Abdominal Pain is a symptom that can be associated with mild illnesses or serious disorders that can be life threatening. The most common abdominal pain disorders include gastroenteritis and irritable bowel disease. Approximately 10% of patients have a more serious underlying condition, such as appendicitis, abdominal aortic aneurysm, diverticulitis, or ectopic pregnancy. In one-third of cases, no specific cause can be established.
Because several diseases can cause some form of abdominal pain, a systematic approach to the patient and the development of a differential diagnosis remains important.
As noted above the most common causes of abdominal pain are gastroenteritis (13%), irritable bowel (8%). In addition, urinary tract problems (5%), gastritis (5%) and constipation (5%) are found. In about 30% of cases, the cause cannot be determined. About 10% of patients may have a more serious disorder, including gallbladder problems (gallstones or biliary dyskinesia), pancreatic problems (4%), diverticulitis (3%), appendicitis (2%) and cancer (1%). In older adults the most common causes are mesenteric ischemia and abdominal aortic aneurysms, which can be more serious problems.
Acute Abdominal Pain
Acute abdominal pain is a disorder that can be of severe severity, characterized by abdominal pain of sudden onset and likely to require surgical intervention. The pain is usually associated with nausea and vomiting, abdominal bloating, ileus (stopped bowel movement), fever and signs of shock (decreased blood pressure). One of the most common causes associated with acute abdomen is appendicitis.
Causes of Acute Abdomen
There are some important causes of acute abdomen among which are:
Infections: Appendicitis, cholecystitis, pancreatitis, pyelonephritis (kidney infection), pelvic inflammatory disease, hepatitis, mesenteric adenitis.
Perforation of abdominal viscera: peptic ulcer, cecum, diverticulum.
Abdominal trauma: Blunt trauma that can affect stomach, liver, pancreas, spleen and kidney.
Small bowel obstruction due to adhesions from previous surgeries, intussusception (introduction of one intestinal segment into another) especially in children which is a surgical emergency, malignant or benign tumors.
Intestinal ischemia due to arterial occlusion, generally caused by thromboembolism of the superior mesenteric artery.
The physician should perform a complete history and clinical examination in order to identify the most probable cause of the pain.
The area of pain, time of onset, character and type of pain, irradiation to another part of the abdomen, history of previous illness, previous surgeries should be located. Inquire about the presence of extra-abdominal symptoms such as fever, chills, chest pain, labored breathing and in women vaginal bleeding.
Laboratory and Imaging Studies
The studies to be performed include:
1. Complete blood test.
2. General urine test.
4. Chest and abdominal X-ray.
5. Abdominal and pelvic ultrasound.
Other complementary tests that may be requested are:
1. Computed tomography.
2. Upper and lower gastrointestinal endoscopy.
If a patient presents abdominal pain of moderate or severe intensity and rapid onset, he/she should be treated urgently by a physician. Self-medication, such as the use of analgesics, is counterproductive, since it may mask a more serious disorder and delay an urgent intervention required by the patient.
The management of abdominal pain will depend on the clinical situation of the patient and the determination of the cause of the pain. Mild disorders will be treated conservatively and with therapeutic measures such as intravenous hydration, suspension of the oral route to reduce nausea and vomiting.
More serious or life-threatening conditions will most likely require surgical treatment.