Abdominal pain is such a commonly occurring symptom that it is sometimes difficult to judge when it is due to a serious problem requiring immediate medical attention.
However the pain itself may be a most useful pointer to the underlying disease and in that respect, we must admit that pain serves as an important protective mechanism and forms a key to early diagnosis and timely treatment.
Types of Abdominal Pain
Visceral pain is experienced when pain receptors in the abdominal organs are stimulated. The pain is usually dull, difficult to pinpoint to a particular location and is felt in the midline. It is generally described as cramping, gnawing or burning and is often accompanied by sweating, nausea and vomiting. The person suffering from visceral pain is often restless and constantly moves about in an attempt to relieve the discomfort. An example is the pain of intestinal obstruction.
Somatoparietal pain arises from irritation of the lining of the abdominal cavity (peritoneum). It is more intense and more precisely localized than visceral pain; and is aggravated by movement, coughing or sneezing; so that the sufferer lies absolutely still in order to reduce the pain. Another characteristic feature of peritoneal irritation is a relief spasm of the abdominal musculature, localized to the involved area. An example of this kind of pain is that caused by irritation of the peritoneal lining by acid gastric juice due to a perforated peptic ulcer.
Referred pain is felt in areas far away from the diseased organ due to the nerve supply arising from the same spinal segments. Pain arising from the gallbladder, for instance may be felt in the right upper back or shoulder. There are some characteristics of abdominal pain such rapidity of onset, location duration and intensity that can give the physician as well as the patient some idea about the cause.
- Pain that is of sudden onset severe and well localized is likely due to an intra abdominal catastrophe such as a perforation.
- Pain is self-limiting and subsides in disorders such as gastroenteritis.
- Pain in the upper abdomen above the naval can be from pancreatitis of from a performed peptic ulcer.
- Pain in the right upper portion of the abdomen could be from the gallbladder or liver.
- Pain originating in the small intestine is felt around the umbilicus.
- Pain can also spread from its original site to another as in appendicitis, where it starts around the umbilicus and then spreads to the right lower portion of the abdomen.
- Although it is hard to be objective about the pain intensity due to variations in the pain threshold among individuals, the severity of pain is loosely related to the magnitude of the disease process.
- The character of the pain (dull aching spasmodic, crampy or severe boring) can also suggest its origin.
Causes of abdominal pain
Performed Duodenal Ulcer
Acute Small Intestinal Obstruction
This is characterized by cramps around the navel, with diarrhea, sometimes with blood and mucus, with or without vomiting and fever. Most cases are self-limiting or respond rapidly to antibiotics and fluid replacement. There may be a history of other family members or friends affected at the same time. Gynaecological causes, such as endometriosis, twisted ovarian cyst or ruptured tubal pregnancy and urological causes such as kidney stones should not be overlooked.
Abdominal pain can also originate from disorders involving extra abdominal organs and systemic illnesses. Examples include acute myocardial infarction (heart), pneumonia (lung), disc prolapse, spinal cord tumors (nervous system), metabolic (renal failure diabetes), toxic (lead poisoning), infections (herpes zoster) and muscle contusions or haematomas.
It is therefore extremely important to consult the nearest physician or the Emergency Department when one has abdominal pain with any of the characteristics described above. Even if the cause of the pain turns out to be innocuous, it is better to err on the side of caution than to land up with an abdominal catastrophe!