Abdominal Pain (cont.)
Special problem in irritable bowel syndrome (IBS) of diagnosing the cause of abdominal pain
As previously discussed, the pain of
irritable bowel syndrome is due either to abnormal intestinal
muscle contractions or visceral hypersensitivity. Generally, abnormal muscle
contractions and visceral hypersensitivity are much more difficult to diagnose
than other diseases causing abdominal pain, particularly since there are no
typical abnormalities of the physical examination or the usual tests. The
diagnosis is based on the history (typical symptoms) and the absence of other
causes of abdominal pain.
Why can diagnosis of the cause of abdominal pain be difficult?
Modern advances in technology have greatly improved the accuracy, speed, and
ease of establishing the cause of abdominal pain, but significant challenges
remain. There are many reasons why diagnosing the cause of abdominal pain can be
difficult. They are:
- Symptoms may be atypical. For example, the pain of appendicitis sometimes
is located in the right upper abdomen, and the pain of diverticulitis on the
right side. Elderly patients and patients taking corticosteroids may have little
or no pain and tenderness when there is inflammation, for example, with cholecystitis
or diverticulitis. This occurs because corticosteroids reduce the inflammation.
- Tests are not always abnormal.
- Ultrasound examinations can miss
gallstones, particularly small ones.
- CT scans may fail to show pancreatic
cancer, particularly small ones.
- The KUB can miss the signs of intestinal
obstruction or stomach perforation.
- Ultrasounds and CT scans may fail to
demonstrate appendicitis or even abscesses, particularly if the abscesses are
small.
- The CBC and other blood tests may be normal despite severe infection or
inflammation, particularly in patients receiving corticosteroids.
- Diseases can mimic one another.
- IBS symptoms can mimic bowel obstruction,
cancer, ulcer, gallbladder attacks, or even appendicitis.
- Crohn's disease can
mimic appendicitis.
- Infection of the right kidney can mimic acute cholecystitis.
- A ruptured right ovarian cyst can mimic appendicitis; while a ruptured left
ovarian cyst can mimic diverticulitis.
- Kidney stones can mimic appendicitis or
diverticulitis.
- The characteristics of the pain may change. Examples discussed previously
include the extension of the inflammation of pancreatitis to involve the entire
abdomen and the progression of biliary colic to cholecystitis.
Next: How can I help my doctor to determine the cause of my abdominal pain? »
- Cox-2 Inhibitors - Explanation of Cox-2 Inhibitors (Cox-2 inhibitor drugs) used to treat the pain of arthritis conditions, colon polyps, menstrual cramps, and sports injuries.
- 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.
Latest Medical News
Digestion RSS