Abdominal Pain
Medical Authors: Jay W. Marks,
MD and Dennis Lee, MD
Medical Editor: William C. Shiel, Jr., MD, FACP, FACR
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Abdominal Pain - Timely Diagnosis
Medical Author: Jay W. Marks, M.D.
Medical Editor: Melissa Conrad Stöppler, MD
 When a medical problem comes on quickly or occurs periodically over a longer
period, it is often best to move quickly and make a diagnosis while symptoms are still present. The more serious the
problem, the greater the urgency. Nevertheless, urgency should never replace
careful and complete diagnostic testing, as is illustrated by a recent
experience.
I was asked
to see a patient, a young man in his late twenties, who for several years had
been having episodes of abdominal pain. There was nothing very distinctive about
the pain except that it would last from hours to one or two days and then
disappear. During the episodes, he would not eat; he also noted some nausea. He
had visited an emergency room once, but only limited testing had been done, and
no diagnosis was made. At a later time, he had been seen by a gastroenterologist
who had performed an upper gastrointestinal endoscopy. No abnormalities were found by
endoscopy.
The patient was healthy except for the bouts of abdominal pain. Despite
discussing
his medical history in detail and examining him, I
could find no clues to the cause of his problem. Since the episodes always resolved
completely, I thought the best course of action would be to see him during
an episode of pain. By examining the patient during an episode, I hoped to
be able to decide on the best diagnostic course.
It took almost 12 months, but finally, early one morning I got a call from the
patient. A typical episode of abdominal pain was beginning...
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What is abdominal pain?
Abdominal pain is pain that is felt in the abdomen. The abdomen is an anatomical area that is bounded by the lower margin of the ribs and diaphragm above, the pelvic bone (pubic ramus) below, and the flanks on each side. Although abdominal pain can arise from the tissues of the abdominal wall that surround the abdominal cavity (such as the skin and abdominal wall muscles), the term abdominal pain generally is used to describe pain originating from organs within the abdominal cavity. Organs of the abdomen include the stomach, small intestine, colon, liver, gallbladder, and pancreas.
Occasionally, pain may be felt in the abdomen even though it is arising from organs that are close to, but not within, the abdominal cavity. For example, conditions of the lower lungs, the kidneys, and the uterus or ovaries can cause abdominal pain. On the other hand, it also is possible for pain from organs within the abdomen to be felt outside of the abdomen. For example, the pain of pancreatic inflammation may be felt in the back. These latter types of pain are called "referred" pain because the pain does not originate in the location that it is felt. Rather, the cause of the pain is located away from where it is felt.
What causes abdominal pain?
Abdominal pain is caused by inflammation (for example,
appendicitis, diverticulitis, colitis
), by stretching or distention of an organ (for example, obstruction of the
intestine, blockage of a bile duct by
gallstones, swelling of the liver with
hepatitis), or by loss of the supply of blood to an organ (for example, ischemic
colitis).
To complicate matters, however, abdominal pain also can occur without
inflammation, distention or loss of blood supply. An important example of this
latter type of pain is the irritable bowel syndrome (IBS). It is not clear what
causes the abdominal pain in IBS, but it is believed to be due either to
abnormal contractions of the intestinal muscles (for example, spasm) or abnormally
sensitive nerves within the intestines that give rise to painful sensations
inappropriately (visceral hyper-sensitivity). These latter types of pain are often referred to as functional pain because no recognizable (visible) causes for the pain have been found - at least not yet.
Next: How is the cause of abdominal pain diagnosed? »
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