Abdominal pain classification

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Abdominal pain can be classified into three categories: acute abdomen, recurrent, and chronic functional.

Classification

Abdominal pain is traditionally described by its:

• Chronicity (acute or chronic)
• Progression over time
• Nature (sharp, dull, colicky)
• Characterization of the factors that make the pain worse or alleviate it
• Distribution determined by various methods:
  • Such as abdominal quadrant (left upper quadrant, left lower quadrant, right upper quadrant, right lower quadrant)
  • Other methods that divide the abdomen into nine sections

Acute Abdomen

Acute abdomen refers to a sudden, severe pain in the abdomen that is less than 24 hours in duration. It is in many cases an emergency condition requiring urgent and specific diagnosis, and the treatment usually involves surgery.

Peritonitis

Acute abdomen is occasionally used synonymously with peritonitis. This is not incorrect; however, peritonitis is the more specific term, referring to inflammation of the peritoneum. It is diagnosed on physical examination as rebound tenderness, or pain upon removal of pressure rather than application of pressure to the abdomen. Peritonitis may result from several diseases, notably appendicitis and pancreatitis.

Ischemic Acute Abdomen

Vascular disorders are more likely to affect the small bowel than the large bowel. Arterial supply to the intestines is provided by the superior and inferior mesenteric arteries, (SMA and IMA respectively) both of which are direct branches of the aorta.

Recurrent Abdominal Pain

Recurrent abdominal pain (RAP) occurs in 5–15% of female children 6–19 years old. In a community-based study of middle and high school students, 13–17% had weekly abdominal pain. Using criteria for irritable bowel syndrome (IBS), 14% of high school students and 6% of middle school students fit the criteria for adult IBS. As with other difficult to diagnose chronic medical problems, patients with RAP account for a very large number of office visits and medical resources in proportion to their actual numbers.

Chronic Fuctional Abdominal Pain

Chronic functional abdominal pain (CFAP) is the ongoing presence of abdominal pain for which there is no known medical explanation.