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Abdominal pain
Differential diagnosis according to pain location (common diseases)
Right lower abdomen:   move down on table
appendicitis ovarian cancer
Crohns disease ovarian cyst
gastroenteritis PID
ileus testicular torsion
inguinal hernia tubal pregnancy
irritable bowel syndrome volvulus
kidney stone
Right upper abdomen:   move down on table
cholangitis kidney stone
collapsed lung(atelectasis) liver abscess
common bile duct stone liver cancer
Crohns disease pyelonephritis
duodenal ulcer right lower lobe pneumonia
gallbladder disease subphrenic abscess
hepatitis
Epigastric area (mid upper abdomen):   move down on table
aortic aneurysm hiatus hernia
duodenal ulcer irritable bowel syndrome
gastritis liver abscess
gastric ulcer liver cancer
gastroenteritis liver cirrhosis
GERD (reflux esophagitis) stomach cancer
heart attack (MI) ulcerative colitis
Left upper abdomen:   move down on table
bowel obstruction left lower lobe pneumonia
colon cancer leukemia
constipation pyelonephritis
Crohns disease ruptured spleen
diverticulitis spleen abscess
irritable bowel syndrome ulcerative colitis
kidney stone
Left lower abdomen:   move down on table
colon cancer kidney stone
constipation ovarian cancer
Crohns disease ovarian cyst
diverticulitis PID
ileus testicular torsion
inguinal hernia tubal pregnancy
irritable bowel syndrome ulcerative colitis
Suprapubic area (mid lower abdomen):  

bladder infection (cystitis)

PID
cancer of uterus prostate cancer
dysmenorrhea prostate hypertrophy
endometriosis prostatitis
endometritis uterine fibroids
Return to top of table
 

In the following I will mention some general guidelines that the physician follows when analyzing a patient with abdominal pain. Details about the symptoms and treatment modalities for the conditions listed in the table above can be found by clicking on these links.

 

Abdominal Pain

Introduction:

    Abdominal pain always has to be taken seriously as life threatening situations can arise out of it. Different organs within the abdominal cavity can be the cause of pain, but on the other hand often severe pain that appears organic in nature, can turn out to be psychosomatic. In other words, when a thorough work-up has been done, the physician often comes to the conclusion that there is nothing organically wrong, but 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 and then one by one is excluded until the real diagnosis is left behind. This way nothing is overlooked. Abdominal pain can be divided into various locations of the abdomen and then the differential diagnoses can be listed. I attempted to do this in the following table. It contains most of the important causes of abdominal pain, but can not claim to be complete as there are many less common causes that were left out.

Signs and symptoms:

  All of the conditions above will be associated with some abdominal pain. However, depending on the location of the organ the pain will be located and will irradiate into different areas. Also the quality of pain will vary and there will be different associated symptoms and findings depending on the underlying pathophysiology. The conditions that were described earlier in the chapter will not be repeated below. The other conditions of the differential diagnosis table of abdominal pain above will be briefly explained below.

Treatment:

  As all of the diseases listed above in the table have a different pathophysiology, it is clear that treatment must be individualized. 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 needs to be removed surgically. An incarcerated 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.

  Quite a number of diseases are treated by not giving anything by mouth and resting the gut through the use of intravenous fluids for a period of time. This is true for pancreatitis, for acute cholecystitis, ileus and ulcerative colitis just to mention a few.

Abdominal pain
 
 

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.

  

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