Causes of abdominal pain

The causes of abdominal pain may be surgical, gynecological, mental illnesses and many other internal diseases. Abdominal pain is an alarming symptom. It is practically important to distinguish between acute and chronic abdominal pain and their intensity. Acute intense abdominal pain may indicate a dangerous disease, in which a quick assessment of the situation ensures the implementation of life-saving emergency treatment measures.

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

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Acute abdominal pain

The first thing to suspect when there is abdominal pain is acute diseases of the abdominal organs that require emergency surgical intervention (acute abdomen).

It is necessary to know the most common causes of such pain. Most often they occur with pathology of the abdominal organs, but they can also be of extra-abdominal origin.

The causes of abdominal pain are the following diseases:

1. involvement of the parietal peritoneum (appendicitis, cholecystitis, perforation of a gastric ulcer or duodenal ulcer);
2. mechanical obstruction of a hollow organ (intestine, bile ducts, ureter);
3. vascular disorders (thrombosis of mesenteric vessels);
4. pathology of the abdominal wall (muscle injury or infection, hernia);
5. acute inflammation of the gastrointestinal tract (salmonellosis, food poisoning).

Reflected pain of extra-abdominal origin can occur with:

1. pleuropulmonary diseases;
2. myocardial infarction;
3. spinal lesions.

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). In case of abdominal pain in elderly people who suffer from atherosclerosis, arrhythmia or have recently had a myocardial infarction, acute circulatory disorder in the intestine should be suspected.

Pain in acute abdomen can be constant and paroxysmal. Paroxysmal pain with gradual increase and then complete disappearance is called colic. Colic is caused by spasm of smooth muscles of hollow internal organs (bile ducts and gall bladder, ureter, intestine, etc.), innervated by the autonomic nervous system. Depending on the localization, intestinal, renal and biliary colic are distinguished.

In all cases of acute, intense abdominal pain that appears without an obvious external cause, first of all, it is necessary to exclude the presence of peritonitis or acute intestinal obstruction with or without signs of centralization of blood circulation, i.e. shock of varying severity and other life-threatening conditions.

Peritoneal pains, usually constant, strictly limited, located directly above the inflamed organ, necessarily increase with palpation, coughing, movements, accompanied by muscle tension. The patient with peritonitis lies motionless, while with colic he constantly changes position.

With obstruction of a hollow organ, the pain is usually intermittent, colicky, although it can be constant, with periodic intensification. With obstruction of the small intestine, they are located in the peri- or supra-umbilical region, with large intestinal obstruction - often below the navel. Stool retention, gas discharge, visible peristalsis, intestinal noises are taken into account. With sudden obstruction of the bile duct, pain, rather constant in nature, occurs in the right upper quadrant of the abdomen with irradiation posteriorly to the lower back and under the scapula; with stretching of the common bile duct, pain can irradiate to the epigastric and upper lumbar region. Similar pains also occur with obstruction of the pancreatic duct, they intensify when lying down and are relieved when standing.

Pain in mesenteric thromboembolism is usually diffuse and severe, but without signs of peritonitis. Dissecting aortic aneurysm is characterized by pain radiating downwards and backwards. The presence of risk factors for these complications (age, heart disease, heart rhythm disturbances, thromboembolism in the past, etc.) is important.

Dangerous or Life-Threatening Causes of Abdominal Pain

Cause of pain	Signs of the disease	Key symptoms
Intestinal obstruction (due to adhesions, intestinal volvulus, swelling of the duodenum, tumor)	Bloating, peritoneal irritation, persistent vomiting, vomiting of feces	Bloating, abnormal sounds in the intestines (gurgling, ringing)
Cancer (colon, pancreas)	Weight loss, loss of appetite, increased fatigue	Palpable abdominal mass, rectal bleeding. Anemia. Mechanical jaundice.
Abdominal aortic aneurysm	Cutting or tearing pain radiating to the side (history of high blood pressure)	Absence of femoral pulse, pulsating abdominal mass, elevated blood pressure
Bowel perforation	Pain, temperature	No bowel sounds, abdominal rigidity
Intestinal infarction (thrombosis of mesenteric vessels or their ischemia)	Atrial fibrillation or severe atherosclerosis	No bowel sounds, rectal bleeding, Facies Hyppocratica
Acute gastrointestinal bleeding	Dizziness, weakness, bloody vomiting, intestinal bleeding	Tachycardia, low blood pressure (in the early stages there 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, ultrasound of pelvic organs, pregnancy test

Diffuse abdominal pain against the background of gastrointestinal disorders (vomiting, diarrhea) and fever are usually a symptom of an acute intestinal infection.

Reflected pain is most often associated with diseases of the chest organs. This possibility should be considered in all cases of their localization in the upper half of the abdomen. The causes of such pain may be pleurisy, pneumonia, pulmonary infarction, myocardial infarction, pericarditis, and sometimes esophageal diseases. To exclude them, appropriate questioning of the patient and systematic examination are required. With reflected pain, breathing and chest excursion are more impaired than those of the abdomen. Muscle tension decreases with inhalation, and pain often does not increase or even decreases with palpation. However, it should be borne in mind that the detection of any intrathoracic pathology does not exclude simultaneous intra-abdominal pathology.

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

There are at least 85 causes of abdominal pain in children, but it is rare to have a problem finding the exact cause to establish a rather rare and precise diagnosis. Most often, the question has to be answered: is there an organic disease or do abdominal pains arise as a result of emotional stress or some other physiological factor? Only in 5-10% of children hospitalized for abdominal pain is the organic nature of the disease established, but even in this case, stress often plays a very important role (for example, when it comes to peptic ulcer). When conducting differential diagnostics at the initial stage, Apley's aphorism can 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 indicate the exact place where the stomach hurts, so some other information about the causes of pain may be more reliable. For example, the answers of a sick child to the doctor's question: "When did you feel abdominal pain?" are most often: "When I was supposed to go to school"; "When I realized I was walking down the wrong street." Or answers to the doctor's question: "Who was with you when the pain started?" "What (or who) relieved the pain?" Other anamnesis data may also be revealed that point to a possible diagnosis. For example, very hard stools suggest that constipation may be the cause of the abdominal pain.

• In black children, sickle cell anemia should be suspected and appropriate testing should be performed.
• Children from Asian families may have tuberculosis - a Mantoux test should be done.
• In children with a tendency to eat inedible things (perverted appetite), it is advisable to test the blood for lead content.
• Abdominal migraine should be suspected if the pain is clearly periodic, accompanied by vomiting, and especially if there is a family history. In these children, metherasine, 2.5-5 mg orally every 8 hours, may be tried.

Most often, abdominal pain is a consequence of gastroenteritis, urinary tract infection, viral diseases (for example, tonsillitis combined with nonspecific mesadenitis) and appendicitis. Less common causes include pancreatitis in epidemic parotitis, diabetes mellitus, intestinal volvulus, intestinal intussusception, Meckel's diverticulum, pellicle ulcer, Hirschsprung's disease, Henoch-Schonlein purpura and hydronephrosis. In older girls, abdominal pain may be caused by menstruation and salpingitis.

In boys, testicular torsion should always be ruled out.

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Abdominal pain in chronic diseases

Abdominal pain, dyspepsia, heartburn, and indigestion are common conditions that often manifest as non-specific abdominal discomfort. This pain may be associated with food intake, weight loss, minor changes in bowel habits, blood in the stool, stress, or other psycho-emotional conditions.

Any abdominal pain or discomfort is assessed based on the following criteria: duration, intensity, location, type, associated clinical manifestations, such as nausea, vomiting, constipation, diarrhea, tenderness, fever, tachycardia, bloating; activity level of patients with severe pain, such as restlessness or inability to lie still.

Complaints of heartburn or indigestion are difficult diagnostic problems because they are often non-specific:

• specify the patient's complaints and symptoms;
• Perform a thorough physical examination to determine if a referral to a specialist is needed.

Periodic digestive disorders (heartburn, dyspepsia) can be associated with spicy and fatty foods, alcohol, carbonated drinks, drinking coffee in large quantities, excessive smoking, drug use, and taking NSAIDs (ibuprofen, aspirin).

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

Constipation can be caused by many reasons (some of which are very serious): poor diet (insufficient fiber and fluid intake); sedentary lifestyle; pregnancy; old age; side effects of certain medications; endocrine disorders; neurogenic causes; intestinal malformations (dolichosigma, intestinal diverticula, etc.); psychogenic disorders; intestinal cancer; delayed urge to defecate.

Be especially wary of any sudden change in your bowel habits, as there is a risk of colon cancer.

Therapeutic goals for constipation: symptom relief, dietary and lifestyle recommendations, identification of cases requiring referral to a specialist.

Non-drug methods: recommend a more active lifestyle, physical exercise; intake of foods rich in fiber (for example, vegetables, whole-grain corn and bran); recommend emptying the bowels at a certain time, even if there is no urge; avoid systematic use of laxatives.

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

Warning: Long-term constipation may manifest itself as "overflow diarrhea".

Referral to a specialist is made in cases of coprostasis, recent changes in bowel habits, poor response to non-drug treatments, and in cases where the cause of constipation is unclear.

The most common cause of pain associated with bowel movements is considered to be bowel diseases of functional origin, i.e. without specific morphological manifestations, which is designated by the term "irritable bowel syndrome". Therefore, in such cases, the doctor always faces the task, first of all, of differentiating organic and functional changes. To a certain extent, this can be done on the basis of clinical data.

Irritable bowel syndrome is primarily characterized by a connection between abdominal pain and constipation (in 90% of patients) or diarrhea (in 10%), usually in the morning. Along with this, there are a number of other complaints in various combinations: heaviness or pain in the epigastric region, loss of appetite, nausea, belching, sometimes vomiting, bloating, a feeling of rumbling, pouring. There are complaints of a neurotic nature: mood disorders, sleep, fatigue, a feeling of a lump in the throat, migraine, hypochondria, dysmenorrhea, cancerophobia, fluctuations in blood pressure, etc. With an increase in the number of different symptoms, the likelihood of this disease increases. The connection of pain with psychoemotional factors is also important to a greater extent than with dietary habits. Irritable bowel syndrome is more common among the urban population, in 2/3 of cases in women aged 30-40, but can also occur in the elderly. The disease is clearly benign, not accompanied by weight loss, anemia, or disability. No organic pathology is detected during objective examination. There may be rumbling in the ileocecal region, sensitivity or mild pain along the colon, in the hypochondrium. There is no research method that confirms this diagnosis: it is always established by exclusion.

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