Abdominal Pain

From Anvita Health Wiki

Contents 1 More Specific Terms 2 Etiology 3 Pathology 4 History 5 Clinical-manifestations 6 Laboratory 7 Diagnostic-procedures 8 Radiology 9 Management 10 More General Terms 11 Additional Terms 12 References

More Specific Terms

• chronic abdominal pain
• colic
• epigastric pain
• left lower quadrant pain
• left upper quadrant pain
• right lower quadrant pain
• right upper quadrant pain

Etiology

• (also see pelvic pain)

• intra-abdominal disorders

• inflammatory

• appendicitis
• pyelonephritis
• abscesses
• cholecystitis
• urinary calculus
• pancreatitis
• perforated duodenal ulcer
• diverticulitis
• inflammatory bowel disease
• hepatitis
• peritonitis

• mechanical

• visceral obstruction
• aneurysms
• trauma

• vascular

• mesenteric ischemia
• acute mesenteric arterial occlusion

• embolus
• thrombosis

• extra-abdominal

• pneumonia
• myocardial infarction
• shingles
• sickle cell anemia
• diabetic ketoacidosis
• depression
• anxiety
• porphyria

• food poisoning

• bacterial toxins
• plant toxins
• parasites

• pharmacologic agents

• digoxin
• theophylline
• iron supplements
• erythromycin

• household chemical ingestion
• occupational & environmental exposure

Pathology

• abdominal viscera has splanchnic innervation

• only distention or stretch is recognized
• visceral pain is bilateral, felt in midline
• onset of pain is slow
• visceral pain may progress to involve parietal peritoneum

• parietal peritoneum has somatic innervation

• T6-T12 nerve roots
• localized pain
• parietal pain may be so great as to shadow underlying visceral pain

• visceral peritoneum has no innervation

History

• duration, pattern of progression, location at onset, present location, character of pain ( burning, cramping, dull, sharp, constant or intermittent), rate of onset, fever/ chills, nausea/ vomiting, hematemesis, temporal relationship of vomiting to abdominal pain, chest pain, constipation, change in bowel habits, obstipation, diarrhea, dysuria, hematuria, hematochezia, melena, anorexia, weight loss, dysphagia, trauma

Clinical-manifestations

• rebound tenderness indicates parietal peritoneum involvement
• fever & jaundice suggest hepatobiliary involvement
• cramping suggests relationship to bowel peristalsis
• objective signs of organic disease

• pain or diarrhea awakening patient from sleep
• vomiting
• dysphagia
• blood in the stool
• weight loss
• fever
• abdominal mass or organomegaly
• anemia
• jaundice

Laboratory

• complete blood count ( CBC) with differential
• urinalysis
• serum chemistries

• electrolytes
• urea nitrogen
• creatinine
• glucose
• lipase
• amylase
• bilirubin - conjugated & unconjugated
• transaminases
• albumin
• PT/PTT
• PSA to rule out prostatitis

• fecal occult blood testing
• urine pregnancy test

Diagnostic-procedures

• (procedures)
• abdominal paracentesis
• endoscopy

Radiology

• flat & upright abdominal radiograph
• chest radiograph
• abdominal ultrasount &/or pelvic ultrasound

• ultrasound followed by CT only if ultrasound results are nondiagnostic optimizes sensitivity while minimizing radiation exposure [8]

• early abdominal CT better than plain film [4,6]
• upper &/or lower GI contrast studies

Management

• general measures

• nothing by mouth until diagnosis is made
• pharmacologic agents

• parenteral analgesics
• narcotic & non- narcotic
• early administration of morphine does not delay diagnosis [5,7]
• parenteral anti-emetics

• prochlorperazine ( Compazine)
• metoclopramide ( Reglan)

• H2-blockers

• laparoscopy if indicated
• surgery if indicated

• specific measures for specific etiologies

More General Terms

• sign/symptom
• pain [odyn-]

Additional Terms

• abdominal trauma
• appendicitis
• pelvic pain

References

1. Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 291-92, 1152-1156
2. Chan & Winkle, Diagnostic History & Physical Examination, Current Clinical Strategies Publishing. Laguna Hills, 1996
3. Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998
4. Journal Watch 23(5):40, 2003 Ng CS et al, Evaluation of early abdominopelvic computed tomography in patients with acute abdominal pain of unknown cause: prospective randomized study BMJ 325:1387, 2002 <PubMed> PMID: [1] <Internet> [2]
5. Journal Watch 23(5):40, 2003 Thomas SH et al, Effects of morphine analgesia on diagnostic accuracy in Emergency Department patients with abdominal pain: a prospective study J Am Coll Surg 196:18, 2003 <PubMed> PMID: [3] <Internet> [4]
6. MacKersie AB, Lane MJ, Gerhardt RT, Claypool HA, Keenan S, Katz DS, Tucker JE. Nontraumatic acute abdominal pain: unenhanced helical CT compared with three-view acute abdominal series. Radiology. 2005 Oct;237(1):114-22. PMID: [5]
7. Green R, Bulloch B, Kabani A, Hancock BJ, Tenenbein M. Early analgesia for children with acute abdominal pain. Pediatrics. 2005 Oct;116(4):978-83. PMID: [6]
   - Armstrong FD. Analgesia for children with acute abdominal pain: a cautious move to improved pain management. Pediatrics. 2005 Oct;116(4):1018-9. No abstract available. PMID: [7]
   - Vane DW. Efficacy and concerns regarding early analgesia in children with acute abdominal pain. Pediatrics. 2005 Oct;116(4):1018. No abstract available. PMID: [8]
8. Lameris W et al Imaging strategies for detection of urgent conditions in patients with acute abdominal pain: Diagnostic accuracy study. BMJ 2009 Jun 26; 338:b2431 <PubMed> PMID: [9] <Internet> [10]
   - Dixon AK and Watson CJ Imaging in patients with acute abdominal pain. BMJ 2009 Jun 26; 338:b1678. <PubMed> PMID: [11] <Internet> [12]
9. National Guideline Clearinghouse
   - ACR Appropriateness Criteria acute abdominal pain and fever or suspected abdominal abscess. (American College of Radiology) ngc-guideline: [13]

abdominal pain