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Symptom/Sign: Abdominal pain
Classifications and external resources
ICD-10 R10.
ICD-9 789.0

Abdominal pain can be one of the symptoms associated with transient disorders or serious disease. A symptom' (from Greek σύμπτωμα, "accident misfortune that which befalls" from συμπίπτω, "I befall" from A Sign is an indication of some fact or quality and a medical sign is an objective indication of some medical fact or quality that is detected by a Physician The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The International Statistical Classification of Diseases and Related Health Problems 10th Revision ( ICD -10) is a coding of diseases and signs symptoms abnormal findings R00-R69 - Symptoms and Signs (R00-R09 Circulatory and Respiratory systems ( Abnormalities of Heart beat The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. A symptom' (from Greek σύμπτωμα, "accident misfortune that which befalls" from συμπίπτω, "I befall" from Making a definitive diagnosis of the cause of abdominal pain can be difficult, because many diseases can result in this symptom. Abdominal pain is a common problem. Most frequently the cause is benign and/or self-limited, but more serious causes may require urgent intervention.

Contents

Introduction

Abdominal pain is traditionally described by its chronicity (acute or chronic), its progression over time, its nature (sharp, dull, colicky), its distribution (by various methods, such as abdominal quadrant (left upper quadrant, left lower quadrant, right upper quadrant, right lower quadrant) or other methods that divide the abdomen into nine sections), and by characterization of the factors that make it worse, or alleviate it. "Cholic" redirects here For cholic acid see Cholic acid.

Due to the many organ systems in the abdomen, abdominal pain is a concern of general practitioners/family physicians, surgeons, internists, emergency medicine doctors, pediatricians, gastroenterologists, urologists and gynecologists. The human abdomen (from the Latin word meaning "belly" is the part of the body between the Pelvis and the thorax. A general practitioner, or GP is a medical practitioner who provides Primary care and specializes in Family medicine. Family medicine differs from the traditional European general practitioner Surgery (from the χειρουργική cheirourgikē, via chirurgiae meaning "hand work" is a medical specialty that uses operative manual and instrumental Internal medicine is the medical specialty concerned with the diagnosis management and nonsurgical treatment of unusual or serious diseases Emergency Medicine is a speciality of Medicine that focuses on the Diagnosis and treatment of acute illnesses and injuries that require immediate medical attention Pediatrics (also spelled paediatrics) is the branch of Medicine that deals with the medical care of Infants Children and Adolescents Gastroenterology ( MeSH heading is the branch of Medicine whereby the Digestive system and its disorders are studied Urology is the branch of Surgery that focuses on the Urinary tracts of males and females and on the reproductive system of males Gynaecology or gynecology (see spelling differences) refers to the surgical specialty dealing with health of the female reproductive system ( Uterus Occasionally, patients with rare causes can see a number of specialists before being diagnosed adequately (e. g. , chronic functional abdominal pain)

Types and mechanisms

  1. The pain associated with the abdomen of inflammation of the parietal peritoneum (the part of the peritoneum lining the abdominal wall) is steady and aching, and worsened by changes in the tension of peritoneum caused by pressure or positional change. Chronic functional abdominal pain (CFAP is the ongoing presence of Abdominal pain for which there is no known medical explanation In higher Vertebrates the peritoneum is the Serous membrane that forms the lining of the abdominal cavity &mdash it covers most of the intra-abdominal It is often accompanied by tension of the abdominal muscles contracting to relieve such tension.
  2. The pain associated with obstruction of a hollow viscus (as opposed to peritoneal and solid organ pain) is often intermittent or "colicky", coinciding with the peristaltic waves of the organ. "Cholic" redirects here For cholic acid see Cholic acid. Such cramps are exactly what is experienced with early acute appendicitis and gastroenteritis and are somewhat relieved by writhing and massage. Appendicitis (or epityphlitis) is a condition characterized by Inflammation of the appendix. Gastroenteritis (also known as gastro, gastric flu, and stomach flu, although unrelated to Influenza) is Inflammation of the
  3. The pain associated with abdominal vascular disturbances (thrombosis or embolism) can be sudden or gradual in onset, and can be severe or mild. Thrombosis is the formation of a blood Clot ( Thrombus) inside a Blood vessel, obstructing the flow of Blood through the Circulatory In Medicine, an embolism occurs when an object (the embolus, plural emboli) migrates from one part of the Body (through circulation Pain associated with the rupture of an abdominal aortic aneurysm may radiate to the back, flank, or genitals. Abdominal aortic aneurysm, also written as AAA and often pronounced 'triple-A' is a localized dilatation of the Abdominal aorta, that exceeds the normal diameter
  4. Pain that is felt in the abdomen may be "referred" from elsewhere (e. g. , a disease process in the chest may cause pain in the abdomen), and abdominal processes can cause radiated pain elsewhere (e. g. , gall bladder pain—in cholecystitis or cholelithiasis—is often referred to the shoulder). The gallbladder (or cholecyst sometimes gall bladder is a small organ whose function in the body is to store Bile and aid in the digestive process Cholecystitis is Inflammation of the Gall bladder. Causes and pathology Cholecystitis is often caused by Cholelithiasis (the presence of In Medicine, gallstones (choleliths are Crystalline bodies formed within the body by accretion or concretion of normal or abnormal Bile component In Human anatomy, the shoulder joint comprises the part of the body where the Humerus attaches to the Scapula.

Causes

The following is an incomplete list of possible causes of abdominal pain. [1]

Acute Abdomen

Acute abdomen can be defined as severe, persistent abdominal pain of sudden onset that is likely to require surgical intervention to treat its cause. Gastroenteritis (also known as gastro, gastric flu, and stomach flu, although unrelated to Influenza) is Inflammation of the Appendicitis (or epityphlitis) is a condition characterized by Inflammation of the appendix. Gastritis is an inflammation of the lining of the stomach There are many possible causes Esophagitis (or Oesophagitis) is Inflammation of the Esophagus. Diverticulitis is a common Digestive disease particularly found in the Large intestine. Crohn's disease is a Disease of the Digestive system which may affect any part of the Gastrointestinal tract from Mouth to Anus Ulcerative colitis ( Colitis ulcerosa, UC) is a form of Inflammatory bowel disease (IBD Microscopic colitis refers to two medical conditions which cause Diarrhoea: Collagenous colitis and Lymphocytic colitis. A hernia is a protrusion of a tissue, structure or part of an organ through the muscular tissue or the membrane by which it is normally contained A volvulus is a life-threatening bowel obstruction in which a loop of Bowel has abnormally twisted on itself Adhesions are fibrous bands that form between tissues and organs often as a result of injury during surgery See also Cancer A tumor or tumour is the name for a swelling or lesion formed by an abnormal growth of cells (termed neoplastic Superior mesenteric artery (SMA syndrome is a rare life-threatening Gastrointestinal disorder characterized by a compression of the third portion of the Duodenum Constipation, costiveness, or irregularity, is a condition of the Digestive system in which a person (or animal experiences hard Feces that In Medicine, an embolism occurs when an object (the embolus, plural emboli) migrates from one part of the Body (through circulation Thrombosis is the formation of a blood Clot ( Thrombus) inside a Blood vessel, obstructing the flow of Blood through the Circulatory Bleeding, technically known as hemorrhaging / haemorrhaging (see American and British spelling differences) is the loss of Blood from Sickle-cell disease or sickle-cell anaemia (or anemia) is a Blood disorder characterized by Red blood cells that assume an abnormal rigid Abdominal angina (aka bowelgina) is postprandial Abdominal pain that occurs in individuals with insufficient blood flow to meet Mesenteric visceral demands A peptic ulcer, also known as PUD or peptic ulcer disease, is an Ulcer (defined as mucosal erosions equal to or greater than 0 Lactose intolerance is the inability to metabolize Lactose, a sugar found in Milk and other Dairy products because the required enzyme Coeliac Cholecystitis is Inflammation of the Gall bladder. Causes and pathology Cholecystitis is often caused by Cholelithiasis (the presence of Cholangitis is Inflammation of the Bile duct. The most common cause is a Bacterial infection, and the problem is then an Ascending cholangitis In Medicine, gallstones (choleliths are Crystalline bodies formed within the body by accretion or concretion of normal or abnormal Bile component See also Cancer A tumor or tumour is the name for a swelling or lesion formed by an abnormal growth of cells (termed neoplastic Hepatitis (plural hepatitides) implies injury to the Liver characterized by the presence of Inflammatory cells in the tissue of A liver Abscess is a pus-filled mass inside or attached to the Liver. Pancreatitis is the Inflammation of the Pancreas. See also Acute pancreatitis and Chronic pancreatitis for more details Pyelonephritis is an ascending Urinary tract infection that has reached the pyelum ( pelvis) of the Kidney ( nephros in Greek Cystitis is Inflammation of the Urinary bladder. The condition more often affects women but can affect either sex and all age groups Kidney stones, also called renal calculi, are solid concretions (crystal aggregations of dissolved minerals in Urine; calculi typically form Kidney stones, also called renal calculi, are solid concretions (crystal aggregations of dissolved minerals in Urine; calculi typically form See also Cancer A tumor or tumour is the name for a swelling or lesion formed by an abnormal growth of cells (termed neoplastic In Medicine, the nutcracker syndrome — also known as nutcracker phenomenon, renal vein entrapment syndrome or mesoaortic compression of the left Pelvic inflammatory disease (or disorder) ( PID) is a generic term for Inflammation of the female Uterus, Fallopian tubes, and/or See also "Mensuration" a term sometimes used to describe Measurement, particularly in the context of Forestry. Mittelschmerz ( German: "middle pain" is a medical term for "ovulation pain" or "midcycle pain" Endometriosis (from endo, "inside" and metra, " Womb " is a common medical condition characterized by growth beyond or outside the uterus Uterine fibroids (singular Uterine Fibroma) ( leiomyomata, singular leiomyoma) are Benign Tumors which grow from the muscle layers of An ovarian cyst is any collection of fluid surrounded by a very thin wall within an Ovary. Ovarian cancer is a cancerous growth arising from an Ovary. The cancer most commonly forms in the lining of the ovary (resulting in epithelial An ectopic pregnancy is a Complication of pregnancy in which the fertilized Ovum is implanted in any tissue other than the uterine wall Miscarriage or spontaneous abortion is the natural or spontaneous end of a Pregnancy at a stage where the embryo or fetus is incapable of surviving generally defined The abdominal wall represents the boundaries of the Abdominal cavity. The nervous system is a Network of specialized cells that communicate information about an animal's surroundings and itself Herpes zoster (or simply zoster) commonly known as shingles, is a Viral disease characterized by a painful skin rash with Blisters in a limited Radicular Pain, or Radiculitis, is pain "radiated" along the dermatome (sensory distribution of a Nerve due to inflammation or other irritation Lyme disease, or borreliosis, is an Emerging infectious disease caused by at least three Species of Bacteria belonging to the Genus The abdominal cutaneous nerve entrapment syndrome ( ACNES) consists of pain caused by entrapment of the Abdominal segmental nerves within the Rectus abdominis muscle Tabes dorsalis is a slow degeneration of the Nerve cells and nerve fibers that carry sensory information to the Brain. Referred pain is a term used to describe the phenomenon of pain perceived at a site adjacent to or at a distance from the site of an injury's origin The thorax is a division of an Animal 's body that lies between the head and the Abdomen. Pneumonia is an inflammatory illness of the Lung. Frequently it is described as lung Parenchyma / alveolar inflammation and abnormal Pulmonary embolism (PE is a blockage of the Pulmonary artery or one of its branches usually occurring when a venous Thrombus (blood clot from a vein Ischaemic or ischemic heart disease (IHD or myocardial ischaemia, is a Disease characterized by reduced blood supply to the heart muscle Pericarditis is an Inflammation ( -itis) of the Pericardium (the fibrous sac surrounding the heart In Human anatomy, the vertebral column ( backbone or spine) is a column of 34 Vertebrae the Sacrum, Intervertebral Radicular Pain, or Radiculitis, is pain "radiated" along the dermatome (sensory distribution of a Nerve due to inflammation or other irritation A sex organ, or primary sexual characteristic, as narrowly defined is any of the anatomical parts of the body which are involved in sexual reproduction and constitute In testicular torsion the Spermatic cord that provides the blood supply to a Testicle is twisted cutting off the blood supply often causing Orchalgia. Inborn errors of metabolism comprise a large class of genetic Diseases involving disorders of Metabolism. Uremia is a term used to loosely describe the illness accompanying kidney failure (also called renal failure Diabetic ketoacidosis (DKA is a life-threatening complication in patients with diabetes mellitus Porphyrias are a group of inherited or acquired disorders of certain Enzymes in the Heme biosynthetic pathway (also called Porphyrin pathway Angioedema ( BE: angiooedema) also known by its Eponym Quincke's edema, is the rapid swelling ( Edema) of the Dermis Lead poisoning (also known as saturnism, plumbism, or painter's colic) is a medical condition caused by increased levels of the metal Lead in The black widow spider is a group of Spiders which includes the southern black widow ( Latrodectus mactans) the northern black widow The term narcotic (ναρκωτικός is believed to have been coined by the Greek physician Galen to refer to agents that benumb or deaden causing loss Withdrawal, also known as withdrawal/abstinence syndrome, refers to the characteristic signs and symptoms that appear when a drug that causes Physical dependence is Abdominal aortic aneurysm, also written as AAA and often pronounced 'triple-A' is a localized dilatation of the Abdominal aorta, that exceeds the normal diameter Sarcoidosis, also called sarcoid (from the Greek sarx, meaning "flesh" or Besnier-Boeck disease, is an immune system disorder characterized Vasculitis (plural vasculitides) a group of diseases featuring Inflammation of the wall of Blood vessels including veins ( Phlebitis) arteries Familial Mediterranean fever (FMF is a hereditary inflammatory disorder that affects groups of patients originating from around the Mediterranean Sea (hence In Gastroenterology, irritable bowel syndrome ( IBS) is a Functional bowel disorder characterized by mild to severe Abdominal pain, discomfort The term acute abdomen refers to a sudden severe Abdominal pain that is less than 24 hours in duration Surgery (from the χειρουργική cheirourgikē, via chirurgiae meaning "hand work" is a medical specialty that uses operative manual and instrumental The pain may frequently be associated with nausea and vomiting, abdominal distention, fever and signs of shock. Nausea ( Latin: Nausea, Greek:, " Sea-sickness " also called wamble) is the sensation of unease and discomfort Vomiting (also called throwing up, emesis) is the forceful expulsion of the contents of one's Stomach through the Mouth and sometimes the Abdominal distension (or "distended abdomen" can be a sign of many other conditions including Diverticulitis Lactose intolerance Fever (also known as pyrexia, from the Greek pyretos meaning fire or a febrile response, from the Latin word Febris

Selected causes of acute abdomen

Recurrent Abdominal Pain in Female Adolescents

Recurrent abdominal pain (RAP) occurs in 5–15% of female children 6–19 years old. Treatment of physical trauma is described here and in First aid. In Human anatomy, the stomach is a J-shaped hollow muscular organ of the Gastrointestinal tract involved in the second phase of Digestion, following In Anatomy, the intestine is the segment of the alimentary canal extending from the Stomach to the Anus and in humans and other mammals consists The spleen is an organ found in all Vertebrate animals In humans the spleen is located in the abdomen of the body where it functions in the destruction of redundant Red The liver is a vital organ in the human body and is present in Vertebrates and some other animals The kidneys are complicated organs that have numerous biological roles Appendicitis (or epityphlitis) is a condition characterized by Inflammation of the appendix. Cholecystitis is Inflammation of the Gall bladder. Causes and pathology Cholecystitis is often caused by Cholelithiasis (the presence of Pancreatitis is the Inflammation of the Pancreas. See also Acute pancreatitis and Chronic pancreatitis for more details Pyelonephritis is an ascending Urinary tract infection that has reached the pyelum ( pelvis) of the Kidney ( nephros in Greek Pelvic inflammatory disease (or disorder) ( PID) is a generic term for Inflammation of the female Uterus, Fallopian tubes, and/or Hepatitis (plural hepatitides) implies injury to the Liver characterized by the presence of Inflammatory cells in the tissue of Adenitis is a general term for an Inflammation of a gland or Lymph node. An abscess (abscessus is a collection of Pus (dead Neutrophils) that has accumulated in a cavity formed by the tissue on the basis of an infectious process Gastrointestinal perforation is a complete penetration of the wall of the stomach small intestine or large bowel resulting in intestinal contents flowing into the abdominal cavity A peptic ulcer, also known as PUD or peptic ulcer disease, is an Ulcer (defined as mucosal erosions equal to or greater than 0 Diverticulitis is a common Digestive disease particularly found in the Large intestine. The cecum or caecum (from the Latin caecus meaning Blind) is a pouch connected to the Ascending colon of the Large In Medicine, inflammatory bowel disease ( IBD) is a group of inflammatory conditions of the large intestine and Small intestine Crohn's disease is a Disease of the Digestive system which may affect any part of the Gastrointestinal tract from Mouth to Anus Ulcerative colitis ( Colitis ulcerosa, UC) is a form of Inflammatory bowel disease (IBD In Biology the small Intestine is the part of the Gastrointestinal tract (gut between the Stomach and the Large intestine, and comprises Bowel obstruction (or intestinal obstruction) is a mechanical or functional obstruction of the intestines preventing the normal transit of the products of digestion A hernia is a protrusion of a tissue, structure or part of an organ through the muscular tissue or the membrane by which it is normally contained The colon is a storage tube for solid wastes The main function of the colon appears to be extraction of Water and salts from Feces. Bowel obstruction (or intestinal obstruction) is a mechanical or functional obstruction of the intestines preventing the normal transit of the products of digestion Colorectal cancer, also called colon cancer or large bowel cancer, includes Cancerous growths in the colon, Rectum and In Medicine, inflammatory bowel disease ( IBD) is a group of inflammatory conditions of the large intestine and Small intestine A volvulus is a life-threatening bowel obstruction in which a loop of Bowel has abnormally twisted on itself A fecal impaction is a solid immobile bulk of Stool that can develop in the Rectum as a result of chronic Constipation. A hernia is a protrusion of a tissue, structure or part of an organ through the muscular tissue or the membrane by which it is normally contained This article concerns ischemia of the large bowel See Mesenteric ischemia for ischemia of small bowel Ischemic colitis (Ischaemic Colitis Thrombosis is the formation of a blood Clot ( Thrombus) inside a Blood vessel, obstructing the flow of Blood through the Circulatory See also Superior Mesenteric Artery Syndrome In Human anatomy, the superior mesenteric artery (SMA arises from the anterior surface of the Abdominal aorta 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. In Gastroenterology, irritable bowel syndrome ( IBS) is a Functional bowel disorder characterized by mild to severe Abdominal pain, discomfort As with other difficult to diagnose chronic medical problems, patients with RAP [Recurrent Abdominal Pain] account for a very large number of office visits and medical resources in proportion to their actual numbers.

Etiology

Medical Assessment

When a physician assesses a patient to determine the etiology and subsequent treatment for abdominal pain the patients history of the presenting complaint and physical examination should derive a diagnosis in over 90% of cases. Dysmenorrhea (or dysmenorrhoea) is a medical condition characterized by severe Uterine Pain during Menstruation. Endometriosis (from endo, "inside" and metra, " Womb " is a common medical condition characterized by growth beyond or outside the uterus Pelvic inflammatory disease (or disorder) ( PID) is a generic term for Inflammation of the female Uterus, Fallopian tubes, and/or

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. Myocardial infarction ( MI or AMI for acute myocardial infarction) also known as a heart attack, occurs when the blood supply Pneumonia is an inflammatory illness of the Lung. Frequently it is described as lung Parenchyma / alveolar inflammation and abnormal

Investigations that would aid diagnosis include

If diagnosis remains unclear after history, examination and basic investigations as above then more advanced investigations may reveal a diagnosis. X-radiation (composed of X-rays) is a form of Electromagnetic radiation. These as such would include

See also

References

Footnotes

  1. ^ Cartwright SL, Knudson MP. Evaluation of Acute Abdominal Pain in Adults. Am Fam Physician. 2008;77(7):971-978.

External links

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