|
|
(43 intermediate revisions by the same user not shown) |
Line 1: |
Line 1: |
| Common causes include [[gastroenteritis]] and [[irritable bowel syndrome]].<!-- <ref name=Vin2014/> --> In a third of cases the exact cause is unclear.<!-- <ref name=Vin2014/> --> About 10% of people have a more serious underlying condition such as [[appendicitis]] or [[diverticulitis]].<ref name=Vin2014/> Determining the cause can be difficult, because many diseases can cause this symptom.
| | {{#widget:bookshelfmobile}} |
| | |
| ==Differential diagnosis==
| |
| The most frequent cause of abdominal pain is [[gastroenteritis]] (13%), [[irritable bowel syndrome]] (8%), urinary tract problems (5%), [[gastritis|inflammation of the stomach]] (5%) and [[constipation]] (5%).<!-- <ref name=Vin2014/> --> About 30% of cases the cause is not determined.<!-- <ref name=Vin2014/> --> About 10% of cases have a more serious cause including gallbladder or [[pancreas]] problems (4%), [[diverticulitis]] (3%), [[appendicitis]] (2%) and [[cancer]] (1%).<ref name=Vin2014>{{cite journal|last1=Viniol|first1=A|last2=Keunecke|first2=C|last3=Biroga |first3=T|last4=Stadje|first4=R|last5=Dornieden|first5=K|last6=Bösner|first6=S|last7=Donner-Banzhoff|first7=N|last8=Haasenritter|first8=J|last9=Becker|first9=A|title=Studies of the symptom abdominal pain--a systematic review and meta-analysis.|journal=Family practice|date=October 2014|volume=31|issue=5|pages=517–29|pmid=24987023|doi=10.1093/fampra/cmu036}}</ref> More common in those who are older, [[mesenteric ischemia]] and [[abdominal aortic aneurysm]]s are other serious causes.<ref>{{cite journal|last1=Spangler|first1=R|last2=Van Pham|first2=T|last3=Khoujah |first3=D|last4=Martinez|first4=JP|title=Abdominal emergencies in the geriatric patient |journal=International journal of emergency medicine|date=2014|volume=7|pages=43|pmid=25635203 |doi=10.1186/preaccept-3303381914150346}}</ref>
| |
| | |
| A more extensive list includes the following:
| |
| * Gastrointestinal
| |
| ** GI tract
| |
| *** Inflammatory: [[gastroenteritis]], [[appendicitis]], [[gastritis]], [[esophagitis]], [[diverticulitis]], [[Crohn's disease]], [[ulcerative colitis]], [[microscopic colitis]]
| |
| *** Obstruction: [[hernia]], [[intussusception (medical disorder)|intussusception]], [[volvulus]], post-surgical [[adhesions]], [[tumour]]s, [[superior mesenteric artery syndrome]], severe [[constipation]], [[hemorrhoids]]
| |
| *** Vascular: [[embolism]], [[thrombosis]], [[hemorrhage]], [[sickle cell disease]], [[abdominal angina]], blood vessel compression (such as celiac artery compression syndrome), [[Postural orthostatic tachycardia syndrome]]
| |
| *** [[digestion|digestive]]: [[peptic ulcer]], [[lactose intolerance]], [[coeliac disease]], [[food allergies]]
| |
| ** Glands
| |
| *** Bile system
| |
| **** Inflammatory: [[cholecystitis]], [[cholangitis]]
| |
| **** Obstruction: [[cholelithiasis]], [[tumour]]s
| |
| *** Liver
| |
| **** Inflammatory: [[hepatitis]], [[liver abscess]]
| |
| *** Pancreatic
| |
| **** Inflammatory: [[pancreatitis]]
| |
| * Renal and urological
| |
| ** Inflammation: [[pyelonephritis]], [[cystitis|bladder infection]]
| |
| ** Obstruction: [[nephrolithiasis|kidney stones]], [[urolithiasis]], [[Urinary retention]], [[tumour]]s
| |
| ** Vascular: [[left renal vein entrapment]]
| |
| * Gynaecological or obstetric
| |
| ** Inflammatory: [[pelvic inflammatory disease]]
| |
| ** Mechanical: [[ovarian torsion]]
| |
| ** Endocrinological: [[menstruation]], [[Mittelschmerz]]
| |
| ** Tumors: [[endometriosis]], [[fibroids]], [[ovarian cyst]], [[ovarian cancer]]
| |
| ** Pregnancy: ruptured [[ectopic pregnancy]], [[threatened abortion]]
| |
| * [[Abdominal wall]]
| |
| ** muscle strain or trauma
| |
| ** muscular infection
| |
| ** [[neurogenic]] pain: [[herpes zoster]], [[radiculitis]] in [[Lyme disease]], [[Nerve compression syndrome#Lower limb.2C abdomen and pelvis|abdominal cutaneous nerve entrapment syndrome]] (ACNES), [[tabes dorsalis]]
| |
| * [[Referred pain]]
| |
| ** from the [[thorax]]: [[pneumonia]], [[pulmonary embolism]], [[ischemic heart disease]], [[pericarditis]]
| |
| ** from the [[vertebral column|spine]]: [[radiculitis]]
| |
| ** from the [[genitals]]: [[testicular torsion]]
| |
| * [[Metabolic disturbance]]
| |
| ** [[uremia]], [[diabetic ketoacidosis]], [[porphyria]], [[C1-esterase inhibitor deficiency]], adrenal insufficiency, [[lead poisoning]], [[latrodectus|black widow spider]] bite, [[narcotic]] [[Drug withdrawal|withdrawal]]
| |
| * Blood vessels
| |
| ** [[aortic dissection]], [[abdominal aortic aneurysm]]
| |
| * Immune system
| |
| ** [[sarcoidosis]]
| |
| ** [[vasculitis]]
| |
| ** [[familial Mediterranean fever]]
| |
| * Idiopathic
| |
| ** [[irritable bowel syndrome]] (affecting up to 20% of the population, IBS is the most common cause of recurrent, intermittent abdominal pain)
| |
| | |
| ===Acute abdominal pain===
| |
| [[Acute abdomen]] can be defined as severe, persistent abdominal pain of sudden onset that is likely to require [[surgery|surgical intervention]] to treat its cause. The pain may frequently be associated with [[nausea]] and [[vomiting]], [[abdominal distention]], [[fever]] and signs of [[Shock (circulatory)|shock]]. One of the most common conditions associated with acute abdominal pain is acute [[appendicitis]].
| |
| | |
| ====Selected causes of acute abdomen====
| |
| | |
| * Traumatic: [[Blunt trauma|blunt]] or perforating [[physical trauma|trauma]] to the [[stomach]], [[bowel]], [[spleen]], [[liver]], or [[kidney]]
| |
| * Inflammatory:
| |
| ** Infections such as [[appendicitis]], [[cholecystitis]], [[pancreatitis]], [[pyelonephritis]], [[pelvic inflammatory disease]], [[hepatitis]], [[mesenteric adenitis]], or a subdiaphragmatic [[abscess]]
| |
| ** [[Gastrointestinal perforation|Perforation]] of a [[peptic ulcer]], a [[diverticulitis|diverticulum]], or the [[caecum]]
| |
| ** Complications of [[inflammatory bowel disease]] such as [[Crohn's disease]] or [[ulcerative colitis]]
| |
| * Mechanical:
| |
| ** [[Small bowel]] [[bowel obstruction|obstruction]] secondary to adhesions caused by previous surgeries, [[intussusception (medical disorder)|intussusception]], [[hernia]]s, benign or malignant [[neoplasia|neoplasm]]s
| |
| ** [[Large bowel]] [[bowel obstruction|obstruction]] caused by [[colorectal cancer]], [[inflammatory bowel disease]], [[volvulus]], [[fecal impaction]] or [[hernia]]
| |
| * Vascular: occlusive [[ischemic colitis|intestinal ischemia]], usually caused by [[thromboembolism]] of the [[superior mesenteric artery]]
| |
| | |
| ===By location===
| |
| Location<ref>{{Cite book | author = Richard F.LeBlond | title = Diagnostics | location = US | publisher = McGraw-Hill Companies, Inc. |isbn =0-07-140923-8 }}</ref>
| |
| * Upper middle abdominal pain
| |
| ** Stomach ([[gastritis]], [[stomach ulcer]], [[stomach cancer]])
| |
| ** Pancreas pain ([[pancreatitis]] or [[pancreatic cancer]], can radiate to the left side of the waist, back, and even shoulder)
| |
| ** Duodenal ulcer, diverticulitis
| |
| ** [[Appendicitis]] (starts here, after several times moves to lower right abdomen)
| |
| * Upper right abdominal pain
| |
| ** Liver (caused by [[hepatomegaly]] due to [[fatty liver]], [[hepatitis]], or caused by [[liver cancer]], [[abscess]])
| |
| ** Gallbladder and biliary tract ([[gallstones]], inflammation, roundworms)
| |
| ** Colon pain (below the area of liver — [[bowel obstruction]], functional disorders, gas accumulation, spasm, inflammation, [[colon cancer]])
| |
| * Upper left abdominal pain
| |
| ** Spleen pain ([[splenomegaly]])
| |
| ** Pancreas
| |
| ** Colon pain (below the area of spleen — bowel obstruction, functional disorders, gas accumulation, spasm, inflammation, colon cancer)
| |
| * Middle abdominal pain (pain in the area around belly button)
| |
| ** [[Appendicitis]] (starts here)
| |
| ** Small intestine pain (inflammation, intestinal spasm, functional disorders)
| |
| * Lower abdominal pain ([[diarrhea]], [[colitis]] and [[dysentery]])
| |
| * Lower right abdominal pain
| |
| ** Cecum ([[intussusception (medical disorder)|intussusception]], bowel obstruction)
| |
| ** [[Vermiform appendix|Appendix]] point ([[Appendicitis]] location)
| |
| * Lower left abdominal pain
| |
| ** Sigmoid colon ([[Polyp (medicine)|polyp]]), sigmoid volvulus, obstruction or gas accumulation)
| |
| * Pelvic pain
| |
| ** bladder ([[cystitis]], may be secondary to diverticulum and [[bladder stone]], [[bladder cancer]])
| |
| ** pain in women (uterus, ovaries, fallopian tubes)
| |
| * Right lumbago and back pain
| |
| ** liver pain ([[hepatomegaly]])
| |
| ** right kidney pain (its location below the area of liver pain)
| |
| * Left lumbago and back pain
| |
| ** less in spleen pain
| |
| ** left kidney pain
| |
| * Low back pain
| |
| ** kidney pain ([[kidney stone]], [[kidney cancer]], [[hydronephrosis]])
| |
| ** Ureteral stone pain
| |
| | |
| ==Diagnostic approach==
| |
| When a physician assesses a patient to determine the etiology and subsequent treatment for abdominal pain the patient's history of the presenting complaint and physical examination should derive a diagnosis in over 90% of cases.
| |
| | |
| It is important for a physician to remember that abdominal pain can be caused by problems outside the abdomen, especially [[heart attacks]] and [[pneumonia]]s which can occasionally present as abdominal pain.
| |
| | |
| Investigations that aid diagnosis include
| |
| * Blood tests including full blood count, [[electrolytes]], [[urea]], [[creatinine]], liver function tests, [[pregnancy test]], [[amylase]] and [[lipase]].
| |
| * [[Urinalysis]]
| |
| * Imaging including erect chest [[X-ray]] and plain films of the abdomen
| |
| * An [[electrocardiograph]] to rule out a heart attack which can occasionally present as abdominal pain
| |
| | |
| If diagnosis remains unclear after history, examination and basic investigations as above then more advanced investigations may reveal a diagnosis. These as such would include
| |
| * [[Computed Tomography]] of the abdomen/pelvis
| |
| * Abdominal or pelvic [[ultrasound]]
| |
| * [[Endoscopy]] and [[colonoscopy]] (not used for diagnosing acute pain)
| |
| | |
| ==Management==
| |
| [[Butylscopolamine]] (Buscopan) is used to treat cramping abdominal pain with some success.<ref>{{cite journal |author=Tytgat GN |title=Hyoscine butylbromide: a review of its use in the treatment of abdominal cramping and pain |journal=Drugs |volume=67 |issue=9 |pages=1343–57 |year=2007 |pmid=17547475 |doi= 10.2165/00003495-200767090-00007|url=}}</ref>
| |
| | |
| ==Epidemiology==
| |
| Abdominal pain is the reason about 3% of adults see their family physician.<ref name=Vin2014/> Rates of [[emergency department]] visits in the United States for abdominal pain increased 18% from 2006 through 2011. This was the largest increase out of 20 common conditions seen in the ED. The rate of ED use for nausea and vomiting also increased 18%.<ref>{{cite web | author = Skiner HG, Blanchard J, Elixhauser A | title = Trends in Emergency Department Visits, 2006-2011 | work = HCUP Statistical Brief #179 | publisher = Agency for Healthcare Research and Quality | location = Rockville, MD | date = September 2014 | url = https://www.hcup-us.ahrq.gov/reports/statbriefs/sb179-Emergency-Department-Trends.jsp}}</ref>
| |
| | |
| ==References==
| |
| {{reflist}}
| |