Pain in the abdomen could occur due to multiple causes – local causes
within the abdomen, causes outside the abdomen, and causes affecting
the whole body. Pain originating from the abdomen could arise from
the different abdominal organs like liver, gall bladder, spleen,
stomach, intestines and pancreas, or from the peritoneum (the lining of
various organs and the inner wall of the abdomen), or abdominal wall.
Cause Located in the Abdomen:
Inflammation or infection of an organ:
Type of pain:
Pain due to inflammation or infection may be accompanied by fever. The pain is often located over the organ involved. The type of pain also depends on the organ involved and the degree of inflammation.The pain may originate from:
Appendix:
Pain of appendicitis is sustained and worsening. It usually starts as
an aching pain near the umbilicus or belly button and then shifts to the
right lower abdomen. Stomach:
Pain of gastritis (inflammation of the stomach) and stomach ulcer is of
burning type and affects the upper mid-abdomen. It is often relieved
with antacids Intestines:
Inflammation of the intestines is accompanied by diarrhea, fever and
sometimes rectal bleeding. Viral infections usually resolve on their
own, but bacterial infections need antibiotics. Parasitic infection
commonly causes abdominal pain in children. Pain precipitated by intake
of milk may point to lactose intolerance. Food allergy and
gastroenteritis or food poisoning are also commonly associated with
abdominal pain. Poisoning including with lead can also cause abdominal
pain. Pain of diverticulitis is often located on the left side.
Typhoid fever can also cause intestinal inflammation and give rise to
abdominal pain. Pancreas and Gall Bladder:
Pain of pancreatitis is of gradual onset, severe, steady and
unrelenting. It is usually located in upper abdomen and upper back.
Pain from gall bladder inflammation is usually located on the upper
right side of the abdomen.Inflammation of the peritoneum:
Type of pain:
Pain occurring due to inflammation of the peritoneum is steady and aching type, and is felt directly over the inflamed area. The muscle overlying the painful area may undergo spasm. Severity depends on the type of contamination and the rate of contamination. Pain increases with pressure or changes in tension, such as during examination of the abdomen, sneezing or coughing. Patient prefers to lie quietly in bed without moving with the knees drawn up and shallow breathing.Causes of peritoneal inflammation:
Bacterial contamination of the peritoneum:
This could occur in cases of perforation of an appendix or other
organs, or in case of pelvic inflammatory disease. Pain in the early
stages of pelvic inflammatory disease is usually mild. An
intra-abdominal abscess may also present with persistent abdominal pain. Chemical irritation of the peritoneum:
This could occur in case of a perforated ulcer where acid and digestive
juices cause irritation of the peritoneum, pancreatitis where
pancreatic enzymes are released into the peritoneum, and Mittelschmerz
where pain occurs during release of the ovum from the ovary, possibly
due to irritation by fluid or blood. Pain caused by gastric acid is
much worse as compared to pain caused by contamination of feces.
Similarly, pain caused pancreatic enzymes is much worse than pain caused
by bile.Obstruction in a hollow organ:
Type of pain:
Pain due to obstruction of a hollow organ often comes in colics and is
intermittent (not continuous). Infants often suffer from colics, which
may be relieved by passage of gas or stool.Causes of obstruction:
Obstruction in the intestines:
Pain due to obstruction in the small intestine usually appears around
or above the umbilicus or belly button and is difficult to localize.
Pain due to large intestine obstruction usually appears below the
umbilicus. The pain may spread to the loin. Obstruction of stomach outlet:
Pyloric stenosis is a condition where the food is obstructed from
moving from the stomach into the intestines. Pain may be relieved by
vomiting. The condition affects children. Pyloric stenosis may affect
adults if a cancerous growth obstructs the outlet. Obstruction in the biliary tree:
Pain due to obstruction of the biliary tree is usually located at the
right upper part of the abdomen and may radiate to the back of the
chest. Obstruction in the urinary tract:
Obstruction of the urinary bladder results in dull pain just above the
pubic bone. Obstruction in the ureters causes severe pain just above
the pubic bone and in the flanks that radiates to the penis, scrotum or
inner side of the upper thigh. Obstruction high up in the ureters
results in upper back pain at the costoverterbral angle (the angle
between the spine and the last rib).Pathology in a blood vessel:
Type of pain:
The type of pain may vary, from a mild continuous and diffuse pain to a very severe pain.Blood vessels diseases that could result in abdominal pain are:
Thrombus or embolism:
Presence of a clot in the superior mesenteric artery interrupts blood
supply to the intestines and can lead to diffuse pain, which after 2 to 3
days can lead to signs of peritoneal inflammation or of vascular
collapse. The pain is of a sudden onset. Rupture of a blood vessel:
Pain may appear several days before rupture of an abdominal aortic
aneurysm (A condition where the aorta is dilated). It could spread to
the back, flanks and genitalia and may persist till rupture or vascular
collapse occurs. Sickle cell anemia:
Sickling of red blood cells in sickle cell anemia can obstruct blood
flow to various organs and cause severe abdominal pain. It may be
accompanied by pain in other parts of the body like arms and legs.Pathology in the abdominal wall:
Type of pain:
The pain is usually constant and aching. It is increased with movement, prolonged standing and pressure.Abdominal wall pathologies that can result in pain are:
Trauma to or infection of the muscle:
In case of trauma to the muscle, a swelling due to accumulation of
blood may be observed. In case of inflammation of muscle, other muscles
in the body may also be involved.Stretching of capsules surrounding organs:
Type of pain:
The pain is usually constant. Location of the pain depends on the organ affected.The capsules of organs affected by stretching are:
Liver or kidney capsules:
The capsules surrounding the liver or kidneys could be stretched by
accumulation of blood beneath them or by the presence of cancer, giving
rise to pain. The pain in the case of the liver may be mild and more in
the form of discomfort. The pain in the case of the kidney may radiate
to the back.Cause of Pain located outside the Abdomen:
Some conditions may affect organs outside the abdomen such as in the chest, spine, genitals or pelvis but the pain may seem to be appearing from the abdomen. Examples of such pain include:
Chest Conditions:
Type of pain:
Pain referred from the chest is accompanied by decreased movements of the chest with breathing.
The spasm of the abdominal muscles decreases during inspiration, which
is not the case if the cause of pain is located in the abdomen. If pressure is applied over the painful area on the abdomen, the pain does not worsen, and may sometimes actually be relieved.Causes of pain located outside the abdomen:
Heart – related conditions: Some heart conditions like heart attack, inflammation of heart and heart failure can result in chest pain. Lung conditions:
Lung conditions like pneumonia, inflammation of the pleura (the
covering of the lungs), empyema (pus in the lungs) or pneumothorax (air
in the chest) can cause abdominal pain. Esophageal conditions: Some conditions affecting the food pipe like rupture or inflammation can cause abdominal pain.Genital conditions:
Type of pain:
The pain is of dull and aching character and is difficult to localize. Pain is increased on touching the genitals even slightly.
Genital causes of pain are:
Testicular conditions:
Tortion of the testis, where the spermatic cord twists on itself and
cuts blood supply to the testis, can cause abdominal pain.Pelvic conditions:
Type of pain:
In females, conditions affecting the reproductive organs could also produce referred pain in the abdomen.Pelvic causes of pain are:
Menstruation: Menstruation can cause abdominal pain, which should be ruled out in a female. Endometriosis:
Endometriosis is a condition where tissue from the uterus is displaced
to somewhere else like the pelvic wall or ovaries. Pain may be felt in
the lower abdomen. Menstruation is accompanied by severe pain. Pelvic inflammatory disease (PID): Pelvic inflammatory disease may result from a sexually transmitted disease. Pain may be mild to severe. Ectopic Pregnancy:
An ectopic pregnancy, or a pregnancy outside the normal location in the
uterus, may mimic menstrual cramping and bleeding. However, symptoms
are usually more intense than those usually experienced during a
menstrual period. Urinary Bladder:
Pain due to bladder infection is usually located just above the pubic
bone. The pain is of burning character and is accompanied by other
urinary symptoms.Metabolic Causes:
Type of pain:
When the cause of pain is not obvious, a metabolic cause should be suspected.
Metabolic causes:
Metabolic causes that can lead to abdominal pain are diabetes, uremia,
hyperlipidemia which can also cause pain by causing pancreatitis,
hyperparathyroidism, acute adrenal insufficiency, familial Mediterranean
fever, porphyria and angioneurotic edema.Nerve related or Psychiatric causes:
Type of pain:
Pain due to nerves is not related to food intake, respiration or abdominal distention. Pain may be increased with touch. Pain due to functional cause may be increased in stressful conditions.Causes of nerve-related or psychiatric related pain are:
Causalgia:
Causalgia occurs in diseases that affect sensory nerves. The pain is
usually of burning type and is located in the area supplied by the
affected nerve. Pain is often present at rest and may be increased by
touch and change in temperature. Respiration is usually not affected
and abdominal muscles are not rigid. Pain from spinal nerves or roots:
Conditions that affect spinal nerves include herpes zoster, compression
of the nerve from spinal tumors and other causes, inflammation of the
nerves due to infection or arthritis, diabetes or syphilis. The pain
comes and goes and is of lancinating type. Spasm, if present, is not
increased by abdominal distention. Pain worsens with movement of the
spine and activities like coughing, sneezing or strain. Pain due to functional disorders:
Functional disorders like irritable bowel syndrome and constipation are
accompanied by pain and altered bowel habits. Pain varies with type
and location and increases with stress. It may be relieved with bowel
movement and passage of gas.Other Causes of Abdominal Pain
Other causes of abdominal pain include:
Bites from snakes or insects like black widow spiders. Black widow
spider bites result in intense pain and stiffness of muscles of abdomen
and back. Narcotic withdrawal: Narcotic withdrawal is associated with abdominal cramping. Heat stroke: Heat stroke can result in severe abdominal cramps. FAQs
1. Which doctor should I visit in case of abdominal pain?You could visit your family doctor or a surgeon for abdominal pain. You may be referred to a specialist depending on the cause of pain.
2. What are the common tests used to evaluate abdominal pain?
A careful history often helps in diagnosing the cause of abdominal pain. Some tests that assist in the diagnosis are:
Complete
blood counts, liver and pancreatic enzyme estimation and urinalysis. A
pregnancy test may be done in women to rule out ectopic pregnancy.Radiological tests like plain x-ray, ultrasound, CT scan, MRI and barium x-ray.Endoscopic procedures like esophagogastroduodenoscopy, colonoscopy, flexible sigmoidoscopy and balloon enteroscopy3. How is colic in infants treated?
The exact cause of colics in infants is not known. It usually disappears as the infant gets older. Holding the baby and gently rocking her could help to pacify the baby. A gentle massage over the abdomen may also help
Sources : medindia
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