pregnancy
• Endometriosis
• Inguinal hernia
• Injury
• Intestinal obstruction
• Kidney infection
• Kidney stones
• Mittelschmerz (pain associated with ovulation)
• Ovarian cysts
• Seminal vesiculitis (inflammation of the seminal vesicles)
• Torn colon
• Tuboovarian abscess (pus-filled pocket involving a fallopian tube and an ovary)
• Ulcerative colitis

Causes of upper left abdominal pain include:

• Angina (reduced blood flow to the heart)
• Aortic aneurysm
• Cancer
• Diverticulitis
• Empyema (infection of the lining around the lungs)
• Enlarged spleen (splenomegaly)
• Fecal impaction (hardened stool that can't be eliminated)
• Gastritis (inflammation of the stomach lining)
• Heart attack
• Hiatal hernia
• Injury
• Kidney infection
• Kidney stones
• Pancreatitis (pancreas inflammation)
• Pneumonia
• Pulmonary infarction (loss of blood flow to the lungs)
• Pyloric stenosis (in infants)
• Ruptured spleen
• Shingles
• Spleen infection
• Splenic abscess (pus-filled pocket in the spleen)
• Torn colon

[Colicky abdominal pain]

Causes of lower right abdominal pain include:

• Aortic aneurysm
• Appendicitis
• Cancer
• Cholecystitis (gallbladder inflammation)
• Diverticulitis
• Ectopic pregnancy
• Endometriosis
• Inguinal hernia
• Injury
• Intestinal obstruction
• Kidney infection
• Kidney stones
• Mittelschmerz (pain associated with ovulation)
• Ovarian cysts
• Salpingitis (inflammation of the fallopian tubes)
• Seminal vesiculitis (inflammation of the seminal vesicles)
• Tuboovarian abscess (pus-filled pocket involving a fallopian tube and an ovary)
• Viral gastroenteritis (stomach flu) (stomach inflammation)

Causes of upper right abdominal pain include:

• Appendicitis
• Cholangitis (bile duct inflammation)
• Diverticulitis
• Fecal impaction (hardened stool that can't be eliminated)
• Gallbladder cancer
• Gallstones
• Gastritis (inflammation of the stomach lining)
• Hepatitis (liver inflammation)
• Hiatal hernia
• Injury
• Intestinal obstruction
• Kidney cancer
• Kidney infection
• Kidney stones
• Liver abscess (pus-filled pocket in the liver)
• Liver cancer
• Liver hemangioma
• Pancreatic cancer
• Pancreatitis (pancreas inflammation)
• Peptic ulcer
• Pericarditis (inflammation of the tissue around the heart)
• Pleurisy (inflammation of the membrane surrounding your lungs)
• Pneumonia
• Pulmonary infarction (loss of blood flow to the lungs)
• Pyloric stenosis (in infants)
• Shingles
• Stomach cancer

Symptoms :

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

• Fever
• Inability to keep food down for several days
• Inability to pass stool, especially if you are also vomiting
• Vomiting blood
• Bloody stools
• Difficulty breathing
• Painful or unusually frequent urination
• The pain occurs during pregnancy
• The abdomen is tender to the touch
• The pain is the result of an injury to the abdomen in the previous days
• The pain lasts for several days

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

How Is the Cause of Abdominal Pain Determined?

• How long have you had the pain?
  
  
• What were you doing when it started?
  
  
• How did you feel before the pain started?
  
  
• Have you felt OK over the last few days?
  
  
• What have you tried to make the pain better? Did it work?
  
  
• Does the pain make you want to stay in one place or move around?
  
  
• How was the ride to the hospital? Did riding in the car hurt you?
  
  
• Is the pain worse when you cough?
  
  
• Have you thrown up?
  
  
• Did throwing up make the pain better or worse?
  
  
• Have your bowel movements been normal?
  
  
• Are you passing gas?
  
  
• Do you feel you might have a fever?
  
  
• Have you had a pain like this before? When? What did you do for it?
  
  
• Have you ever had surgery? What surgery? When?
  
  
• Are you pregnant? Are you using birth control?
  
  
• Have you been around anyone with symptoms like this?
  
  
• Have you traveled out of the country recently?
  
  
• When did you eat last? What did you eat?
  
  
• Did you eat anything out of the ordinary?
  
  
• Did your pain start all over your stomach and move to one place?
  
  
• Does the pain go into your chest? Into your back? Where does it go?
  
  
• Can you cover the pain with the palm of your hand, or is the hurting area bigger than that?
  
  
• Does it hurt for you to breathe?
  
  
• Do you have any medical problems such as heart disease, Diabetes, orAIDS?
  
  
• Do you take steroids? Pain medicine such as aspirin or Motrin?
  
  
• Do you take antibiotics? Over-the-counter pills or herbs?
  
  
• Do you drink alcohol? Coffee? Tea?
  
  
• Do you smoke cigarettes?
  
  
• Do you use cocaine or other drugs?

Find possible causes of abdominal pain based on specific factors. Check one or more factors on this page that apply to your symptom.

Pain is

• Acute, or began suddenly

• Burning

• Chronic, or ongoing

• Crampy

• Dull

• Gnawing

• Intense

• Intermittent or episodic

• Progressive, or worsens over time

• Sharp

• Steady

Pain located in

• Abdomen but radiates to other parts of the body

• Lower abdomen

• Middle abdomen

• One or both sides

• Upper abdomen

Triggered or worsened by

• Coughing or other jarring movements

• Drinking alcohol

• Eating certain foods

• Menstrual cycle

• Stress

Relieved by

• Antacids

• Avoiding certain foods

• Changing position

• Drinking more water

• Eating certain foods

• Eating more fiber

Accompanied by

• Abdominal swelling

• Black or bloody stools

• Constipation

• Diarrhea

• Fever

• Inability to move bowels in spite of urge

• Nausea or vomiting

• Passing gas

• Rash

• Stomach growling or rumbling

• Unintended weight loss

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 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, or ischemia.

For example:

• Finding tenderness and signs of inflammation in the left lower abdomen often means that diverticulitis is present, while finding a tender (inflamed) mass in the same area may mean that the inflammation has progressed and that an abscess has formed.
  
  
• Finding tenderness and signs of inflammation in the right lower abdomen often means that appendicitis is present, while finding a tender mass in the same area may mean that appendiceal inflammation has progressed and become an abscess.
  
  
• Inflammation in the right lower abdomen, with or without a mass, also may be found in Crohn's disease. (Crohn's disease most commonly affects the last part of the small intestine, usually located in the right lower abdomen.)
  
  
• A mass without signs of inflammation may mean that a cancer is present.

Exams and tests :

While the history and physical examination are vitally important in determining the cause of abdominal pain, testing often is necessary to determine the cause.

Laboratory tests

Laboratory tests such as the complete blood count (CBC), liver enzymes, pancreatic enzymes (amylase and lipase), and urinalysis are frequently performed in the evaluation of abdominal pain.

• An elevated white count suggests inflammation or infection (as with appendicitis, pancreatitis, diverticulitis, or colitis).
  
  
• Amylase and lipase (enzymes produced by the pancreas) commonly are elevated in pancreatitis.
  
  
• Liver enzymes may be elevated with gallstone attacks.
  
  
• Blood in the urine suggests kidney stones.
  
  
• When there is diarrhea, white blood cells in the stool suggest intestinal inflammation.

Plain x-rays of the abdomen

Plain abdominal x-rays of the abdomen also are referred to as a KUB (because they include the kidney, ureter, and bladder). The KUB may show enlarged loops of intestines filled with copious amounts of fluid and air when there is intestinal obstruction. Patients with a perforated ulcer may have air escape from the stomach into the abdominal cavity. The escaped air often can be seen on a KUB on the underside of the diaphragm. Sometimes a KUB may reveal a calcified kidney stone that has passed into the ureter and resulted in referred abdominal pain or calcifications in the pancreas that suggests chronic pancreatitis.

Radiographic studies

• Abdominal ultrasound is useful in diagnosing gallstones, cholecystitis appendicitis, or ruptured ovarian cysts as the cause of the pain.
  
  
• Computerized tomography (CT) of the abdomen is useful in diagnosing pancreatitis, pancreatic cancer, appendicitis, and diverticulitis, as well as in diagnosing abscesses in the abdomen. Special CT scans of the abdominal blood vessels can detect diseases of the arteries that block the flow of blood to the abdominal organs.
  
  
• Magnetic resonance imaging (MRI) is useful in diagnosing many of the same conditions as CT tomography.
  
  
• 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.
  
  
• Computerized tomography (CT) of the small intestine can be helpful in diagnosing diseases in the small bowel such as Crohn's disease.
  
  
• Capsule enteroscopy, a small camera the size of a pill swallowed by the patient, can take pictures of the entire small bowel and transmit the pictures onto a portable receiver. The small bowel images can be downloaded from the receiver onto a computer to be inspected by a doctor later. Capsule enteroscopy can be helpful in diagnosing Crohn's disease, small bowel tumors, and bleeding lesions not seen on x-rays or CT scans.

Endoscopic procedures

• Esophagogastroduodenoscopy or EGD is useful for detecting ulcers, gastritis (inflammation of the stomach), or stomach cancer.



• Colonoscopy or flexible sigmoidoscopy is useful for diagnosing infectious colitis,ulcerative colitis, or colon cancer.



• Endoscopic ultrasound (EUS) is useful for diagnosing pancreatic cancer or gallstones if the standard ultrasound or CT or MRI scans fail to detect them.
  
  
• Balloon enteroscopy, the newest technique allows endoscopes to be passed through the mouth or anus and into the small intestine where small intestinal causes of abdominal pain or bleeding can be diagnosed, biopsied, and treated.

Self-Care at Home :

Abdominal pain without fever, vomiting, vaginal bleeding, passing out, chest pain, or other serious symptoms often gets better without special treatment.

• If the pain persists or if the patient believes the pain may represent a serious problem, they should see their healthcare provider.
  
  
• A heating pad or soaking in a tub of warm water may ease the patient's pain.
  
  
• Over-the-counter antacids, such as Tums, Maalox, or Pepto-Bismol, also can reduce some types of abdominal pain. Activated charcoal capsules also may help.
  
  
• Acetaminophen (common brand names areArthritis Foundation Pain Reliever, AspirinFree Anacin, Panadol, Liquiprin, Tylenol) may help. Try to avoid aspirin or ibuprofen(common brand names are Advil, Motrin, Midol, Nuprin, Pamprin IB). These drugs can make some types of stomach ache worse.

Medical Treatment :

The patient's treatment will depend on what the doctor thinks is causing the abdominal pain.

The patient may be given IV fluids. The healthcare provider may ask the patient not to eat or drink anything until the cause of the pain is known. This is done to avoid worsening certain medical conditions (for example adding food to the stomach if there is a ruptured ulcer) or to prepare the patient in case they need to go to the operating room (an empty stomach is better when general anesthesia is needed).

The patient may be given pain medication.

• For pain caused by bowel spasm, they may be given a shot in the hip, arm, or leg.
  
  
• If the patient is not throwing up, they may receive a drink that has antacid in it or pain medication.
  
  
• Although the patient's pain may not go away completely, they have the right to be comfortable and should ask for pain medicine until they are made comfortable.

Abdominal Pain At A Glance

• Abdominal pain is pain that is felt in the abdomen.

• Abdominal pain comes from organs within the abdomen or organs adjacent to the abdomen.

• Abdominal pain is caused by inflammation, distention of an organ, or by loss of the blood supply to an organ. Abdominal pain in IBS may be caused by contraction of the intestinal muscles or hyper-sensitivity.

• The cause of abdominal pain is diagnosed on the basis of the characteristics of the pain, physical examination, and testing. Occasionally, surgery is necessary for diagnosis.

• The diagnosis of the cause of abdominal pain is challenging because characteristics of the pain may be atypical, tests are not always abnormal, diseases causing pain may mimic each other, and the characteristics of the pain may change over time