Abdominal Pain and Discomfort.

Abdominal Pain

What is Abdominal Pain?

Commonly used terms for Pain in abdomen include tummy pain, tummy ache, stomach ache and stomach pain. Most of the time pain in the abdomen is mild and because of distension of stomach or intestines with food or air. Severe abdominal pain may need visit to a doctor/general surgeon.

Sometimes immediate hospital admission may be required such as acute appendicitis, acute pancreatitis. Some cases are life threatening and require urgent diagnosis and surgery.

Causes of Abdominal Pain

Most of the time causes involve Gastrointestinal, Urinary or reproductive system.

Abdominal pain can arise from skin/muscles of abdomen or from inside organs such as stomach, small intestine, colon, Apendix, liver, gallbladder, pancreas, Kidney and spleen.

Occasionally, problems in lower lungs, kidneys, uterus or ovaries can cause abdominal pain called referred pain.
causes of abdominal pain

Abdominal pain may be caused by inflammation (for example, appendicitis, by stretching of an organ (for example, obstruction of the intestine, blockage of a bile duct by gall stones, or by loss of the supply of blood to an organ (for example, ischemic colitis).

Pain may be functional such as in irritable bowel syndrome.

Causes of Acute Abdomen

  • Appendicitis

  • Gallstones

  • Pancreatitis

  • Hernia

  • Intestinal Obstruction

  • Kidney Stones

  • Diverticulitis

Appendicitis

Appendicitis means inflammation of the appendix. Typical symptoms include abdominal pain and vomiting that gradually get worse over 6-24 hours. Appendicits pain is initially felt in the centre of the abdomen, and later moves to become a sharper pain in the right lower abdomen. Some people may have less typical symptoms.

Read Appendicitis for more details

Gallstones

Many people with gallstones have no symptoms; and these stones are called “silent stones.”

Symptom may be severe pain in the upper right side of the abdomen, called biliary colic. Usually to the right upper abdomen just below the ribs.

Sometimes less severe but niggly pain occur now and then, particularly after a fatty meal when the gallbladder contracts most.

Read Gall Stone for more information.

Pancreatitis

Acute Pancreatitis typically causes severe, steady pain in the upper abdomen and upper back.

Read more about Pancreatitis

Hernia

Symptom may be pain with swelling or lump in abdomen, shows fluctuation in severity in relation to the size, such as it becomes more while straining, coughing when swelling becomes prominent. If hernia is complicated by obstruction /strangulation pain may be severe requiring hospitalization and surgery.

Read More About Hernia

Kidney Stones

Pain that start at back (loin) and going around the side of abdomen to groin, may be a kidney stone. The pain is severe and comes and goes. This is called renal colic. There may be blood in.

Read Kidney Stone for more information.

Diverticulitis

Diverticulitis causes pain in the left lower abdomen where most colonic diverticuli are located.

How is the Cause of Abdominal Pain Diagnosed?

endoscopic

The cause of abdominal pain is diagnosed by relying on:

Thorough History of Patient-characteristics of the pain is most important like where is pain, what type, duration of pain , what aggravates it and associated symptoms.

Examination of abdomen by Surgical Gastroenterologist/GI surgeon/General Surgeon.

Investigations–Blood tests, radiological, and endoscopic tests, Laparoscopic examination.

Investigation for the Pain In Abdomen

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 CBC (complete Blood Count), Liver Enzymes(SGOT and SGPT), pancreatic enzymes (Amylase and lipase), Urine examination and stool examination are frequently performed in the evaluation of abdominal pain.

  • An elevated white count suggests infection (as with appendicitis, pancreatitis, diverticulitis, or colitis).

  • Elevated Amylase and lipase enzymes suggest pancreatitis.

  • With Gallstone Liver enzymes may be elevated.

  • Kidney stone may have Blood in the urine.

Plain X-rays of the abdomen. Plain X-rays of the abdomen ( KUB -because it include the kidney, ureter, and bladder) are helpful to diagnose intestinal obstruction, perforated ulcer, calcified kidney stone, chronic pancreatitis.

Abdominal ultrasonography is useful in diagnosing gallstones, cholecystitis ,appendicitis, or ruptured ovarian cyst as the cause of the pain.

CT Scan or MRI helpful in diagnosing many of the same conditions as CT tomography.

Capsule Endoscopy , patient swallows a small camera the size of a pill, It can take pictures of the entire small boweland transported to portable receiver. Images can be downloaded from the receiver onto a computer. 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.

  • Oesophagogastrodudenoscopy (OGD scopy) or upper GI endoscopy is useful for detecting ulcers, gastritis (inflammation of the stomach), or stomach cancer.

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

Surgery:-Sometimes, diagnosis requires examination of the abdominal cavity either by Laparoscopy or open surgery.

Why can Diagnosis of the Cause of Abdominal Pain Be Difficult?

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

Treatment of Abdominal Pain

Because Abdominal Pain may be caused by several reasons; most important is to diagnose cause of the pain.

Some causes are easily treated by simple medicines like wind (gas) and simple acidity can be relieved by antacids, infection can be treated by antibiotics

However if pain is severe visit to a doctor/general surgeon is required to diagnose the proper cause of pain in abdomen. Sometimes immediate hospital admission may be required such as acute appendicitis, acute pancreatitis.

Some cases of abdominal pain are life threatening and require urgent diagnosis, urgent supportive measures and surgery.


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