Abdominal Pain

Here are some general guidelines that physicians follow when analyzing a patient with abdominal pain. Pain in one area of the abdomen can be due to a number of quite different conditions. Many of the major ones are listed in this table, but there are more rare ones as well that are not mentioned here. Details about the symptoms and treatment modalities for the conditions listed in the "abdominal pain" table can be found by clicking on these links.

Introduction:

Abdominal pain always has to be taken seriously as life threatening situations can arise out of it. Different organs within the abdominal cavity can be the cause of pain, but severe pain that appears organic in nature, can also turn out to be "psychosomatic". In other words, when a thorough work-up has been done, the physician often comes to the conclusion that there is nothing organically wrong, but that the pain is due to psychological reasons (this is also termed "psychogenic abdominal pain").

The physician needs to think: what diagnoses could be behind this type of abdominal pain? We call this "differential diagnosis". In other words the physician makes a mental list of all the possible diagnoses and then one by one is excluded until the real diagnosis is left behind. This way nothing is overlooked. Abdominal pain can be divided into various locations of the abdomen and then the differential diagnoses can be listed. I attempted to do this in the following table. It contains most of the important causes of abdominal pain, but can not claim to be complete as there are many less common causes that were left out.

Signs and symptoms:

All of the conditions above will be associated with some abdominal pain. However, depending on the location of the organ the pain will be located and will irradiate into different areas. Also the quality of pain will vary and there will be different associated symptoms and findings depending on the underlying pathophysiology. The conditions that were described earlier in the chapter will not be repeated below. The other conditions of the differential diagnosis table of abdominal pain above will be briefly explained below.

Treatment:

As all of the diseases listed above in the table have a different pathophysiology, it is clear that treatment must be individualized. I have described specific treatments below for those conditions not already mentioned above in the chapter. However, there are some common themes. If there is an infectious process such as with PID (=pelvic inflammatory disease) or diverticulitis, then intravenous antibiotics are given.

If there is an abscess such as a liver abscess or a perforated appendicitis, then this has to be surgically drained and also be treated with antibiotics. A cancerous growth needs to be removed surgically. An incarcerated hernia or a volvulus needs to be surgically reduced before it leads to gangrene of a segment of the bowel. Acute pancreatitis needs to be supportively treated and the pain needs to be suppressed with narcotics, the same is true for kidney stones.

Quite a number of diseases are treated by not giving anything by mouth and resting the gut through the use of intravenous fluids for a period of time. This is true for pancreatitis, for acute cholecystitis, ileus and ulcerative colitis just to mention a few.

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Abdominal pain

Pain conditions

References:

1. DM Thompson: The 46^th Annual St. Paul's Hospital CME Conference for Primary Physicians, Nov. 14-17, 2000, Vancouver/B.C./Canada

2. C Ritenbaugh Curr Oncol Rep 2000 May 2(3): 225-233.

3. PA Totten et al. J Infect Dis 2001 Jan 183(2): 269-276.

4. M Ohkawa et al. Br J Urol 1993 Dec 72(6):918-921.

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