Acute abdominal pain: causes, diagnosis

One of the most common complaints is acute abdominal pain. Let's consider the causes of its appearance, symptomatology, methods of diagnosis, treatment and prevention.

Most often the appearance of unpleasant sensations in the abdomen is associated with a violation of eating behavior, that is, overeating, emotional disorders, colds. But intense and sharp pain can indicate serious diseases of the abdominal cavity, so it requires timely diagnosis and, if necessary, treatment.

Such a concept as acute abdomen is a collective term in relation to abdominal symptomatology. The description of unpleasant sensations in the epigastrium is limited in its informative value, because people have different reactions to them. Some people tolerate discomfort firmly, others exaggerate significantly, and in others it is difficult to establish the localization of pain. [1]

Causes of the acute abdominal pain

There are many reasons for the appearance of acute painful sensations in the abdominal region. These can be various diseases of the GI organs, food intoxication, oncological pathologies, gynecological diseases, problems with the cardiovascular system and much more.

In some cases, acute pain is a sign of diseases with an acute course, which are dangerous not only for the health, but also for the life of the patient:

• Diseases of the GI organs - appendicitis, perforation or obstruction of the intestine, acute gastritis and enterocolitis, inflammatory processes.
• Liver and biliary tract diseases - acute cholecystitis or cholangitis, biliary colic, hepatic vein thrombosis, heart failure. Pancreatitis, rupture of the spleen.
• Diseases of the genitourinary system - cystitis, pyelonephritis, torsion or cyst of appendages, ectopic pregnancy.
• Diseases of the glands of internal secretion - diabetic enteropathy, hypercalcemic/thyrotoxic crisis, adrenal crisis.
• Vascular pathologies - systemic vasculitis, mesenteric artery thromboembolism, venous thrombosis, abdominal aortic dissection.
• Toxin intoxication.
• Allergic Reactions.
• Metabolic diseases - porphyria, uremia.
• Diseases of the chest organs - pneumonia, pleurisy, myocarditis, pericarditis, coronary artery disease.

Acute, sharp and severe pain is an irritation of the pain receptors of the parietal peritoneum and abdominal walls. In terms of intensity, the unpleasant sensations can increase over several days or hours. [2]

Risk factors

There are a number of factors that increase the risk of discomfort in the epigastrium, let's consider the main ones:

• Improper nutrition - the diet is excessive in fatty foods, fried foods, carbohydrates and preservatives. Such a diet increases the risk of digestive diseases and GI cancers.
• Mode of nutrition - long breaks between meals, refusal to eat breakfast, overeating before bedtime and much more, contribute to the development of many pathologies from the GI tract.
• Stress and emotional stress - nervous overstrain leads to spasms of the capillaries of the stomach, which disrupts the secretion of mucus, which protects the mucous membrane. Because of this, gastric juice negatively affects the tissue of the organ, provoking the development of ulcers and peptic ulcers. Stress also leads to dysbacteriosis, i.e. Disruption of the intestinal microflora.
• Overweight - obesity is a risk factor for pancreatitis, cholelithiasis, malignant processes in the gallbladder.
• Lack of physical activity - lack of movement negatively affects the functioning of the entire body. This leads to weakness of the abdominal wall muscles and discomfort.
• Age and gender - the risk of digestive cancer is increased for men over 50 years old, peptic ulcer disease for men 20-40 years old. For women over 40 years of age - cholelithiasis.
• Hereditary predisposition - peptic ulcer disease, stomach cancer, colon cancer and other pathologies in the family history.

Also risk factors include bad habits (alcohol abuse, smoking), various endocrine diseases. [3]

Pathogenesis

The mechanism of origin of acute abdominal pain may be visceral, somatic, or irradiating.

1. Visceral pain comes from internal organs that receive innervation. Unpleasant sensations arise from spasms or stretching of the muscle layer, local irritation. The pain has a vague and aching character, may occur with nausea.

• Painful sensations in the upper parts (stomach, liver, pancreas, duodenum) are localized under the ribs and in the upper abdomen.
• Pain from the mid-sections (small intestine, appendix, proximal colon) radiates parumbilically.
• Distal discomfort is localized in the lower abdomen (distal part of the colon, genitourinary system).

2. Somatic pain originates from the parietal peritoneum and occurs when irritated by inflammatory, infectious, chemical and other pathologic factors. Somatic pain has a clear localization and a pronounced acute character.
3. Irradiating - unpleasant sensations in areas of the body remote from the main source of discomfort. It occurs due to convergence of nerve fibers at the level of the spinal cord. For example, kidney colic causes pain in the groin, and biliary colic causes pain in the right shoulder blade.

Epidemiology

According to medical statistics, acute abdominal pain most often develops due to neglected inflammatory processes and dietary errors.

Special attention should be paid to diseases of the digestive system that cause both visceral, somatic and irradiating pain. The most common diseases include: gastritis, peptic ulcer disease, pancreatitis, gallstone disease and others.

Less frequently diagnosed acute conditions requiring emergency surgical intervention (appendicitis, hernia, peritonitis). [4]

Diagnostics of the acute abdominal pain

The greatest difficulties arise in diagnosing the causes of acute abdominal pain in infants, young children and the elderly. Children can not describe in detail the nature and localization of discomfort. Older patients have a very blurred symptomatology, which requires complex diagnosis.

In order to diagnose the causes of acute pain, the abdomen is divided into four parts. To do this, mentally draw a vertical line from the base of the rib cage to the pubis, and a horizontal line through the navel from left to right. The result is four quadrants:

• Upper left - pancreatitis, pyelonephritis, ruptured spleen, pneumonia and other.
• Upper right - bowel obstruction, pneumonia, gallbladder disease, esophagitis, heart failure, pneumonia, hepatitis.
• Lower left - irritable bowel syndrome, diverticulitis, cyst or torsion of the left ovary and other gynecologic diseases.
• Lower right - appendicitis, bowel diseases, abscess, hernia, inflammation or torsion of the right ovary, uterine diseases.
• Upper half of the abdomen - pancreatitis, peptic ulcer, functional dyspepsia, malignant neoplasms, cardiovascular diseases.
• Mid abdomen - bowel obstruction, colitis, hernia, kidney disease.
• Lower half of the abdomen - irritable bowel syndrome, ureteral infections, intestinal obstruction, colitis, cystitis, diverticulitis, uterine diseases.
• If the pain is difficult to localize in one area, it may be a sign of infectious gastritis, peritonitis, enterocolitis, bladder or urethral infections.

At the same time, diagnosis cannot be made only by the nature and location of pain sensations. This is due to the irradiation of pain, when one internal organ is affected, but it goes to another. This is characteristic of cardiac and pulmonary diseases, pathologies on the part of organs in the pelvis.

For objective examination, the doctor evaluates the general appearance of the patient (breathing, pulse, blood pressure, skin color, presence of hernias). Palpation is performed to determine the place of increased pain. Mandatorily, the patient is prescribed a set of laboratory and instrumental studies, differential diagnosis.

Analyses

Acute pain sensations in the epigastrium require a comprehensive diagnostic approach, which includes such tests.

1. Blood test

Blood is checked for morphology, glucose, electrolytes. An elevated white blood cell count can be a sign of infection or a reaction to pain, stress. Decreased hemoglobin is a sign of internal bleeding. Biochemical study is aimed at studying the state of the liver and pancreas.

• General blood count with leukoformula.
• Biochemical examination of blood (bilirubin, creatinine, urea, liver enzymes).
• Coagulogram (blood clotting test).
• Amylase blood test.
• Blood tests for viral hepatitis C and B.
• Blood tests for HIV, RW.

2. Urinalysis

Infectious processes in the urinary tract are one of the most common causes of abdominal discomfort. The problem can be identified by visual inspection of the urine. If the fluid is cloudy, smells unpleasant, has impurities of blood or flakes, it is a clear sign of infection. Blood may indicate kidney concretions.

3. Fecal analysis

Determines parasitic infestations and infectious processes. The analysis provides information about the condition of the pancreas and gastrointestinal tract. Blood in feces may indicate the presence of ulcers, disorders of the gastric/intestinal mucosa.

Laboratory diagnostics are performed not only at the stage of diagnosis, but also to monitor the progress of the prescribed treatment.

Instrumental diagnostics

An obligatory component of the examination for acute abdominal pain is a set of instrumental diagnostics. It includes such procedures:

1. Ultrasound - ultrasound examination can detect problems in the internal organs (gallbladder, pancreas, liver) and reproductive system. Also ultrasound diagnoses diseases of the kidneys, spleen, blood vessels, determines neoplasms in the abdominal cavity, the presence of free fluid.
2. CT/MRI - used to diagnose the condition of the liver, kidneys, pancreas, spleen, large/thin intestine, ureters. Computed tomography detects inflammatory processes in the abdominal cavity.
3. X-rays - In acute pain, the patient may have a chest x-ray to determine the condition of the chest cavity organs. This is necessary to detect air under the diaphragm and outside the bowel. X-ray identifies biliary and urinary concretions, large masses in the abdominal cavity.

If the cause of the painful condition is not established after the above procedures, then additional tests are prescribed:

• Gastroscopy - is performed when damage to the mucosa of the stomach, esophagus, duodenum is suspected. During the procedure, the patient swallows a long tube with a video camera at the end. Thanks to this, the doctor studies the condition of the surface of the organs of the digestive tract. The endoscope can be used for biopsy, determination of the level of acidity, microbial contamination.
• Colonoscopy - using an endoscope, the doctor examines the condition of the inside of the rectum and large intestine.
• Gastric probing - a probe is inserted into the esophagus and gastric juice, duodenal contents are taken with further study of the material.
• Biopsy - taking and examining under a microscope the tissues that line the inner surface of the digestive tract. Biopsy is required to determine the type of neoplasms, pathological changes in the mucosal epithelium of internal organs.
• Angiography is the study of blood vessels by injecting an X-ray contrast agent into the body. It helps to detect emboli and blood clots in the arteries.
• Cholescintigraphy - is indicated in case of suspicion of acute cholecystitis, bile duct patency disorder and other biliary tract pathologies.
• Irrigoscopy - allows to detect intestinal obstruction, intestinal perforation. For the study, a radiopaque contrast agent is injected into the colon.

To make a final diagnosis, the doctor takes into account the results of not only instrumental, but also other types of diagnostics.

Differential diagnosis

There are many diseases that cause acute abdominal pain. To determine the true cause of the disorder, a differential diagnosis is performed to rule out disorders that do not fit any facts or symptoms.

Differentiation is made with diseases such as:

1. Common

• Acute appendicitis.
• Gastroenteritis.
• Urinary tract infections.
• Constipation.
• Abdominal injuries.
• Functional abdominal pain.
• Gynecological diseases.

2. Unproliferated

• Ulcerative colitis.
• Small/thick bowel obstruction.
• Intestinal blockage.
• Viral hepatitis.
• Crohn's disease.
• Acute pancreatitis.
• Enterocolitis.
• Urolithiasis.
• Inflammatory diseases of the pelvic organs.
• Cyst, ovarian torsion.
• Testicular torsion.
• Biliary dyskinesia.
• Spleen Infarction/Cysts.
• Complications of pregnancy.

In the process of diagnosis, a set of laboratory and instrumental methods are used. Particular attention is paid to the collection of anamnesis and visual examination of the patient with palpation of the abdomen.

Complications and consequences

Complications of acute pain depend on the causes that provoked it. If the discomfort is caused by an acute attack of appendicitis, then without timely medical care there is a risk of developing complications such as:

• Perforation (occurs after 12 hours of progressive appendicular inflammation).
• Generalized peritonitis (develops due to acute inflammation and perforation).
• Appendicular infiltrate, abscess.
• Postoperative infection.

If the pain is due to vascular pathologies, it can cause life-threatening consequences (myocardial infarction, stroke, heart attack). On this basis, in order to prevent the development of serious complications, it is necessary to contact the attending physician when acute painful sensations appear. [5]

Acute abdominal pain in a woman

There are many reasons for the appearance of acute painful sensations in a woman in the abdominal area. In addition to problems with the gastrointestinal tract, it can be gynecological diseases and a number of other pathologies.

• If discomfort occurs near the navel and moves to the lower right side of the peritoneum, it may indicate inflammation of the appendix.
• Pain in the lower part of the epigastrium on the left side can be a sign of diverticulitis. With this pathology, spherical capsules are formed in the walls of the large intestine, which become infected and inflamed. The disorder proceeds with fever, nausea and vomiting, cramps, stool disturbance.
• Sharp sensations in the right subcostal area, which intensify after eating - this is a sign of gallbladder damage. Diagnosis may reveal concrements, inflammatory process (cholecystitis).
• Pain in the abdomen that subsides after defecation and occurs with stool irregularities may be a sign of irritable colon syndrome. This condition occurs with various GI symptoms, flatulence, mucousy stools, frequent urges to the toilet.

Acute pain in women appears with problems with the reproductive system. Soreness is observed before menstruation, with endometriosis. If the lower abdomen hurts, it may indicate inflammation of the pelvic organs (infection of the ovaries, fallopian tubes, uterus). Another possible cause of the disorder in women is ectopic pregnancy, ovarian cysts, uterine fibroma, urinary tract infections, and more.

Sharp abdominal pain during menstruation

The most common reason for the development of acute pain in women is menstruation. According to medical statistics, every third woman has a painful menstrual period. In medicine, this condition is called algomenorrhea, i.e. Painful menstruation. It can be a peculiarity of a woman's physical structure or a sign of serious diseases.

Periods are especially acute in adolescence. In addition to abdominal pain there is vomiting, diarrhea, dizziness and headaches, fainting. As a rule, such a condition begins 1-2 days before the onset of menstruation and ends on the 3-4 day.

The main signs of algomenorrhea include:

• Sharp pains in the lower abdomen.
• Aching pain in the lumbar and sacral region.
• Aching sensations in the lower abdomen.

In this case, doctors distinguish two types of algomenorrhea:

1. Primary - painful menstruation caused by abnormalities of the nervous system or anatomical features of the structure of the genital organs. The latter factors include underdevelopment or abnormal position of the uterus. Because of this, the outflow of menstrual secretions from the uterus is disturbed and its spasm increases.
2. Secondary - develops as a result of inflammatory processes in the body and due to diseases of the genitourinary system (endometriosis, cysts, fibromatous nodes, tumor neoplasms).

In order to determine what caused the discomfort in the abdomen during periods, you should visit a gynecologist and endocrinologist. It is also recommended to take a biochemical blood test, check the hormonal background, take smears for flora and make a bacteriological culture. Obligatory is and gynecological examination in the process of which the doctor assesses the position and size of the uterus, appendages. If necessary, an ultrasound examination of the pelvic organs is performed.

Based on the results of the diagnosis, the doctor prescribes treatment. Painkillers are used to eliminate pain syndrome. In some cases, patients are prescribed combined oral contraceptives (contraceptives).

Sharp abdominal pain in pregnancy

The appearance of such symptoms causes anxiety in expectant mothers, as it can be a threat to pregnancy and life of a woman. The nature of unpleasant sensations and their prognosis depends on the gestational age.

Let's look at the main causes of the disorder:

• Discomfort can be caused by increased blood flow and growth of the uterus in early pregnancy, and in the last trimester by the increasing weight of the baby. The pelvic floor muscles are stretched and the uterus starts to press on the bladder and rectum, which causes pain.
• As the uterus grows, the other organs have to move. This movement is accompanied by unpleasant and sometimes sharp sensations in different parts of the abdomen.
• Ectopic pregnancy - the fertilized egg does not develop in the uterus, but attaches to the wall of the fallopian tube. When the embryo becomes too large for the tube, it ruptures, which is manifested by severe pain and internal bleeding. This condition requires emergency medical attention.
• Spontaneous abortion - miscarriage occurs due to many different causes and at any term. If painful symptoms are accompanied by bleeding, an ambulance should be called immediately.
• Placental abruption - normally, the placenta is tightly attached to the uterus and separated after delivery. But in some cases, partial or complete detachment of the placenta occurs before the due date. This condition causes severe pain and is dangerous for the fetus and the mother.

Discomfort in the third trimester can be caused by training contractions. They differ from real contractions in that they come and go as they please. While real contractions are intensified and constantly felt.

Acute abdominal pain in men

There are many reasons that provoke painful sensations in men in the abdomen. Most often, the unpleasant condition is associated with such factors:

• Diseases of the GI organs - the patient complains of problems with defecation (constipation, diarrhea), there is an elevated body temperature, chills, deterioration of general well-being.
• Affection of the urogenital system - it can be inflammatory and infectious processes. Discomfort is localized in the lower abdomen.
• If unpleasant symptoms make themselves known down the right side, it may be a sign of prostate adenoma.
• Eating disorders, appendicitis, peptic ulcer disease.

Soreness can be caused by sedentary lifestyle, prolonged sedentary work, addictions, advanced age and a number of other factors.

Acute abdominal pain in a child

Children very often complain of painful sensations in the epigastric region. The main causes of acute sensations include:

• Intestinal infections (diarrhea, vomiting, febrile condition).
• Constipation.
• Inflammatory diseases.
• Eating disorders (overeating, junk food).
• Functional infant colic.
• GI disorders.
• Urinary tract infections.
• Acute respiratory infections.

To determine the cause of the disorder, the child should be seen by a pediatrician and tests should be taken if necessary.

Read also: Acute abdominal pain and other symptoms: nausea, vomiting, diarrhea

Prevention

From the cause of the appearance of acute painful sensations in the abdomen depend on the methods of prevention. Prevention of the most common causes and factors of the disorder is reduced to these recommendations:

1. Nutrition
   • Regimen - you should eat every 3-4 hours, but in small portions. Do not overeat. Be sure to eat breakfast and do not skip meals. To protect the body from getting pathogens, wash your hands thoroughly before eating and foods that are not heat-treated.
   • Proper nutrition - minimize the use of fatty, fried and spicy foods. Avoid carbonated drinks, strong tea and coffee, and alcohol. Consume more fiber (cereal, vegetables, fruits, greens).
   • Watch your weight - excessive body weight increases the risk of many diseases and negatively affects the cardiovascular system.
2. Harmful habits - refuse to drink alcohol, as chemical components, colorings and flavorings have a detrimental effect on the digestive system. Nicotine addiction also has a negative impact on health.
3. Active lifestyle.
4. Control your stress, get enough sleep, and get more rest.

The above recommendations not only indirectly affect the state of the digestive system, but also strengthen health in general. Compliance with simple rules will prevent acute diseases such as: pancreatitis, gastritis, peptic ulcer disease and many others.

Forecast

In most cases, disorders causing acute abdominal pain have a positive prognosis, as they pass without inpatient treatment and surgical intervention. Symptom relief comes after taking painkillers and eliminating the factors that provoke discomfort.

If unpleasant symptoms are caused by a disease that requires surgical treatment and long-term therapy, the prognosis depends on both the severity of the disease and the general condition of the patient. For example, if acute pain is caused by gallbladder nodules or inflammation of the appendix, a long recovery period awaits the patient after surgery.