Abdominal Pain: From Diagnosis to Treatment

Abdominal pain is a common symptom that can have many causes, ranging from mild conditions to life-threatening illnesses. Understanding the different types of abdominal pain, identifying the cause, and providing appropriate treatment is crucial.

1. Types of Abdominal Pain:

Abdominal pain can be classified based on its nature, duration, and severity:

• By nature:

• Acute abdominal pain: Onset is sudden and severe, often accompanied by other symptoms like vomiting, nausea, fever, etc.

• Recurrent abdominal pain: Pain that recurs, potentially following a pattern or irregularly, and may be associated with other symptoms.

• Chronic abdominal pain: Pain lasting longer than 3 months, with fluctuating severity over time, often impacting daily life.

• By cause:

• Medical abdominal pain: Caused by illnesses in the organs within the abdomen, such as gastritis, enteritis, cholecystitis, kidney stones, etc.

• Surgical abdominal pain: Caused by conditions requiring surgery, such as perforation of a hollow organ, bowel obstruction, intussusception, peritonitis, etc.

2. Difference Between Frequent Abdominal Pain (FAP) and Chronic Abdominal Pain (CAP):

• Frequent Abdominal Pain (FAP):

• Occurs >= 3 times / 3 months.

• Impacts daily life, diminishing quality of life.

• Chronic Abdominal Pain (CAP):

• Occurs 2-3 times / 2 months.

• A dull, persistent pain that may disappear for a period and then return.

3. Medical History:

To accurately diagnose the cause of abdominal pain, a doctor will gather information from the patient by taking a medical history. Common questions include:

• Onset: When did the abdominal pain start? After eating something specific? After physical activity?

• Mode of onset: Did the pain come on suddenly or gradually?

• Course of the pain: Is the pain continuous or in episodes? How long does each episode last? Does it gradually diminish or increase?

• Severity of pain: Is the pain mild, moderate, or severe? (Note: The severity of pain can be exaggerated, so it’s important to observe other symptoms.)

• Location of pain: Where is the pain located? Does it radiate to any other areas?

• Other symptoms: In addition to abdominal pain, are there any other symptoms? Such as vomiting, nausea, diarrhea, constipation, fever, etc.

4. Common Cases of Abdominal Pain:

• Abdominal pain after a heavy meal: Often due to acute pancreatitis.

• Abdominal pain in the epigastric region, later localized to the lower right abdomen with vomiting and constipation: Suspect acute appendicitis.

• Sudden abdominal pain radiating to the groin and back, with burning and frequent urination: Suspect kidney stones or ureteral colic.

5. Other Symptoms Besides Abdominal Pain:

Besides abdominal pain, patients may experience other symptoms like:

• Gastrointestinal symptoms:

• Vomiting, nausea.

• Diarrhea, constipation, inability to pass gas.

• Non-gastrointestinal symptoms:

• Fever, chills.

• Rash, pale skin.

• Dehydration, shock.

6. Physical Examination:

A physical examination of the abdomen is crucial for diagnosing abdominal pain. The doctor will perform various maneuvers to assess:

• Location of pain: Pinpoint the exact location of the pain.

• Abdominal wall response: Evaluate the response of the abdominal wall to palpation, helping differentiate medical and surgical causes of abdominal pain.

• Rectal examination: Performed last, to examine for tumors, polyps, etc.

7. Abdominal Wall Response:

Abdominal wall response refers to the rigidity of the abdominal muscles, helping the doctor assess the severity of the condition.

• Localized abdominal wall response: Often seen in children due to weaker abdominal muscles.

• Generalized abdominal wall response: Often seen in severe cases, potentially indicating peritonitis, perforation of a hollow organ, etc.

8. Rectal Examination:

A rectal examination helps the doctor directly examine the lower intestinal tract, detecting any abnormalities like polyps or tumors.

9. Other Physical Examinations:

Besides examining the abdomen, the doctor will perform other physical examinations to assess the patient’s overall health, including:

• General examination: Checking for signs of infection (fever, chills), rash, pale skin, etc.

• Shock: Evaluating for shock (rapid heart rate, low blood pressure, etc.)

• Dehydration: Checking for signs of dehydration (dry mouth, tongue, skin, etc.)

• Examination of other organs: Examining the heart, lungs, etc. to rule out related illnesses.

• Child’s lifestyle: In young children, examining their eating habits, sleep patterns, and bowel movements.

10. Diagnostic Tests:

• X-ray:

• Free air under the diaphragm: Suspect perforation of a hollow organ.

• Fluid levels in the bowel: Assess bowel obstruction.

• Free fluid in the abdomen: Suspect peritonitis.

• Note: X-rays cannot detect a perforation of the posterior wall of the stomach.

• Routine laboratory tests:

• CBC: Assess infection, anemia, etc.

• Blood amylase: Elevated early on in acute pancreatitis.

• Blood lipase: Elevated in acute pancreatitis.

• Urine: Check for urinary tract infection, kidney stones, etc.

• LDH: Assess cell damage.

• Electrolytes: Check for dehydration, electrolyte imbalances.

• CRP, PCT: Assess the severity of inflammation.

• Ultrasound:

• Signs of mesenteric adenitis.

• Intussusception.

• Images of appendicitis.

• Free/localized fluid in the abdomen.

• Images of worms in the bile duct, pancreatic duct, etc.

• Laparoscopy: Performed in the upper and lower abdomen, allowing direct visualization of the stomach and intestinal lining.

• Upper endoscopy: Used to directly visualize the lining of the esophagus, stomach, and duodenum.

• Colonoscopy: Used to directly visualize the lining of the colon.

• Abdominal CT: Provides detailed images of the organs in the abdomen, helping detect abnormalities in structure and morphology.

• Abdominal MRI: Provides sharper images than abdominal CT, particularly useful for soft tissue abnormalities.

• Urine tests: Only performed when necessary to evaluate kidney function, urinary tract infection, etc.

• IVP (Intravenous Pyelogram): Only performed when necessary to evaluate kidney function, urinary tract obstruction, etc.

11. Diagnosis and Treatment:

After taking a medical history, conducting a physical examination, and performing diagnostic tests, the doctor will diagnose the cause of the abdominal pain and choose the appropriate treatment.

• If symptoms suggest acute abdominal pain:

• The patient should be referred to a surgeon for evaluation and timely surgical intervention.

• Some conditions requiring surgery:

• Abdominal aortic aneurysm rupture.

• Splenic rupture.

• Bowel perforation.

• Intussusception.

• Bowel volvulus.

• Peritonitis.

• Incarcerated hernia.

• Ectopic pregnancy.

• Ovarian/testicular torsion.

• If no symptoms suggest acute abdominal pain:

• The doctor will use the location of the pain to choose appropriate diagnostic tests.

• Location of pain:

• Upper abdomen: Abdominal ultrasound, chest X-ray, liver function tests, amylase, lipase, etc.

• Lower abdomen: Abdominal ultrasound, urinalysis, upright abdominal X-ray, pregnancy test, pelvic imaging, etc.

• Around the umbilicus: Abdominal ultrasound, upright abdominal X-ray, etc.

• Back, shoulder, hip: Abdominal ultrasound, liver function tests, amylase, lipase, urinalysis, etc.

• Chronic abdominal pain:

• If no signs of constipation: Perform routine laboratory tests, CBC, liver function tests, etc., and other diagnostic tests.

• If no constipation and no other symptoms: May be functional abdominal pain, functional dyspepsia.

• If no constipation, diarrhea, and weight loss: Perform routine laboratory tests, upper endoscopy, calprotectin, upright abdominal X-ray, etc.

• If no constipation, increased/decreased sensation when eating: Perform routine laboratory tests, upper endoscopy, etc.

• If no constipation, abdominal distention, diarrhea, steatorrhea: Perform routine laboratory tests, upper endoscopy, stool analysis (calprotectin), MRI, ultrasound, abdominal CT, colonoscopy, etc.

• If no constipation and general health concerns: Perform routine laboratory tests, upper endoscopy, etc.

Important notes:

• Abdominal pain can be a symptom of many conditions, so it’s important to consult a doctor for an accurate diagnosis and treatment.

• Do not self-medicate without a doctor’s prescription.

• If the abdominal pain is severe, take the patient to the nearest medical facility for immediate examination and treatment.

12. Common Conditions Causing Abdominal Pain:

• Hirschsprung’s disease:

• Symptoms: Abdominal pain, frequent constipation alternating with diarrhea.

• X-ray: Fluid/air levels in the bowel.

• The severity and length of the affected bowel depend on the length of the aganglionic segment.

• Duodenal stenosis:

• Symptoms: Double bubble sign.

• Gastroenteritis:

• Ultrasound cannot diagnose the cause.

• Endoscopy is required for diagnosis.

13. Causes of Back, Shoulder, and Hip Pain:

• Gallstones: Radiates from the upper abdomen to the back and shoulder.

• Pancreatitis: Radiates from the upper abdomen to the back and shoulder.

• Splenic hemorrhage/trauma: Radiates from the upper abdomen to the back and shoulder.

• Kidney stones: Radiates from the lower abdomen to the back and hip.

• Acute pyelonephritis: Radiates from the lower abdomen, around the umbilicus, to the back and hip.

14. Conclusion:

Abdominal pain is a common symptom that can indicate a variety of conditions. Understanding the different types of abdominal pain, identifying the cause, and choosing appropriate treatment are crucial for protecting your health.

15. References:

• Gastroenterologist.

• Reputable medical sources.