Causes of abdominal pain

The causes of abdominal pain can be surgical, gynecological, mental illness and many other internal diseases. Pain in the abdomen is an alarming symptom. It is practically important to distinguish acute and chronic pain in the abdomen and their intensity. Acute intense abdominal pain can indicate a dangerous disease, in which a quick assessment of the situation ensures the holding of life-saving urgent medical interventions.

It is worth recalling the existing generally accepted rule: to refrain from using drugs and other analgesics until a diagnosis or action plan is established.

[1], [2], [3]

Acute abdominal pain

The first thing you need to suspect with abdominal pain - acute diseases of the abdominal cavity, requiring emergency surgery (sharp abdomen).

You need to know the most common causes of such pain. More often they arise in the pathology of the abdominal organs, but can be of extra-abdominal origin.

The following diseases are the causes of abdominal pain:

1. involvement of the parietal peritoneum (appendicitis, cholecystitis, perforation of the stomach or duodenal ulcer);
2. mechanical obstruction of the hollow organ (intestine, biliary tract, ureter);
3. Vascular disorders (thrombosis of mesentery vessels);
4. pathology of the abdominal wall (trauma or infection of muscles, hernia);
5. acute inflammation of the gastrointestinal tract (salmonellosis, food intoxication).

Reflected pains of extra-abdominal origin can be with:

1. pleuro-pulmonary diseases;
2. myocardial infarction;
3. defeats of the spine.

The most common causes of acute abdominal pain in adults are acute appendicitis, as well as intestinal, renal and biliary colic: in children - acute appendicitis, intestinal, renal and biliary colic, mesadenitis (inflammation of the lymph nodes of the intestine and mesentery). With abdominal pain in elderly people who suffer from atherosclerosis, arrhythmia or have recently suffered a myocardial infarction, one should suspect an acute circulatory disturbance in the intestine.

Pain with an acute abdomen can be constant and paroxysmal. Paroxysmal pain with gradual increase, and then complete disappearance - is called colic. Colic is caused by a spasm of smooth muscles of the hollow internal organs (biliary tract and gall bladder, ureter, gut, etc.) innervated by the autonomic nervous system. Depending on the location, distinguish intestinal, renal and biliary colic.

In all cases of acute intense pains in the abdomen, which have appeared without an obvious external cause, first of all, the presence of peritonitis or acute intestinal obstruction with or without centralization of blood circulation, ie shock of different severity and other life-threatening conditions, should be excluded.

Peritoneal pains, usually permanent, severely limited, are located directly above the inflamed organ, necessarily amplified by palpation, coughing, movements, accompanied by muscular tension. The patient with peritonitis lies motionless, while in colic all the time it changes position.

When obstructing the hollow organ pain usually intermittent, koliko-shaped, although they can be permanent, with periodic enhancements. When the small intestine is obstructed, they are located in the near-or nadpupochnoy area, with colonic obstruction - often below the navel. Take into account the delay of stool, gas leakage, visible peristalsis, intestinal noises. With a sudden obstruction of the cholelithiasis duct of pain, more likely of a permanent character, arise in the right upper quadrant of the abdomen with irradiation posteriorly in the lower back and under the scapula; with the extension of the common bile duct pain can be irradiated to the epigastric and upper lumbar region. Similar pains occur in the obstruction of the pancreatic duct, they increase lying down and are eased standing.

Pain in thromboembolism of mesentery vessels is usually diffuse and severe, but without signs of peritonitis. For the dissecting aortic aneurysm, the irradiation of the pains down and back is characteristic. Important is the presence of risk factors for these complications (age, heart disease, heart rhythm disturbances, thromboembolism in the past, etc.).

Dangerous or life-threatening causes of abdominal pain

Cause of pain	Signs of the disease	Key Symptoms
Intestinal obstruction (due to adhesions, curvature of the intestines, edema of the duodenum, tumor)	Inflammation, irritation of the peritoneum, constant vomiting, vomiting of faecal masses	Bloated abdomen, abnormal sounds in the intestines (gurgling, ringing)
Cancer (colon, pancreas)	Weight loss, loss of appetite, increased fatigue	Palpable tumor in the abdominal cavity, bleeding from the rectum. Anemia. Mechanical jaundice
Aneurysm of the abdominal aorta	Cutting or tearing pain, giving off in the side (history of high blood pressure)	Absence of the femoral pulse, pulsating abdominal formation, high blood pressure
Intestinal perforation	Pain, fever	Absence of intestinal sounds, rigidity of abdominal muscles
Infarction of the intestine (thrombosis of mesenteric vessels or their ischemia)	Atrial fibrillation or severe atherosclerosis	Absence of intestinal sounds, rectal bleeding, Facies Hyppocratica
Acute gastrointestinal bleeding	Dizziness, weakness, bloody vomiting, intestinal bleeding	Tachycardia, low blood pressure (in the early stages may be a reflex increase in blood pressure), anemia, hematocrit
Diseases of the pelvic organs (ectopic pregnancy, inflammatory disease of the genitals, ovarian cysts)	Violation Menstrual cycle, vaginal discharge or bleeding	Vaginal examination, pelvic ultrasound, pregnancy test

Pain in the abdomen of a diffuse nature against a background of gastrointestinal disorders (vomiting, diarrhea) and fever is usually a symptom of an acute intestinal infection.

Reflected pain is most often associated with diseases of the chest. This possibility should be considered in all cases of their localization in the upper half of the abdomen. The causes of such pain can be pleurisy, pneumonia, lung infarction, myocardial infarction, pericarditis, sometimes esophageal diseases. To exclude them, the patient must be appropriately questioned and systematically examined. With reflected pain, breathing and chest excursion are more disturbed than the abdomen. Muscle tension is reduced by inhalation, with palpation pain is often not enhanced or even reduced. It should be borne in mind, however, that the detection of any intrathoracic pathology does not exclude simultaneous intra-abdominal pathology.

Pain in spine diseases, as a manifestation of secondary radicular syndrome, is accompanied by local soreness, dependence on movements, coughing.

There are at least 85 causes that cause abdominal pain in children, but there is rarely a problem of finding the exact cause to establish a fairly rare and accurate diagnosis. Most often it is necessary to decide the question: is there an organic disease or does the abdominal pain arise as a result of emotional stress or some other physiological factor? Only 5-10% of children hospitalized for abdominal pain determine the organic nature of the disease, but even in this case stress is very important (for example, when it comes to peptic ulcers). When conducting differential diagnostics at the initial stage, Apley's aphorism may be very useful: the further from the navel the abdominal pain is localized, the more likely it is of organic origin. However, children often find it difficult to pinpoint where the abdomen hurts, so some other information about the causes of pain may be more reliable. For example, the answers of a sick child to a doctor's question: "When did you feel pain in your stomach?" Most often these are: "When I had to go to school"; "When I realized that I was walking along the wrong street." Or the answers to the doctor's question: "Who was with you when the pain began?" "What (or who) reduced the pain"? Other history data suggesting a possible diagnosis can also be identified. For example, a very hard feces suggests that the cause of abdominal pain may be constipation.

• The children of the Negroid race should be suspected of sickle cell anemia. It is necessary to make an appropriate test.
• In children from Asian families, tuberculosis is possible - it is necessary to make a Mantoux reaction.
• In children with a tendency to eat inedible things (perverted appetite), it is advisable to examine the blood for the maintenance of lead in it.
• Abdominal migraine should be suspected if the pains are of a periodical nature, accompanied by vomiting, and especially in cases where there is a corresponding family anamnesis. These children can try to appoint meterazin, 2.5-5 mg every 8 hours inside.

Most of the abdominal pain is a consequence of gastroenteritis, urinary tract infection, viral diseases (for example, tonsillitis associated with nonspecific mezadenitis) and appendicitis. The pancreatitis in case of epidemic parotitis, diabetes mellitus, intestinal involution, intestinal invasion, Meckelian diverticulum, pelvic ulcer, Hirschsprung disease, Shenlaine-Henoch purpura and hydronephrosis are somewhat less likely cause. In older girls, menstruation and salpingitis may be the cause of abdominal pain.

Boys always need to exclude a testicle.

[4], [5], [6]

Abdominal pain in chronic diseases

Abdominal pain, dyspepsia, heartburn, indigestion are common conditions that often manifest as nonspecific abdominal discomfort. This pain can be associated with eating, losing weight, minor changes in the habitual mode of defecation, blood in the stool, stress or other psychoemotional conditions.

Any pain or discomfort in the abdomen is assessed according to the following criteria: duration, intensity, localization, type, concomitant clinical manifestations, eg nausea, vomiting, constipation, diarrhea, tenderness, fever, tachycardia, bloating; the level of activity of patients with severe pain, for example anxiety or the inability to lie still.

Complaints of heartburn or indigestion are complex diagnostic problems because they are often nonspecific:

• specify the complaints and symptoms of the patient;
• conduct a thorough physical examination in order to find out if a referral is necessary to a specialist.

Periodic digestive disorders (heartburn, indigestion) can be associated with acute and fatty foods, alcohol, fizzy drinks, coffee consumption in large quantities, excessive smoking, drug use, intake of NSAIDs (ibuprofen, aspirin).

Chronic pain in other areas of the abdomen is usually associated with disorders of bowel evacuation (constipation, diarrhea, or alternation).

Constipation can be triggered by a variety of causes (some of which are very serious): an improper diet (insufficient intake of fiber and fluid); sedentary lifestyle; pregnancy; advanced age; the side effects of certain medicines; endocrine disorders; neurogenic causes; abnormalities of intestinal development (dolichosigma, intestinal diverticula, etc.); psychogenic disorders; intestinal cancer; delayed urge to defecate.

Be especially wary of a sudden change in the usual mode of defecation, since there is a chance of colon cancer.

Therapeutic tasks in case of constipation: weakening of symptoms, recommendations on diet and lifestyle, determination of cases to be referred to a specialist.

Non-pharmacological methods: recommend a more mobile lifestyle, exercise; reception of fiber-rich foods (eg vegetables, coarse corn and bran); recommend the emptying of the intestine at a certain time, even if there is no urge; avoid systematic use of laxatives.

Drug treatment: senna preparations and other laxatives; medicinal herbs.

Attention! Long-term constipation can manifest as a "diarrhea of a crowded intestine."

Referral to a specialist is carried out in the case of coprostasis, recent changes in the mode of bowel evacuation, poor response to non-drug methods and in cases where the cause of constipation is unclear.

The most common cause of pain associated with emptying is considered to be bowel disease of functional origin, i.e., without certain morphological manifestations, which is referred to as the "irritable bowel syndrome". Therefore, the doctor always has a task in such cases, first of all, to differentiate organic and functional changes. To a certain extent, this can be done on the basis of clinical data.

For irritable bowel syndrome, first of all, the relationship of abdominal pain with constipation (in 90% of patients) or diarrhea (in 10%) is usually in the morning. Along with this, there are a number of other complaints in various combinations: severity or pain in the epigastric region, decreased appetite, nausea, eructation, sometimes vomiting, bloating, sensation of rumbling, transfusion. There are complaints of a neurotic nature: mood disturbance, sleep, fatigue, a feeling of a coma in the throat, migraine, hypochondria, dysmenorrhea, carcinophobia, fluctuations in blood pressure, etc. With the increase in the number of different symptoms, the probability of this disease increases. It is also important to relate pain to psycho-emotional factors more than to eating habits. Irritable bowel syndrome is more common among the urban population, in 2/3 of cases in women aged 30-40 years, but may be in the elderly. The disease is clearly benign, not accompanied by weight loss, anemia, disability. With an objective examination, no organic pathology is found. There may be rumbling in the ileocecal region, sensitivity or inconspicuous tenderness along the colon, in the hypochondrium. There is no method of research confirming this diagnosis: it is always established by the method of elimination.

[7], [8], [9], [10], [11]