Abdominal Pain
Abdominal Pain
We have described in article :
Causes of Abdominal pain
Diagnosis of Abdominal pain
Clinical examination of Abdominal pain.
Investigation of Abdominal pain
Managementof Abdominal pain.
Causes of pain in the abdomen:
A. Inflammation:
- Appendicitis.
- Diverticulitis.
- Cholecystitis
- Pancreatitis.
- Pyelonephritis.
- Intra abdominal absecess.
B. Perforation or rupture :
- Peptic ulcer.
- Diverticular disease.
- Ovarian cyst.
- Aortic aneurysm.
C. Obstruction:
- Intestinal obstruction.
- Ureteric colic.
D. Extra-intestinal causes of chronic or recurrent abdominal pain :
- Diabetes mellitus.
- Addison’s disease.
- Sickle cell disease.
- Haemolytic disorders.
- Drugs: Corticosteriods, lead, alcohol.
E. Other (rare);
1) Retroperitoneal: Aortic aneurysm, Malignancy, Lymphadenopathy, Abscess.
2) Psychogenic: Depression, Anxiety, Hypochondriasis, Somatisation.
3) Locomotor: Vertebral compression, Abdominal muscle strain.
4) Metabolic/endocrine: Diabetes mellitus, Addison’s disease, Acute intermittent prophyria Hypercalcaemia.
5) Drugs/toxins: Corticosteroids, Azathioprine, Lead, Alcohol.
6) Haematological: Sickle cell disease, Haemolytic disorders.
7) Neurological: Spinal cord lesions, Tabes dorsalis, Radiculopathy.
Common causes of acute upper abdominal pain:
- Acute pancreatitis.
- Peptic ulcer disease.
- Acute cholecystitis.
- Acute cholangitis.
- Acute Cholangitis
- Renal colic.
- Acute inferior MI
Differential diagnosis of upper abdominal pain:
A. GIT:
- Peptic ulcer disease.
- Perforation.
- Intestinal obstruction.
- Perforated oesophagus.
- Ca stomach.
B. Hepatobiliary & pancreatic:
- Cholecystitis.
- Hepatitis.
- Pancreatitis.
C. Cardiovascular:
- MI
- Aortic aneurysm.
D. Renal:
- Pyelonephritis.
E. Others:
Ruptured spleen.
Approach to a patient with abdominal pain:
History:
- History of taking NSAIDS.
- History of previous peptic ulcer disease.
- Relation of pain with eating, defaecation or micturition.
- Nausea, vomiting.
- Weight loss.
- Change in bowel habit.
- Previous jaundice.
- Recent dysentery.
- Previous abdominal surgery.
- Previous tuberculosis.
- Personal history-Diet, smoking, alcohol.
Clinical evaluation:
The pain should be evaluated by the following points-
- Site
- Radiation
- Duration
- Severity
- Nature
- Mode of onset
- Aggravating and relieving
- Associated feature
Clinical examination of abdominal Pain :
1`. General examination:
- Hippocratic face in peritonitis.
- Body built-Cachectic in abdominal TB, malignancy.
- Knee-elbow position in acute pancreatitis.
- Anaemia-In acute or chronic Gl bleeding.
- Jaundice.
- Clubbing-In IBD.
- Koilonychia – In iron deficiency anaemia due to chronic GI bleeding.
- Pulse and BP-To assess haemodynamic status.
- Temperature – Raised in inflammatory conditions.
- Dehydration – In vomiting, diarrhoea.
2) Examination of abdomen:
Features of peritonitis: Rigid abdomen.
Tenderness in any particular area.
Abdominal mass.
Organomegaly.
Investigations of abdominal pain :
- Full blood count (leucocytosis).
- Urea and electrolytes (dehydration).
- Serum amylase or lipase level (acute pancreatitis).
- Erect chest X-ray (air under the diaphragm).
- Abdominal X-ray (obstruction).
- Upper Gl endoscopy.
- Abdominal ultrasound.
- Contrast studies for intestinal obstruction.
- CT (pancreatitis, retroperitoneal collections or masses.
- Aangiography (mesenteric ischaemia).
- Multi-slice CT angiography (newer technique).
Management of Abdominal Pain :
1. . Conservative: In acute abdomen-
- Nothing by mouth. Intravenous fluid.
- Empirical intravenous antibiotic.
- Intravenous proton pump inhibitor.
- Parenteral antispasmodic.
2. Specific treatment : According to cause.
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