Abdominal pain , also known as abdominal pain , is a symptom associated with a less serious and serious medical problem.
Common causes of abdominal pain include gastroenteritis and irritable bowel syndrome. About 10% of people have more serious underlying conditions such as appendicitis, leaking or ruptured abdominal aortic aneurysms, diverticulitis, or ectopic pregnancy. In a third case the exact cause is not clear.
Given that various diseases can cause some form of abdominal pain, a systematic approach to a person's examination and differential diagnosis formulation remains important.
Video Abdominal pain
Diagnostic approach
To better understand the cause of abdominal pain, one can perform a thorough anamnesa and physical examination.
The process of collecting history may include:
- Identify more information about the main complaint by bringing up the current disease history; ie narrations of current symptoms such as onset, location, duration, character, incriminating or omitting factors, and the temporal nature of pain. Identify other factors that may be helpful in the diagnosis of underlying causes of abdominal pain, such as recent travel, last contact with other ill individuals, and for women, a complete gynecological history.
- Learn about a patient's previous medical history, focusing on previous problems or surgical procedures.
- Clarify current treatment regimens, including prescription, over-the-counter drugs, and supplements.
- Confirms drug allergies and patient food.
- Discuss with the patient each family history of the disease process, focusing on conditions that may resemble the present presentation of the patient.
- Discuss with patients any health-related behaviors (eg tobacco use, alcohol consumption, drug use, and sexual activity) that may make certain diagnoses more likely.
- Review the presence of non-abdominal symptoms (eg, fever, chills, chest pain, shortness of breath, vaginal bleeding) that may clarify the diagnostic images further.
After collecting a thorough history, one must perform a physical examination to identify important physical signs that may clarify the diagnosis, including cardiovascular exams, lung examinations, abdominal examinations, and for women, genitourinary exams.
Additional investigations that may assist the diagnosis include:
- Blood tests include a complete blood count, basic metabolic panel, electrolytes, liver function tests, amylase, lipase, troponin I, and for women, serum pregnancy tests.
- Urinalysis
- Imaging includes chest X-ray and abdomen
- Electrocardiogram
If the diagnosis remains unclear after the history, examination, and baseline examination as above, more follow-up examination may reveal the diagnosis. Such tests include:
- Computed tomography from the abdomen/pelvis
- Belly or pelvic ultrasound
- Endoscopy and/or colonoscopy
Maps Abdominal pain
Differential diagnosis
The most common reasons for abdominal pain are gastroenteritis (13%), irritable bowel syndrome (8%), urinary tract problems (5%), gastric inflammation (5%) and constipation (5%). In about 30% of cases, the cause is not determined. Approximately 10% of cases have more serious causes including gallbladder (gallstones or bile stool) or pancreatic problems (4%), diverticulitis (3%), appendicitis (2%) and cancer (1%). More common in those older, mesenteric ischemia and abdominal aortic aneurysm are other serious causes.
A more extensive list includes the following:
- Gastrointestinal
- digestive tract
- Inflammation: gastroenteritis, appendicitis, gastritis, esophagitis, diverticulitis, Crohn's disease, ulcerative colitis, microscopic colitis
- Obstruction: hernia, intussusception, volvulus, post-surgical adhesion, tumor, severe constipation, hemorrhoids
- Vascular: embolism, thrombosis, bleeding, sickle cell disease, abdominal angina, vascular compression (such as celiac artery compression syndrome), superior mesenteric artery syndrome, postural orthostatic takikardia syndrome
- Digestion: peptic ulcer, lactose intolerance, celiac disease, food allergy
- Glands
- The bile system
- Inflammation: cholecystitis, cholangitis
- Obstruction: cholelithiasis, tumor
- Heart
- Inflammation: hepatitis, liver abscess
- Pancreas
- Inflammation: pancreatitis
- The bile system
- digestive tract
- Kidney and urologic
- Inflammation: pyelonephritis, bladder infections, indigestion
- Obstruction: kidney stones, urolithiasis, urinary retention, tumors
- Vascular: stroke of the left kidney vein
- Gynecology or midwifery
- Inflammation: pelvic inflammatory disease
- Mechanical: torque ovaries
- Endocrinology: menstruation, Mittelschmerz
- Tumors: endometriosis, fibroids, ovarian cysts, ovarian cancer
- Pregnancy: cracked ectopic pregnancy, threatened abortion
- Abdominal wall
- muscle tension or trauma
- muscle infection
- neurogenic pain: herpes zoster, radiculitis in Lyme disease, cutaneous skin cutaneous trap syndrome (ACNES), tabes dorsalis
- The pain in question
- from thorax: pneumonia, pulmonary embolism, ischemic heart disease, pericarditis
- from the spine: radiculitis
- from genitals: twisted testis
- Metabolic disorders
- uremia, diabetic ketoacidosis, porphyria, deficiency of C1-esterase inhibitors, adrenal insufficiency, lead poisoning, black widow spider bites, narcotics withdrawal
- Blood vessels
- aortic dissection, abdominal aortic aneurysm
- Immune system
- sarcoidosis
- vasculitis
- familial Mediterranean fever
- Idiopathic
- irritable bowel syndrome (attacking up to 20% of the population, IBS is the most common cause of recurrent and intermittent abdominal pain)
Acute abdominal pain
An acute stomach may be defined as severe and persistent abdominal pain from a sudden onset that may require surgical intervention to treat the cause. Pain is often associated with nausea and vomiting, abdominal distension, fever and signs of shock. One of the most common conditions associated with acute abdominal pain is acute appendicitis.
Selected causes
- Trauma: blunt or hollow trauma to the stomach, intestine, spleen, liver, or kidney
- Inflammation:
- Infection such as appendicitis, cholecystitis, pancreatitis, pyelonephritis, pelvic inflammatory disease, hepatitis, mesenteric adenitis, or subdiaphragmatic abscess
- Perforation of peptic ulcer, diverticulum, or cecum
- Complications of inflammatory bowel diseases such as Crohn's disease or ulcerative colitis
- Mechanical:
- Small bowel obstruction due to adhesion caused by previous surgery, intussusception, hernia, benign or malignant neoplasms
- Bowel obstruction caused by colorectal cancer, inflammatory bowel disease, volvulus, faecal impaction or hernia
- Vascular: occlusive intestinal ischemia, usually caused by thromboembolism of the superior mesenteric artery
By location
Locations:
- Upper middle abdominal pain
- Stomach (gastritis, heartburn, stomach cancer)
- Pancreatic pain (pancreatitis or pancreatic cancer, may spread to the left side of the waist, back, and even shoulders)
- Duodenal ulcer, diverticulitis
- Appendicitis (starting here, after some time moving to the lower right abdomen)
- Upper right abdominal pain
- Liver (caused by hepatomegaly because of fatty liver, hepatitis, or caused by liver cancer, abscess)
- Galls and bile ducts (inflammation, gallstones, worm infections)
- Pain of the large intestine (below the liver area - intestinal obstruction, functional abnormalities, gas buildup, seizures, inflammation, colon cancer)
- Upper left abdominal pain
- Spleen pain (splenomegaly)
- Pancreas
- Colon pain (below the spleen area - intestinal obstruction, functional impairment, gas accumulation, seizures, inflammation, colon cancer)
- Middle abdominal pain (pain in the area around the navel)
- Appendicitis (starting here)
- Pain of the small intestine (inflammation, bowel spasm, malfunction)
- Lower abdominal pain (diarrhea, colitis and dysentery)
- Lower right abdominal pain
- Cecum (intussusception, bowel obstruction)
- Attachment Point (Location of appendicitis)
- Lower left abdominal pain
- diverticulitis, sigmoid colonic volvulus, obstruction or accumulation of gas
- Pelvic pain
- bladder (cystitis, possibly secondary to diverticulum and bladder stones, bladder cancer)
- pain in women (uterus, ovary, fallopian tubes)
- Right lower back pain
- heart pain (hepatomegaly)
- right renal pain (located below the area of ​​liver pain)
- Lower left hip pain
- less lymphatic
- left kidney pain
- Lower back pain
- Kidney pain (kidney stones, kidney cancer, hydronephrosis)
- Urethral stone pain
Management
Butylscopolamine (Buscopan) is used to treat stomach cramps with some success.
Epidemiology
Abdominal pain is the reason about 3% of adults see their family doctor. The rate of emergency visits in the United States for abdominal pain increased 18% from 2006 to 2011. This is the largest increase of 20 general conditions seen in the ER. The rate of ED use for nausea and vomiting also increased 18%.
References
External links
Source of the article : Wikipedia
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