ABDOMINAL PAIN Overview Abdominal pain is pain that is felt in the abdomen.

The abdomen is an anatomical area that is bounded by the lower margin of the ribs and diaphragm above, the pelvic bone (pubic ramus) below, and the flanks on each side. Although abdominal pain can arise from the tissues of the abdominal wall that surround the abdominal cavity (such as the skin and abdominal wall muscles), the term abdominal pain generally is used to describe pain originating from organs within the abdominal cavity. Organs of the abdomen include the stomach, small intestine, colon, liver, gallbladder, spleen, and pancreas. Occasionally, pain may be felt in the abdomen even though it is arising from organs that are close to, but not within, the abdominal cavity. For example, conditions of the lower lungs, the kidneys, and the uterus or ovaries can cause abdominal pain. On the other hand, it also is possible for pain from organs within the abdomen to be felt outside of the abdomen. For example, the pain of pancreatic inflammation may be felt in the back. These latter types of pain are called "referred" pain because the pain does not originate in the location that it is felt. Causes of abdominal pain inflammation (for example, appendicitis, diverticulitis, colitis ) stretching or distention of an organ (for example, obstruction of the intestine, blockage of a bile duct by gallstones, swelling of the liver with hepatitis) loss of the supply of blood to an organ (for example, ischemic colitis) abnormal contractions of the intestinal muscles (for example, spasm) abnormally sensitive nerves within the intestines that give rise to painful sensations inappropriately (visceral hyper-sensitivity).

Characteristic of Pain The following information, obtained by taking a patient's history, is important in helping doctors determine the cause of pain:

The way the pain begins. For example, abdominal pain that comes on suddenly suggests a sudden event, for example, the interruption of the supply of blood to the colon (ischemia) or obstruction of the bile duct by a gallstone (biliary colic). The location of the pain. o Appendicitis typically causes pain in the right lower abdomen, the usual location of the appendix. o Diverticulitis typically causes pain in the left lower abdomen where most colonic diverticuli are located. o Pain from the gallbladder (biliary colic or cholecystitis) typically is felt in the right upper abdomen where the gallbladder is located.

The pattern of the pain. o Obstruction of the intestine initially causes waves of crampy abdominal pain due to contractions of the intestinal muscles and distention of the intestine. o True cramp-like pain suggests vigorous contractions of the intestines. o Obstruction of the bile ducts by gallstones typically causes steady (constant) upper abdominal pain that lasts between 30 minutes and several hours. o Acute pancreatitis typically causes severe, unrelenting, steady pain in the upper abdomen and upper back. The pain of acute appendicitis initially may start near the umbilicus, but as the inflammation progresses, the pain moves to the right lower abdomen. The character of pain may change over time. For example, obstruction of the bile ducts sometimes progresses to inflammation of the gallbladder with or without infection (acute cholecystitis). When this happens, the characteristics of the pain change to those of inflammatory pain. (See below.) The duration of the pain. o The pain of IBS typically waxes and wanes over months or years and may last for decades. o Biliary colic lasts no more than several hours. o The pain of pancreatitis lasts one or more days. o The pain of acid-related diseases - gastroesophageal reflux disease (GERD) or duodenal ulcers - typically show periodicity, that is, a period of weeks or months during which the pain is worse followed by periods of weeks or months during which the pain is better. o Functional pain may show this same pattern of periodicity. What makes the pain worse. Pain due to inflammation (appendicitis, diverticulitis, cholecystitis, pancreatitis) typically is aggravated by sneezing, coughing or any jarring motion. Patients with inflammation as the cause of their pain prefer to lie still. What relieves the pain. o The pain of IBS and constipation often is relieved temporarily by bowel movements and may be associated with changes in bowel habit. o Pain due to obstruction of the stomach or upper small intestine may be relieved temporarily by vomiting which reduces the distention that is caused by the obstruction. o Eating or taking antacids may temporarily relieve the pain of ulcers of the stomach or duodenum because both food and antacids neutralize (counter) the acid that is responsible for irritating the ulcers and causing the pain. o Pain that awakens patients from sleep is more likely to be due to non-functional causes. Associated signs and symptoms. o The presence of fever suggests inflammation. o Diarrhea or rectal bleeding suggests an intestinal cause of the pain. o The presence of fever and diarrhea suggest inflammation of the intestines that may be infectious or non-infectious (ulcerative colitis or Crohn's disease).

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, enlarged organ, 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 that an abscess has formed. 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.

Location of Pain

Upper middle abdominal pain o Stomach (gastritis, stomach ulcer, stomach cancer) o Pancreas pain [1] (pancreatitis or pancreatic cancer, can radiate to the left side of the waist, back, and even shoulder) o Duodenal ulcer, diverticulitis o Appendicitis (starts here, after several times moves to lower right abdomen) Upper right abdominal pain o Liver (caused by hepatomegaly due to fatty liver, hepatitis, or caused by liver cancer, abscess) o Gallbladder and biliary tract (gallstones, inflammation, roundworms) o Colon pain (below the area of liver - bowel obstruction, functional disorders, gas accumulation, spasm, inflammation, colon cancer) Upper left abdominal pain o Spleen pain (splenomegaly) o Pancreas o Colon pain (below the area of spleen - bowel obstruction, functional disorders, gas accumulation, spasm, inflammation, colon cancer) Middle abdominal pain (pain in the area around belly button) o Appendicitis (starts here) o Small intestine pain (inflammation, intestinal spasm, functional disorders) Lower right abdominal pain o Cecum (intussusception, bowel obstruction)

o Appendix point (Appendicitis location) Lower left abdominal pain o Sigmoid colon (polyp, sigmoid volvulus, obstruction or gas accumulation) Pelvic pain o bladder (cystitis, may secondary to diverticulum and bladder stone, bladder cancer) o pain in women (uterus, ovaries, fallopian tubes) Right lumbago and back pain o liver pain (hepatomegaly) o right kidney pain (its location below the area of liver pain) Left lumbago and back pain o less in spleen pain o left kidney pain Low back pain o kidney pain (kidney stone, kidney cancer, hydronephrosis) o Ureteral stone pain

Renal Colic Renal colic is a type of abdominal pain commonly caused by kidney stones. The pain typically begins in the abdomen and often radiates to the hypochondrium or the groin. The pain is often colicky (comes in waves) due to ureteric peristalsis, but may be constant It may come in two varieties: dull and acute; the acute variation is particularly unpleasant and is often described as one of the strongest pain sensations felt by humans (being worse than childbirth, broken bones, gunshot wounds, burns, or surgery) Depending on the type and size/s of the kidney stones moving through the urinal tract the pain may be stronger in the renal or bladder area or equally strong in both. In lower obstructions, males may experience pain in the genitals.