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Abdominal pain
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Abdominal pain can be characterized by the region it affects.
ICD-10 R10
ICD-9 789.0
MedlinePlus 003120

Abdominal pain (or stomach ache) is a common symptom associated with transient disorders or serious disease. Diagnosing the cause of pain in the abdomen can be difficult, because many diseases can cause this symptom. Most frequently the cause is benign and/or self-limiting, but more serious causes may require urgent intervention.

Differential diagnosis[]

Acute abdominal pain[]

Acute abdomen can be defined as severe, persistent abdominal pain of sudden onset that is likely to require surgical intervention to treat its cause. The pain may frequently be associated with nausea and vomiting, abdominal distention, fever and signs of shock. One of the most common conditions associated with acute abdominal pain is acute appendicitis.

Selected causes of acute abdomen

By location[]

Location[1]

  • 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 and dysentery)
  • Lower right abdominal pain
    • Cecum (intussusception, bowel obstruction)
    • Appendix point (Appendicitis location)
  • Lower left abdominal pain
    • Sigmoid colon (polyp), sigmoid volvulus, obstruction or gas accumulation)
  • Pelvic pain
    • bladder (cystitis, may 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 also for a physician to remember that abdominal pain can be caused by problems outside the abdomen, especially heart attacks and pneumonias which can occasionally present as abdominal pain.

Investigations that would 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

Management[]

Butylscopolamine (Buscopan) is used to treat cramping abdominal pain with some success.[2]

See also[]

  • Recurrent abdominal pain in children

References[]

  1. Richard F.LeBlond. Diagnostics, US: McGraw-Hill Companies, Inc..
  2. Tytgat GN (2007). Hyoscine butylbromide: a review of its use in the treatment of abdominal cramping and pain. Drugs 67 (9): 1343–57.

Further reading[]

  • Boyle, J. T. (2001). Biopsychosocial issues in functional abdominal pain. Pediatr Ann 30 (1): 32–40..


Template:Digestive system and abdomen symptoms and signs

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