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| 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.
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| ==Differential diagnosis==
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| 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>
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| A more extensive list includes the following:
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| * Gastrointestinal
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| ** GI tract
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| *** Inflammatory: [[gastroenteritis]], [[appendicitis]], [[gastritis]], [[esophagitis]], [[diverticulitis]], [[Crohn's disease]], [[ulcerative colitis]], [[microscopic colitis]]
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| *** Obstruction: [[hernia]], [[intussusception (medical disorder)|intussusception]], [[volvulus]], post-surgical [[adhesions]], [[tumour]]s, [[superior mesenteric artery syndrome]], severe [[constipation]], [[hemorrhoids]]
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| *** Vascular: [[embolism]], [[thrombosis]], [[hemorrhage]], [[sickle cell disease]], [[abdominal angina]], blood vessel compression (such as celiac artery compression syndrome), [[Postural orthostatic tachycardia syndrome]]
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| *** [[digestion|digestive]]: [[peptic ulcer]], [[lactose intolerance]], [[coeliac disease]], [[food allergies]]
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| ** Glands
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| *** Bile system
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| **** Inflammatory: [[cholecystitis]], [[cholangitis]]
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| **** Obstruction: [[cholelithiasis]], [[tumour]]s
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| *** Liver
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| **** Inflammatory: [[hepatitis]], [[liver abscess]]
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| *** Pancreatic
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| **** Inflammatory: [[pancreatitis]]
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| * Renal and urological
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| ** Inflammation: [[pyelonephritis]], [[cystitis|bladder infection]]
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| ** Obstruction: [[nephrolithiasis|kidney stones]], [[urolithiasis]], [[Urinary retention]], [[tumour]]s
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| ** Vascular: [[left renal vein entrapment]]
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| * Gynaecological or obstetric
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| ** Inflammatory: [[pelvic inflammatory disease]]
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| ** Mechanical: [[ovarian torsion]]
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| ** Endocrinological: [[menstruation]], [[Mittelschmerz]]
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| ** Tumors: [[endometriosis]], [[fibroids]], [[ovarian cyst]], [[ovarian cancer]]
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| ** Pregnancy: ruptured [[ectopic pregnancy]], [[threatened abortion]]
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| * [[Abdominal wall]]
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| ** muscle strain or trauma
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| ** muscular infection
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| ** [[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]]
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| * [[Referred pain]]
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| ** from the [[thorax]]: [[pneumonia]], [[pulmonary embolism]], [[ischemic heart disease]], [[pericarditis]]
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| ** from the [[vertebral column|spine]]: [[radiculitis]]
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| ** from the [[genitals]]: [[testicular torsion]]
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| * [[Metabolic disturbance]]
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| ** [[uremia]], [[diabetic ketoacidosis]], [[porphyria]], [[C1-esterase inhibitor deficiency]], adrenal insufficiency, [[lead poisoning]], [[latrodectus|black widow spider]] bite, [[narcotic]] [[Drug withdrawal|withdrawal]]
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| * Blood vessels
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| ** [[aortic dissection]], [[abdominal aortic aneurysm]]
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| * Immune system
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| ** [[sarcoidosis]]
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| ** [[vasculitis]]
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| ** [[familial Mediterranean fever]]
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| * Idiopathic
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| ** [[irritable bowel syndrome]] (affecting up to 20% of the population, IBS is the most common cause of recurrent, intermittent abdominal pain)
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| ===Acute abdominal pain===
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| [[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]].
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| ====Selected causes of acute abdomen====
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|
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| * Traumatic: [[Blunt trauma|blunt]] or perforating [[physical trauma|trauma]] to the [[stomach]], [[bowel]], [[spleen]], [[liver]], or [[kidney]]
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| * Inflammatory:
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| ** Infections such as [[appendicitis]], [[cholecystitis]], [[pancreatitis]], [[pyelonephritis]], [[pelvic inflammatory disease]], [[hepatitis]], [[mesenteric adenitis]], or a subdiaphragmatic [[abscess]]
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| ** [[Gastrointestinal perforation|Perforation]] of a [[peptic ulcer]], a [[diverticulitis|diverticulum]], or the [[caecum]]
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| ** Complications of [[inflammatory bowel disease]] such as [[Crohn's disease]] or [[ulcerative colitis]]
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| * Mechanical:
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| ** [[Small bowel]] [[bowel obstruction|obstruction]] secondary to adhesions caused by previous surgeries, [[intussusception (medical disorder)|intussusception]], [[hernia]]s, benign or malignant [[neoplasia|neoplasm]]s
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| ** [[Large bowel]] [[bowel obstruction|obstruction]] caused by [[colorectal cancer]], [[inflammatory bowel disease]], [[volvulus]], [[fecal impaction]] or [[hernia]]
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| * Vascular: occlusive [[ischemic colitis|intestinal ischemia]], usually caused by [[thromboembolism]] of the [[superior mesenteric artery]]
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| ===By location===
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| Location<ref>{{Cite book | author = Richard F.LeBlond | title = Diagnostics | location = US | publisher = McGraw-Hill Companies, Inc. |isbn =0-07-140923-8 }}</ref>
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| * Upper middle abdominal pain
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| ** Stomach ([[gastritis]], [[stomach ulcer]], [[stomach cancer]])
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| ** Pancreas pain ([[pancreatitis]] or [[pancreatic cancer]], can radiate to the left side of the waist, back, and even shoulder)
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| ** Duodenal ulcer, diverticulitis
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| ** [[Appendicitis]] (starts here, after several times moves to lower right abdomen)
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| * Upper right abdominal pain
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| ** Liver (caused by [[hepatomegaly]] due to [[fatty liver]], [[hepatitis]], or caused by [[liver cancer]], [[abscess]])
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| ** Gallbladder and biliary tract ([[gallstones]], inflammation, roundworms)
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| ** Colon pain (below the area of liver — [[bowel obstruction]], functional disorders, gas accumulation, spasm, inflammation, [[colon cancer]])
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| * Upper left abdominal pain
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| ** Spleen pain ([[splenomegaly]])
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| ** Pancreas
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| ** Colon pain (below the area of spleen — bowel obstruction, functional disorders, gas accumulation, spasm, inflammation, colon cancer)
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| * Middle abdominal pain (pain in the area around belly button)
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| ** [[Appendicitis]] (starts here)
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| ** Small intestine pain (inflammation, intestinal spasm, functional disorders)
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| * Lower abdominal pain ([[diarrhea]], [[colitis]] and [[dysentery]])
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| * Lower right abdominal pain
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| ** Cecum ([[intussusception (medical disorder)|intussusception]], bowel obstruction)
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| ** [[Vermiform appendix|Appendix]] point ([[Appendicitis]] location)
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| * Lower left abdominal pain
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| ** Sigmoid colon ([[Polyp (medicine)|polyp]]), sigmoid volvulus, obstruction or gas accumulation)
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| * Pelvic pain
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| ** bladder ([[cystitis]], may be secondary to diverticulum and [[bladder stone]], [[bladder cancer]])
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| ** pain in women (uterus, ovaries, fallopian tubes)
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| * Right lumbago and back pain
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| ** liver pain ([[hepatomegaly]])
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| ** right kidney pain (its location below the area of liver pain)
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| * Left lumbago and back pain
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| ** less in spleen pain
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| ** left kidney pain
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| * Low back pain
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| ** kidney pain ([[kidney stone]], [[kidney cancer]], [[hydronephrosis]])
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| ** Ureteral stone pain
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| ==Diagnostic approach==
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| 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.
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| 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.
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| Investigations that aid diagnosis include
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| * Blood tests including full blood count, [[electrolytes]], [[urea]], [[creatinine]], liver function tests, [[pregnancy test]], [[amylase]] and [[lipase]].
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| * [[Urinalysis]]
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| * Imaging including erect chest [[X-ray]] and plain films of the abdomen
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| * An [[electrocardiograph]] to rule out a heart attack which can occasionally present as abdominal pain
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| 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
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| * [[Computed Tomography]] of the abdomen/pelvis
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| * Abdominal or pelvic [[ultrasound]]
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| * [[Endoscopy]] and [[colonoscopy]] (not used for diagnosing acute pain)
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| ==Management==
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| [[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>
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| ==Epidemiology==
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| 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>
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| ==References==
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| {{reflist}}
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