Abdominal Pain (cont.)
Physical examinationExamining the patient will provide the doctor with additional clues to the
cause of abdominal pain. The doctor will determine:
- The presence of sounds coming from the intestines
that occur when there is obstruction of the intestines,
- The presence of signs of inflammation (by special
maneuvers during the examination),
- The location of any tenderness
- The presence of a mass within the abdomen that
suggests a tumor or abscess (a collection of infected
pus)
- The presence of blood in the stool that may signify an intestinal problem
such as an ulcer, colon cancer, colitis, or ischemia.
For example:
- Finding tenderness and signs of inflammation in the left lower
abdomen often means that diverticulitis is present, while finding a tender
(inflamed) mass in the same area may mean that the inflammation has progressed
and that an abscess has formed.
- Finding tenderness and signs of inflammation in
the right lower abdomen often means that appendicitis is present, while finding
a tender mass in the same area may mean that appendiceal inflammation has
progressed and become an abscess.
- Inflammation in the right lower abdomen, with
or without a mass, also may be found in Crohn's disease. (Crohn's disease
most commonly affects the last part of the small intestine, usually located in
the right lower abdomen.)
- A mass without signs of inflammation may mean that a
cancer is present.
Exams and tests
While the history and physical examination are vitally important in
determining the cause of abdominal pain, testing often is necessary to determine
the cause.
Laboratory tests. Laboratory tests such as the
complete blood count (CBC),
liver enzymes, pancreatic enzymes (amylase and lipase), and
urinalysis are
frequently performed in the evaluation of abdominal pain.
- An elevated white
count suggests inflammation or infection (as with appendicitis, pancreatitis,
diverticulitis, or colitis).
- Amylase and lipase (enzymes produced by the
pancreas) commonly are elevated in pancreatitis.
- Liver enzymes may be elevated
with gallstone attacks.
- Blood in the urine suggests
kidney stones.
- When there is
diarrhea, white blood cells in the stool suggest intestinal inflammation.
Plain x-rays of the abdomen. Plain abdominal x-rays of the abdomen also are referred to as a KUB (because they include the kidney, ureter, and bladder). The KUB may show enlarged loops of intestines filled with copious amounts of fluid and air when there is intestinal obstruction. Patients with a perforated ulcer may have air escape from the stomach into the abdominal cavity. The escaped air often can be seen on a KUB on the underside of the diaphragm. Sometimes a KUB may reveal a calcified kidney stone that has passed into the ureter and resulted in referred abdominal pain or calcifications in the pancreas that suggests chronic pancreatitis.
Radiographic studies.
- Abdominal
ultrasound is useful in diagnosing
gallstones, cholecystitis appendicitis, or ruptured
ovarian cysts as the cause
of the pain.
- Computerized tomography (CT) of the abdomen is useful in diagnosing
pancreatitis, pancreatic cancer, appendicitis, and diverticulitis, as well as in
diagnosing abscesses in the abdomen. Special CT scans of the abdominal blood
vessels can detect diseases of the arteries that block the flow of blood to the
abdominal organs.
- Magnetic resonance imaging (MRI) is useful in diagnosing many of the same conditions as CT tomography.
- Barium x-rays of the stomach and the intestines (upper gastrointestinal series or UGI with a small bowel follow-through) can be helpful in diagnosing ulcers, inflammation, and blockage in the intestines.
- Computerized tomography (CT) of the small intestine can be helpful in diagnosing diseases in the small bowel such as Crohn's disease.
- Capsule enteroscopy, a small camera the size of a pill swallowed by the patient, can take pictures of the entire small bowel and transmit the pictures onto a portable receiver. The small bowel images can be downloaded from the receiver onto a computer to be inspected by a doctor later. Capsule enteroscopy can be helpful in diagnosing Crohn's disease, small bowel tumors, and bleeding lesions not seen on x-rays or CT scans.
Endoscopic procedures.
- Esophagogastroduodenoscopy or EGD is useful for
detecting ulcers, gastritis (inflammation of the stomach), or
stomach cancer.
- Colonoscopy or
flexible sigmoidoscopy is useful for diagnosing infectious
colitis,
ulcerative colitis, or
colon cancer.
- Endoscopic
ultrasound (EUS) is useful for diagnosing pancreatic cancer or gallstones if the
standard ultrasound or CT or MRI scans fail to detect them.
- Balloon enteroscopy,
the newest technique allows endoscopes to be passed through the mouth or anus and into the small intestine where small intestinal causes of abdominal pain or bleeding can be diagnosed, biopsied, and treated.
Surgery. Sometimes, diagnosis requires examination of the abdominal cavity
either by laparoscopy or surgery.
Next: Special problem in irritable bowel syndrome (IBS) of diagnosing the cause of abdominal pain »
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- Liver Blood Tests - Learn about liver blood tests used to detect liver damage disease such as fatty liver, cirrhosis, hepatitis, Tylenol liver damage, and more. This includes measuring the aminotransferases enzymes (AST and ALT levels)
- Rectal Bleeding - Rectal bleeding can be a sign of several different conditions including hemorrhoids, anal fisure, colitis, and more.
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