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Abdominal Pain

Introduction

Abdominal pain is always serious as life threatening situations can arise out of it. Different organs within the abdominal cavity can be the cause of pain. On the other hand often severe pain that appears organic in nature, can turn out to be psychosomatic. When the physician does a thorough work-up with no resulting diagnosis, the physician often concludes that there is nothing organically wrong.  The physician implies that the pain is due to psychological reasons (this is also termed “psychogenic abdominal pain”).

The physician needs to think: what diagnoses could be behind this type of abdominal pain? We call this “differential diagnosis”. In other words the physician makes a mental list of all the possible diagnoses. Then one by one he/she excludes other diagnoses that do not apply. This way the care giver does not overlook anything. Abdominal pain divides into various locations of the abdomen and then one can list the differential diagnoses. I attempted to do this here by listing the 6 subcategories (links above on the left). They contain most of the important causes of abdominal pain. But the list is incomplete as there are many less common causes that are missing. I am also using text links to pages where you can find more details.

Signs and symptoms

All of the conditions above associate with some abdominal pain. However, depending on the location of the organ the pain maybe local or may radiate into a different area. Also the quality of pain varies and different symptoms associate with other findings.  The underlying pathophysiology determines the symptoms. I do not repeat the conditions that I described earlier in the following chapter. I will briefly explain the other conditions of the differential diagnosis table of abdominal pain.

 Abdominal Pain

Abdominal Pain

Treatment

As all of the diseases, which I mentioned before in the links all have a different pathophysiology. Therefore the physician must individualize treatment. I have described specific treatments below for those conditions not already mentioned above in the chapter. However, there are some common themes. If there is an infectious process such as with PID (=pelvic inflammatory disease) or diverticulitis, then intravenous antibiotics are given.

If there is an abscess such as a liver abscess or a perforated appendicitis, then this has to be surgically drained and also be treated with antibiotics. A cancerous growth requires surgical removal. An incarcerated inguinal hernia or a volvulus needs to be surgically reduced before it leads to gangrene of a segment of the bowel. Acute pancreatitis needs to be supportively treated and the pain needs to be suppressed with narcotics, the same is true for kidney stones.

Treatment for quite a number of diseases is to not give anything by mouth. This rests the gut through the use of intravenous fluids for a period of time. This approach helps for pancreatitis, for acute cholecystitis, ileus and ulcerative colitis just to mention a few.

Last modified: August 26, 2018

Disclaimer
This outline is only a teaching aid to patients and should stimulate you to ask the right questions when seeing your doctor. However, the responsibility of treatment stays in the hands of your doctor and you.

References


  1. DM Thompson: The 46th Annual St. Paul's Hospital CME Conference for Primary Physicians, Nov. 14-17, 2000, Vancouver/B.C./Canada
  2. C Ritenbaugh Curr Oncol Rep 2000 May 2(3): 225-233.
  3. PA Totten et al. J Infect Dis 2001 Jan 183(2): 269-276.
  4. M Ohkawa et al. Br J Urol 1993 Dec 72(6):918-921.
  5. Textbook of Primary Care Medicine, 3rd ed., Copyright © 2001 Mosby, Inc., pages 976-983: "Chapter 107 - Acute Abdomen and Common Surgical Abdominal Problems".
  6. Marx: Rosen's Emergency Medicine: Concepts and Clinical Practice, 5th ed., Copyright © 2002 Mosby, Inc. , p. 185:"Abdominal pain".
  7. Feldman: Sleisenger & Fordtran's Gastrointestinal and Liver Disease, 7th ed., Copyright © 2002 Elsevier, p. 71: "Chapter 4 - Abdominal Pain, Including the Acute Abdomen".
  8. Ferri: Ferri's Clinical Advisor: Instant Diagnosis and Treatment, 2004 ed., Copyright © 2004 Mosby, Inc.