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Diagnosing lower abdominal pain: Evaluation of Acute Abdominal Pain in Adults

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Diagnostic Imaging of Acute Abdominal Pain in Adults

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Abdominal Pain Treatment | Aurora Health Care

We all have stomachaches and abdominal pain from time to time. Causes can range from gas to a pulled muscle. But if you get stomachaches often, or they hurt a lot or don’t go away, you may need to see a doctor. Call your doctor if you have:

  • Abdominal discomfort no matter what position you’re in or persistent discomfort
  • Chest pain – requires prompt medical attention
  • Swelling in the belly
  • Pain as the result of an injury or accident
  • Bloody stools or dark stools
  • Vomiting blood or dark material
  • Change in bowel habit
  • Unexpected weight loss
  • Difficulty swallowing

Abdominal pain diagnosis

First, you’ll meet with your doctor for a thorough physical exam and to discuss your symptoms. This will help your doctor to find the cause and determine what to do about it:

  • General: possibly appendicitis, urinary tract infection, Crohn’s disease or irritable bowel syndrome
  • Lower abdomen: possibly appendicitis, ectopic pregnancy, diverticulitis or inflammation of the fallopian tubes (salpingitis)
  • Upper abdomen: possibly GERD (gastroesophageal reflux), gallstones, pancreatitis or heart attack
  • Middle abdomen: possibly appendicitis, a blockage in your intestines, pancreatitis or thoracic aortic aneurysm
  • Lower left abdomen: possibly Crohn’s disease, diverticulitis, ulcerative colitis or kidney stones
  • Upper left abdomen: possibly shingles, spleen infection, heart attack or hiatal hernia
  • Lower right abdomen: possibly cholecystitis (inflammation of the gallbladder), ovarian cysts, appendicitis or stomach flu
  • Upper right abdomen: Possibly cholangitis (inflammation of the bile duct), hepatitis, fecal impaction (hardened stools) or peptic ulcer

Your doctor may order tests such as urine, blood and stool tests; X-rays; a CT scan (computed tomography scan), ultrasound, barium swallow, and endoscopy.

Abdominal pain services

Treatment plans depend on the cause of your pain and may include medication, surgery or changes to your diet and activities. Our goal is to offer you the best care – to get you back to feeling your best.

Causes & When To Call The Doctor

Overview

What is abdominal pain?

Abdominal pain is discomfort anywhere in your belly — from ribs to pelvis. It’s often called ‘stomach’ pain or a ‘stomach’ ache, although the pain can be coming from any number of internal organs besides your stomach.

A brief episode of pain is called acute, which means ‘of recent onset.’ When you have abdominal pain for three months or longer, it’s considered a chronic or ongoing problem, although this time period is not exact. For example, acute appendicitis is nearly always an acute condition, in contrast to irritable bowel syndrome, which may result in chronic cramping that can span years or longer.

Abdominal pain comes in many forms, and may range from cramps that come and go to sudden, stabbing pains to constant, dull abdominal aching. Even mild pain can be an early sign of a serious condition, which is why healthcare providers often monitor these patients for changes in their conditions.

Keep in mind that abdominal pain is a subjective symptom that cannot be reliably measured by healthcare professionals. The intensity of the pain is what you say that it is.

When you have abdominal pain, you may have other symptoms such as fever, vomiting or diarrhea. Providers will question you carefully if your pain is localized or present throughout the abdomen. They will ask what makes the pain more intense and what seems to calm it down. Is the pain changed by eating or changing position? Does it awaken you from sleep? Does it migrate to another part of the body? Your answers can offer important diagnostic clues.

How common are stomachaches?

Just about everybody will experience abdominal pain at one point or another. Most causes of abdominal pain are not serious and resolve spontaneously. A healthcare provider can usually readily diagnose and treat these conditions. However, abdominal pain can also be a sign of a serious illness, or even an emergency. Abdominal pain is responsible for some 5% of emergency room visits.

Possible Causes

Why does my stomach hurt?

There are numerous reasons for abdominal pain. It can come from any of the organs in your belly — gallbladder, pancreas, liver, stomach and intestines — or the abdominal wall – the outer shell of the body. Sometimes you feel the pain in your belly, but it’s actually coming from the chest, back or pelvis.

Abdominal wall pain is common and easy to miss as healthcare professionals may direct their attention to internal organs as a cause of the pain. Once the abdominal wall is considered as a suspect, it is generally easy to nail down this diagnosis. If a patient strains the ab wall muscles from exertion, he may tell his doctor that he has right sided stomach pain. Clearly, this pain is not caused by a diseased internal organ such as the gallbladder or the stomach.

Healthcare providers can often determine where pain is coming from by taking a detailed history from you. Depending upon the physician’s style, you may be simply asked to relate your medical story in your own words as a narrative. Other physicians may prefer to ask a series of detailed questions. Others may utilize both techniques. This medical history is paramount, even more important than the physical examination. After the history and physical, certain diagnostic tests may be advised to make an accurate diagnosis.

What are the most common causes of abdominal pain?

Because the abdomen is home to multiple organs, a wide range of problems might cause pain. The discomfort can also originate from nearby areas like the chest and pelvis. Causes of abdominal pain include:

Digestive issues

Abdominal problems

Pelvic problems

Chest problems

How is stomach pain in children different?

Up to 15% of children between 5 and 16 years have ongoing or on-again, off-again abdominal pain. Oftentimes, when children get a tummy ache, it’s from constipation. Other common causes of abdominal pain in children include:

Care and Treatment

How is abdominal pain treated?

Treating abdominal pain depends on its cause. Options include:

  • Medications for inflammation, gastroesophageal reflux disease or ulcers.
  • Antibiotics for infection.
  • Changes in personal behavior for abdominal pain caused by certain foods or beverages.
  • Local or spinal injections of numbing agents or corticosteroids by pain management physicians.

In more severe cases like appendicitis and hernia, surgery is necessary.

When to Call the Doctor

Which symptoms of abdominal pain are cause for concern?

If your abdominal pain is severe or if it is accompanied by any of the following symptoms, contact your doctor as soon as possible:

  • Nausea, fever, or the inability to keep food down for several days.
  • Bloody stools.
  • Difficulty breathing.
  • Vomiting blood.
  • The pain occurs during pregnancy.
  • The abdomen is tender to the touch.
  • Pain is the result of an injury to the abdomen in the previous days.
  • Pain lasts for several days.

These symptoms may be an indication of an internal inflammation, infection, or bleeding that requires treatment as soon as possible. Less commonly, some of these symptoms may be caused by colorectal, ovarian or an abdominal cancer.

Approach to Acute Abdominal Pain: Practical Algorithms

Adv J Emerg Med. 2020 Spring; 4(2): e29.

Farzad Vaghef-Davari

1. Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran.

Hadi Ahmadi-Amoli

2. Department of Surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Amirsina Sharifi

1. Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran.

Farzad Teymouri

3. International Campus, Tehran University of Medical Sciences, Tehran, Iran.

Nobar Paprouschi

3. International Campus, Tehran University of Medical Sciences, Tehran, Iran.

1. Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran.

2. Department of Surgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.

3. International Campus, Tehran University of Medical Sciences, Tehran, Iran.

Copyright © 2020 Tehran University of Medical Sciences

This open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial 4.0 License (CC BY-NC 4.0).

This article has been cited by other articles in PMC.

Abstract

Context:

Acute abdominal pain is one of the most common complaints of patients admitted to emergency units. This study aimed to propose a new approach to abdominal pain by designing a more structured diagnostic workup for physicians.

Evidence acquisition:

A comprehensive review of relevant articles and algorithms presented in books and websites was conducted. Approaches which were relevant to the study concept, were selected.

Results:

Seven algorithms were introduced with respect to the site of abdominal tenderness. The mainstay of these algorithms was differential diagnosis of the tenderness site.

Conclusion:

Based on the findings, the designed approach can prevent confusion among physicians and reduce requests for many unnecessary paraclinical tests, which delay the final diagnosis and impose unacceptable costs on patients and healthcare systems.

Keywords: Abdominal Pain, Algorithms, Diagnosis, Disease Management

Context

Abdominal pain is one of the most common complaints of patients admitted to emergency units, accounting for approximately 4–5% of emergency department visits (1–3). Recent studies show that self-referrals due to abdominal pain, as well as primary care physician referrals to emergency departments, have increased, imposing heavy burdens on emergency surgical care providers (4). Generally, suggesting a rational differential diagnosis and planning a suitable diagnostic and management approach have always been challenging for primary care physicians when treating patients with abdominal pain. One challenging aspect of abdominal pain treatment is the request for appropriate paraclinical diagnostic tests (5). In fact, performing many unnecessary laboratory tests and radiological imaging procedures not only delays the final diagnosis, but also imposes significant costs. Among different body parts, the abdomen and abdominal problems have always intrigued researchers (2). Overlaps in the initial presentations of benign and life-threatening pathologies, nonabdominal source of pain, and presentation of atypical signs and symptoms rather than the classic ones, which may also vary with age, sex, and comorbidities, are among confounding factors for timely and accurate diagnosis of abdominal pain (1, 6). Therefore, examination and management of abdominal pain should start with precise history-taking and complete physical examination, followed by the selection of proper diagnostic laboratory tests and imaging modalities to establish a diagnosis. With this background in mind, the purpose of the present study was to design a stepwise approach for first-line physicians treating patients with abdominal pain.

Evidence Acquisition

An extensive search of Medline, PubMed, EMBASE, databases was conducted to identify relevant studies published during 1950–2017 (December 2017), using the following keywords: “abdominal pain”, “diagnostic approach”, “algorithm”, and “management”. In addition, we searched for images of algorithms using Google search. All articles were screened by two independent authors for relevance to the study goals. The selected studies were reviewed, and those including stepwise diagnostic algorithms were included in our algorithm.

Results

Finally, 10 management algorithms were selected for acute abdominal pain; some were used for specific age or disease groups, while some were based on the site of pain (1). The algorithms used some common points in history-taking and physical examination for a systematic approach. The differences were mainly related to the point of start, target age, and type of complaint. Overall, the most common factors, which should be considered when selecting the best line of management, include age, sex, ethnicity, occupation, social habits, onset of pain, location of pain, duration of pain, pain variations, quality of pain, radiation, concomitant symptoms, aggravating factors, and relieving factors (1–3, 7–14).

One common approach among all abdominal pain algorithms was that they all considered pain as a subjective symptom in their approach. The main problem of this approach is that the location of pain is sometimes different from the main pathology site, and it seems that physical examination can play a more important role. Therefore, in this approach, the site of abdominal tenderness is suggested as the main indicator. This approach provides more accurate information about the exact location of intra-abdominal pathology and suggests a more targeted diagnostic line.

We designed our algorithms based on the site of abdominal tenderness: right upper quadrant; left upper quadrant; epigastric; right lower quadrant; left lower quadrant; suprapubic; and generalized tenderness (–). We also established some rules for constructing our algorithms:

An algorithm for generalized abdominal tenderness (IMG: Imaging; LAB: Laboratory Data; HX: History; DDX: Differential Diagnosis)

An algorithm for suprapubic tenderness (IMG: Imaging; LAB: Laboratory Data; HX: History; DDX: Differential Diagnosis)

An algorithm for epigastric tenderness (IMG: Imaging; LAB: Laboratory Data; HX: History; DDX: Differential Diagnosis)

An algorithm for right upper quadrant tenderness (IMG: Imaging; LAB: Laboratory Data; HX: History; DDX: Differential Diagnosis)

An algorithm for left upper quadrant tenderness (IMG: Imaging; LAB: Laboratory Data; HX: History; DDX: Differential Diagnosis)

An algorithm for right lower quadrant tenderness (IMG: Imaging; LAB: Laboratory Data; HX: History; DDX: Differential Diagnosis)

An algorithm for left lower quadrant tenderness (IMG: Imaging; LAB: Laboratory Data; HX: History; DDX: Differential Diagnosis)

The request for all para-clinical tests should be based on the primary differential diagnosis, following history-taking and physical examination. It is not rational to blindly request different laboratory and imaging tests. In fact, it is necessary to request for tests based on the differential diagnosis.

There is no need to request for all the planned para-clinical tests at the same time, as some may become unnecessary during the diagnostic process.

The algorithms are designed for first-line physicians, who plan the primary approach for patients.

The results or each step of the diagnostic process determines the next step.

The algorithms are only designed for primary diagnostic management in emergency units to be used by emergency medical specialists, family physicians, or general physicians.

Discussion

This type of approach to abdominal tenderness seems to have many advantages for physicians, who have the first contact with patients in emergency units. First, the algorithms are based on a common differential diagnosis of the abdominal tenderness site; therefore, they are more targeted and prevent waste of resources due to un-purposeful imaging and laboratory test requests. Second, they help physicians devise a logical and cost-effective approach in the clinical decision-making process by requesting for paraclinical data based on the available data to establish the final diagnosis. This type of approach prevents confusion among physicians and reduces requests for unnecessary paraclinical tests, which can delay the final diagnosis and impose unacceptable costs.

Conclusions

Based on the findings, the designed approach can prevent confusion among physicians and reduce requests for many unnecessary paraclinical tests, which delay the final diagnosis and impose unacceptable costs on patients and healthcare systems.

Footnotes

Authors’ contribution

All the authors met the standards of authorship based on the recommendations of the International Committee of Medical Journal Editors.

Conflict of interest

None declared.

Funding

None declared.

References

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Abdominal Pain

Acute gastritis Any age Epigastric burning pain, associated with food, increases on supine position Upper GI endoscopy, biopsy for H. pylori Gastro-oesophageal reflux disease, perforation
Epigastric tenderness, no rebound tenderness
Peptic ulcer disease Age >50 years, M>F, RF: H. pylori, NSAIDS use, smoking, alcohol Severe epigastric pain 2–5 h after meals or at night, nausea, vomiting, early satiety Stool for occult blood (bleeding ulcer) Upper GI endoscopy Perforation, bleeding
Epigastric tenderness
Biliary tract disease Age: 40–60 years, F>M, RF: childbearing age, obese, alcohol, OC pills Epigastric/RUQ pain, radiating to right shoulder/subscapular, postprandial pain, nausea, fever CBC, liver function test Ultrasonography – most sensitive, CT scan in extrahepatic biliary obstruction, hepatobiliary scintigraphy Septicaemia, pancreatitis
Jaundice, RUQ tenderness, rebound tenderness, Murphy’s sign
Acute pancreatitis Age: 45–60 years, varies with aetiology; M>F, aetiology: gallstones, alcohol Severe epigastric pain following meal, radiating to back, nausea, vomiting, fever, tachycardia, tachypnoea, hypotension, hyperthermia, epigastric tenderness, guarding, Cullen’s sign, Grey Turner’s sign CBC, S. lipase, S. amylase, liver function test Helical CT with contrast, ultrasonography for biliary tract pathology Local complications: acute local fluid collection, pseudocyst, necrosis, abscess
Systemic: septicaemia, ARDS
Bowel obstruction Any age, RF: h/o previous abdominal surgery Crampy abdominal pain, nausea, vomiting, constipation, abdominal distension CBC, S. electrolytes X-ray abdomen standing, CT abdomen Strangulation, incarceration
Tachycardia, diffuse tenderness, tympanic note, hyperactive bowel sound, PR examination – empty
Viscus perforation Elderly age, RF: peptic ulcer, intestinal ulcers, carcinoma Severe abdominal pain, lies still in bed, abdominal distension, vomiting, fever CBC, S. electrolytes X-ray chest, abdomen standing Septicaemia
Signs of shock, generalized abdominal tenderness, rigidity, signs of peritonitis
Mesenteric ischaemia Elderly population, M>F, RF: atherosclerosis, arrhythmia, CHF, recent MI, valvular diseases Diffuse abdominal pain out of proportion, vomiting, diarrhoea CBC, S. lactate, blood pH, S. amylase, S. creatinine kinase CT abdominal angiography Intestinal necrosis, metabolic acidosis
Tachycardia, tachypnoea, hypotension, silent abdomen initially, signs of peritonitis
Diverticulitis Mean age: 60 years, M=F, sigmoid colon – most common site Left lower quadrant pain, fever, change in bowel habits CBC, stool for occult blood CT abdomen Perforation, fistula, obstruction, haemorrhage
Abdominal tenderness, guarding, signs of peritonitis
Appendicitis Young adulthood, M>F Periumbilical pain migrates to RLQ, nausea, vomiting, fever CBC, S. electrolytes, urine examination CT in adult and non-pregnant patients Perforation, peritonitis, septicaemia, abscess
RLQ tenderness, guarding, rebound tenderness, psoas sign, obturator sign
Ureteric colic Age: 30–40 years, M>F Severe colicky flank pain radiating to groin, nausea, vomiting, haematuria, tossing up in bed Urine examination, CBC Spiral CT, ultrasonography in pregnancy UTI
Flank tenderness
Ruptured abdominal aortic aneurysm Age >50 years, M>F, RF: hypertension, atherosclerotic disease, DM, smoking family history Severe sudden onset abdominal pain radiating to back, syncope, GI bleeding, shock Bedside ultrasonography, CT aortogram Shock, limb ischaemia
Tachycardia, hypotension, palpable abdominal mass, unequal femoral pulses
Traumatic organ rupture Age:15–35 years; M>F Abdominal pain, vomiting CBC EFAST, abdominal sonography, CT abdomen Shock, peritonitis, DIC
Signs of shock, injury marks
Ruptured ectopic pregnancy Female of childbearing age, RF: IUCD, previous ectopic, PID Sudden, severe pain, spotting, amenorrhoea UPT, S.HCG, CBC FAST, transvaginal and transabdominal ultrasonography Shock, septicaemia, DIC
Tachycardia, hypotension, peritoneal signs, adnexal mass and tenderness, cervical motion tenderness, blood in vaginal vault
PID Age: 15–49 years; RF: multiple partners, previous PID Lower abdominal pain, fever, nausea, vomiting, vaginal discharge UPT, CBC, vaginal swab test for gonorrhoea/chlamydia Transvaginal ultrasonography Tubo-ovarian abscess, ectopic pregnancy
Cervical motion/uterine/adnexal tenderness, rebound tenderness
C. difficile colitis Elderly population, RF: antibiotics (fluoroquinolones, penicillin, clindamycin) Crampy abdominal pain, watery diarrhoea, fever CBC, Stool culture CT scan Pseudomembranous colitis, toxic megacolon, perforation
Signs of dehydration, abdominal tenderness, distension, rebound tenderness, marked rigidity, decreased bowel sound

Abdominal Pain

Case Study

Case Study: A 43 year-old female with a past medical history of cesarean section presents with four hours of abdominal pain. Pain is located in the right upper quadrant with radiation to the epigastrium and associated with 2 episodes of nonbloody, nonbilious emesis. She ate a cheeseburger with fries and had two beers shortly before the onset of pain. She has had pain like this in the past but this is the first time it has persisted despite acetaminophen. She has no family history, drinks 8-9 alcoholic beverages per week, and is sexually active with her husband. On examination, her vitals are within normal limits and stable  and she has tenderness to palpation to the right upper quadrant (positive Murphy’s) without  rebound or peritoneal signs. She has no CVA tenderness or lower abdominal tenderness. The remainder of her examination is  normal.


Objectives

By the end of this module, the student will be able to:

  1. Recognize physical exam findings requiring emergent resuscitation in the patient presenting with abdominal pain
  2. Create a broad differential for abdominal pain, including extra-abdominal causes
  3. Recognize the critical diagnoses for abdominal pain
  4. Discuss the advantages and limitations of different radiologic modalities used in the evaluation of abdominal pain
  5. Discuss the treatment and disposition for the critical diagnoses for abdominal pain 

Introduction

Abdominal pain is the most common emergency department (ED) chief complaint in adult patients. In the US, abdominal pain is responsible for more than 7 million  ED visits per year. Despite this frequency, it remains a challenging complaint due to the large number of possible etiologies and widely variable clinical presentations. While a specific diagnosis is frequently difficult to make in the ED (approximately 25% of presenting patients are ultimately diagnosed with ‘nonspecific abdominal pain’), it is imperative that the emergency physician exclude time-dependent disease processes that if left undiagnosed could lead to morbidity or mortality.


Initial Actions and Primary Survey

A primary assessment and evaluation of ABCs must be completed on any patient presenting to the emergency department with abdominal pain. While airway compromise and respiratory insufficiency can develop in a patient suffering from an abdominal catastrophe, the circulatory system most commonly needs the attention of the clinician in the setting of abdominal pain.

Abdominal pain in conjunction with hemodynamic instability should alert the physician to the possibility of hemorrhage, sepsis, perforated viscus, or necrotic bowel. Tachycardia or orthostatic vital signs are often the first sign of hemodynamic instability; it requires blood loss of 30-40% of normal blood volume to cause a significant drop in systolic blood pressure. In patients with established hemodynamic instability, immediate fluid resuscitation should begin by establishing 2 large bore IVs and rapidly infusing isotonic crystalloid. Supplemental oxygen should be administered, and patients should be placed on a monitor.

The primary survey of patients with abdominal pain should include a brief history evaluating for      symptoms of infection, bleeding diathesis, and the possibility of pregnancy; an abdominal examination should be performed for the presence of peritonitis, as this indicates a patient requiring more immediate surgical intervention.

In the unstable patient with abdominal pain in whom hemorrhage is diagnosed or highly suspected, typed and crossed blood should be immediately ordered. The transfusion of type O blood can be performed in critical situations where there is not enough time to wait for cross matched blood.

Women of childbearing age who present with abdominal pain require urgent pregnancy testing      to rule out ectopic pregnancy. When such a patient is unstable, rapidly obtain either  urine serum for qualitative beta-HCG testing. If the patient is pregnant, blood should also be sent for a quantitative beta-HCG level.


Presentation

Patients with abdominal pain have a wide range of potential presentations. A thorough history will catch potentially challenging diagnoses in otherwise unrevealing presentations. A clear description of the pain itself is often quite helpful in narrowing down the cause of abdominal pain. Elicit:

  • provocative, palliative factors
  • quality
  • radiation
  • symptoms associated with the pain
  • timing
  • progression and migration

For example, pain that is constant, originally located in the periumbilical area but now      migrated to the right lower quadrant, and palliated by staying still is quite different than a pain that is located in the epigastrium with radiation to the right upper quadrant, worsened with oral intake, and associated with fever and vomiting.

In addition to evaluation of the pain, a brief evaluation of the patient’s previous medical, surgical history, and risk factors may increase your suspicion for particular pathologies. A medical history of diabetes or HIV may result in an atypical presentation of a common complaint. A history of abdominal surgeries or hernias increases the likelihood of bowel obstruction. The social history of a patient with abdominal pain can also be similarly illustrative. Sexual activity puts the patient at risk for sexually transmitted infections and, in the case of the female patient, ectopic pregnancy. A recent diet of highly acidic food, food with significant fats, or alcohol can increase the patient’s risk of gastritis, cholecystitis, or pancreatitis respectively. Ask your patient about similar episodes and associated diagnostics and treatments.

A thorough abdominal examination includes inspection, auscultation, and palpation. Inspect the patient for surgical scars and evidence of distension. Auscultate for bowel sounds is not considered to be diagnostic and can be unreliable. Palpation should focus on the presence or absence of rigidity and the location of primary tenderness, as this will help guide the differential diagnosis. The presence of a Murphy’s sign in the right upper quadrant may suggest gallbladder pathology. Tenderness at McBurney’s point in the right lower quadrant may suggest appendicitis.

In addition to palpation of the abdomen, the costovertebral angles should be percussed for evaluation of the kidneys. In the setting of lower abdominal pain, an evaluation of the genitalia should be completed. In males, this is relevant for referred pain secondary to testicular torsion, infection, or incarcerated hernia. In females, ovarian torsion, pelvic inflammatory disease, and ectopic pregnancy will often present as abdominal pain. 


Differential Diagnosis

The most common approach to the diagnosis of abdominal pain focuses on the location of the pain, with a separate grouping for causes of diffuse abdominal pain. Two other factors that need to be considered up front with abdominal pain include sex and age. Although these lists are useful as an initial approach, it is important to remember that it is common to see diagnoses present with pain and tenderness where it isn’t expected. It is important to begin your differential diagnoses with the potential life-threatening or critical diagnoses in order to rule them out. These diagnoses are highlighted in the tables below and link to their chapters within the site.

Table 1: Differential Diagnosis of abdominal pain by location
Right Upper Quadrant Left Upper Quadrant
  • Biliary colic
  • Cholangitis
  • Cholecystitis
  • Fitz-Hugh-Curtis Syndrome
  • Hepatitis
  • Hepatic abscess
  • Hepatic congestion
  • Herpes zoster
  • Mesenteric ischemia
  • Perforated duodenal ulcer
  • Pneumonia (RLL)
  • Pulmonary embolism
  • Pyelonephritis/nephrolithiasis
  • Gastric ulcer
  • Gastritis
  • Herpes Zoster
  • Myocardial ischemia
  • Pancreatitis
  • Pneumonia (LLL)
  • Pulmonary embolism
  • Splenic rupture/distension
  • Pyelonephritis/nephrolithiasis
Right Lower Quadrant Left Lower Quadrant
  • Aortic aneurysm
  • Appendicitis
  • Crohn disease
  • Diverticulitis
  • Ectopic pregnancy
  • Endometriosis
  • Epiploic appendagitis
  • Herpes zoster
  • Inguinal hernia
  • Ischemic colitis
  • Meckel diverticulum
  • Mittelschmerz
  • Ovarian cyst
  • Ovarian torsion
  • Pelvic inflammatory disease
  • Psoas abscess
  • Regional enteritis
  • Testicular torsion
  • Ureteral calculi
  • Aortic aneurysm
  • Diverticulitis
  • Ectopic pregnancy
  • Endometriosis
  • Epiploic appendagitis
  • Herpes zoster
  • Inguinal hernia
  • Ischemic colitis
  • Meckel diverticulum
  • Mittelschmerz
  • Ovarian cyst
  • Ovarian torsion
  • Pelvic inflammatory disease
  • Psoas abscess
  • Regional enteritis
  • Testicular torsion
  • Ureteral calculi

 

Table 2: Differential Diagnosis for diffuse abdominal pain

  • Aortic aneurysm 
  • Aortic dissection 
  • Appendicitis (early) 
  • Bowel obstruction 
  • Diabetic gastric paresis 
  • Diabetic ketoacidosis 
  • Familial Mediterranean Fever 
  • Gastroenteritis 
  • Heavy metal poisoning 
  • Hereditary angioedema 
  • Malaria 
  • Mesenteric ischemia 
  • Metabolic disorder 
  • Narcotic withdrawal 
  • Pancreatitis 
  • Perforated bowel 
  • Peritonitis 
  • Sickle cell crisis
  • Volvulus 

Diagnostic Testing

Diagnostic testing should be guided by the patient’s history and physical examination findings which can be used to initially narrow the differential diagnosis. Standard “abdominal labs” are listed below, but should be tailored to the patient’s presentation. Refer to the Common Laboratory Studies chapter for further information about each test.

  • Complete blood count
  • Electrolytes
  • Liver function tests
  • Lipase
  • Urine analysis
  • Beta- HCG (females only)

In addition to these labs, further labs that can be helpful in particular presentations of abdominal pain include: troponin, coagulation studies including prothrombin time and partial thromboplastin time, lactate, C reactive protein, and gonococcal/chlamydia testing.


Imaging

Portable x-ray and ultrasound can serve as immediate diagnostic tools that can be performed at the bedside when there is concern for pneumoperitoneum or hemoperitoneum, respectively. An upright chest x-ray or lateral decubitus abdominal film has been demonstrated to reveal free air in 80% of cases with perforated viscus.

Ultrasound is an excellent tool for the evaluation of many urgent causes of abdominal pain. Bedside ultrasound can be used to search for abdominal free fluid suggestive of hemoperitoneum along with possible etiologies such as a ruptured abdominal aortic aneurysm (AAA) or ruptured ectopic pregnancy. Bedside and radiology-performed ultrasound can also be diagnostic of nephrolithiasis, abdominal aneurysms, and in slender patients, appendicitis. An ultrasound verifying intrauterine pregnancy can help to rule out ectopic pregnancy in the case of the pregnant female. It may not entirely rule out ectopic or heterotopic pregnancy. Ultrasound is the diagnostic modality of choice for patients with suspected biliary pathology and ovarian and testicular torsion.

For patients presenting with concerning findings in whom ultrasound is unlikely to be diagnostic, CT should be considered. The use of CT scans can improve diagnosis and treatment of acute abdominal pain and decrease return visits by up to 30%. On the other hand, computed tomography carries significant radiation exposure and cost, can lead to false positives, and does not completely rule out all serious life-threatening illnesses causing abdominal pain.


Treatment

Antibiotics: The abdomen is a frequent site of infection in the development of sepsis. Patients with abdominal pain who are found to be septic should receive early administration of antibiotics as part of their initial resuscitation. Antibiotics should also be given promptly to patients with peritonitis or a perforated viscus.

Antiemetics: Abdominal pain is frequently associated with nausea and vomiting. Two commonly used drugs for nausea and vomiting in the emergency department are ondansetron and metoclopramide and they have been demonstrated to be roughly equivalent in efficacy. Ondansetron is given 4-8 milligrams orally or intravenously every 4 hours; metoclopramide is given 10 milligrams intravenously, sometimes with the addition of diphenhydramine to prevent extrapyramidal side effects.

Analgesia: Patients presenting in significant abdominal discomfort and a history and physical suggesting a concerning diagnosis should be provided with immediate pain relief. Narcotic medication should not be withheld out of concern that the abdominal exam may become unreliable and the diagnosis therefore obscured. Fentanyl provides a nice option if a shorter acting agent is desired or if the blood pressure is tenuous.

Specialty Consultation: Immediate surgical consultation should be obtained in patients whose presentation of abdominal pain involves hemodynamic instability and/or a rigid abdomen. It is important to consider which specialty to consult based on the likely diagnosis. For instance, a ruptured AAA will be managed by vascular surgery, a perforated viscus by general surgery, testicular torsion by urology, and a ruptured ectopic pregnancy by OB/GYN. Nonsurgical consultation such as gastroenterology for a GI bleed or the medical ICU for diabetic ketoacidosis may also be necessary.

Outpatient Follow-up: Approximately 25% of patients presenting to the emergency department with abdominal pain ultimately receive the diagnosis of “nonspecific abdominal pain,” and follow-up is an essential part of their disposition plan. Of these patients, 30-hour follow-up can yield a difference in diagnosis or treatment in up to 20%. In addition to expedited outpatient follow-up, many patients presenting with nonspecific abdominal pain may benefit from outpatient specialty follow-up for further, non-emergent testing.


Pearls and Pitfalls

  • Monitor vital signs for impending hemodynamic collapse
  • Patients with a peritoneal examination warrant early surgical consult.
  • Elderly patients may present with very atypical symptoms but have high morbidity and mortality associated with the complaint of abdominal pain. CT is diagnostic of an urgent intra-abdominal condition in 50% of these patients.
  • Every female of childbearing age with abdominal pain must receive a pregnancy test.
  • Diffuse or upper abdominal pain should warrant thorough cardiac and pulmonary evaluation; diaphragmatic irritation can present as abdominal discomfort.
  • The most frequent causes of emergency department missed CT diagnoses are right upper quadrant pathology (only 15-20% of gallstones are radiopaque) and urinary tract infections.
  • Patients with significant intra-abdominal conditions tend to have exams that evolve over time. Frequent re-examinations will help with both diagnosis and early treatment.
  • Manage and treat pain when appropriate.
  • When in doubt, arrange close follow-up.

Case Resolution

Case Resolution:  The patient is given morphine and ondansetron with good resolution in her symptoms. Her EKG is normal. A bedside ultrasound demonstrates gallstones with a normal-appearing gallbladder without wall thickening, pericholecystic fluid, or dilated common bile duct. Her liver function tests, white blood cell count, and lipase are normal. Her urine pregnancy test and urine analysis are similarly normal. After an hour of observation she tolerates food without significant pain and her abdominal examination is benign. She is discharged home with strict return precautions and an outpatient referral to general surgery to discuss elective cholecystectomy for symptomatic cholelithiasis.


References

Boendermaker AE, Coolsma CW, Emous M, Ter Avest E. Efficacy of scheduled return visits for emergency department patients with non-specific abdominal pain. Emerg Med J. 2018 Aug;35(8):499-506.

Cinar O, Jay L, Fosnocht D, Carey J, Rogers L, Carey A, Horne B, Madsen T. Longitudinal trends in the treatment of abdominal pain in an academic emergency department. J Emerg Med. 2013 Sep;45(3):324-31.

Medford-Davis L, Park E, Shlamovitz G, Suliburk J, Meyer An, Singh H. Diagnostic errors related to acute abdominal pain in the emergency department. Emerg Med J. 2016 Apr;33(4):253-9.

O’Brien MC, In: Tintinalli JE, Stapczynski J, Ma O, Yealy DM, Meckler GD, Cline DM. eds. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 8e New York, NY: McGraw-Hill

Patterson BW, Venkatesh AK, AlKhawam L, Pang PS. Abdominal Computed Tomography Utilization and 30-day Revisitation in Emergency Department Patients Presenting With Abdominal Pain. Acad Emerg Med. 2015 Jul;22(7):803-10.

Lower Abdominal Pain | Patient

Diffuse pain or variable locations:

  • Surgical/gynaecological – peritonitis, aortic aneurysm or dissection, intestinal obstruction, adhesions, ovarian cancer, ovarian hyperstimulation syndrome
  • Medical – septicaemia, diabetic ketoacidosis, sickle cell crisis, hypercalcaemia, Henoch-Schönlein purpura, coeliac disease, Crohn’s disease, ascites, constipation, porphyria, familial Mediterranean fever, hereditary angio-oedema.
  • Infections – gastroenteritis, giardiasis, intestinal tuberculosis, typhoid fever, yersinial enterocolitis.
  • Toxins – opiate withdrawal, methanol poisoning, heavy metal poisoning, black widow spider bite, scorpion sting.
  • Abdominal wall – hernias, muscle strain or injury, shingles, spinal pain.
  • Others – lactose intolerance, specific food allergy, abdominal migraine, somatisation, Münchhausen’s syndrome, childhood abuse or sexual abuse,[8] fictitious pain.
Right subcostal:

  • Cardiac (see epigastric region).
  • Lung – lower lobe pneumonia, pulmonary embolus, pleurisy.
  • Liver – gallstones, cholecystitis, cholangitis, pre-eclampsia and HELLP syndrome (= Haemolysis, EL (elevated liver) enzymes, LP (low platelet) count), hepatitis, hepatic congestion, liver abscess/cyst.
  • Duodenal ulcer.
  • Retrocaecal appendicitis (rarely)
Epigastric:

  • Cardiac – myocardial infarction, angina, pericarditis.
  • Pre-eclampsia.
  • Aortic aneurysm or dissection.
  • Mesenteric ischaemia or infarction.
  • Gastric – oesophagitis, gastritis, peptic ulcer, oesophageal or gastric cancer.
  • Pancreas – pancreatitis, pancreatic cyst or tumour.
Left subcostal:

  • Cardiac (see ‘Epigastric’ region).
  • Lung – pneumonia, pleurisy, pulmonary embolus.
  • Spleen – rupture, abscess, acute splenomegaly.
  • Gastric (see ‘Epigastric’ region).
Right flank and loin:

  • Aortic aneurysm or dissection.
  • Renal – stones,
    pyelonephritis, tumours.
  • Retrocaecal appendicitis.
  • Diverticulitis.
  • Ovarian pathology.
  • Other problems – gallstones (rarely), retroperitoneal haemorrhage, mesenteric ischaemia.
Central abdomen:

  • Appendicitis.
  • Mesenteric adenitis.
  • Meckel’s diverticulitis.
  • Small bowel – mesenteric ischaemia or infarction, small bowel obstruction, Crohn’s disease.
  • Pancreas (see ‘Epigastric’ region).
  • Lymph nodes – lymphoma or metastases.
Left flank and loin:

  • Aortic aneurysm or dissection.
  • Renal – stones, pyelonephritis, tumours.
  • Diverticulitis.
  • Ovarian pathology.
  • Other problems – pancreatitis (rarely), retroperitoneal haemorrhage, mesenteric ischaemia.
Right iliac fossa:

  • Appendicitis.
  • Mesenteric adenitis.
  • Meckel’s diverticulitis.
  • Ectopic pregnancy and other gynaecological causes (see ‘Left iliac fossa’).
  • Testicular torsion.
  • Urinary tract – infection or stones.
  • Colon (see ‘Left iliac fossa’).
  • Hernia – inguinal or femoral.
  • Caecal tumours.
Lower abdomen:

  • Urinary tract – distended bladder, infection.
  • Colon (see ‘Left iliac fossa’).
  • Gynaecological (see ‘Left iliac fossa’).
  • Obstetric – miscarriage, labour, placental abruption.
Left iliac fossa:

  • Gynaecological – ectopic pregnancy, pelvic inflammatory disease, ovarian torsion, ovarian cyst or tumour, ovulation pain, endometriosis.
  • Testicular torsion.
  • Urinary tract – infection or stone.
  • Colon – diverticulitis or diverticular disease, inflammatory bowel disease, large bowel obstruction or tumour, irritable bowel syndrome, constipation.
  • Hernia – inguinal or femoral.
  • Appendicitis in a patient with situs inversus (rare).

90,000 Disease Symptoms – Eleos Clinic

Such pains occur when one or more organs have increased in size and press on the surrounding muscles. Why is this happening?

The reasons can be completely different.
Let’s look at examples from men and women. In both sexes, such pain can cause severe muscle overstrain and the impossibility of their contraction.
It is also worth remembering that such pains accompany genital infections. Always pay attention to the color and odor of your genital discharge.In a healthy person, the discharge is transparent and practically odorless.

Women

Such pains often occur with menstruation. If they happen on the 12-14th day of the usual 28-day cycle, without the usual discharge, then you should immediately contact your gynecologist. This may indicate various inflammations in the uterus and ovaries. If the pain increases during menstruation or becomes unbearable, this indicates a rapidly developing endometriosis or more terrible diseases, up to cancer.

Lower abdominal pain in women often speaks of pregnancy, including ectopic pregnancy.

If you experience similar pain during intercourse, then you should also contact your gynecologist. He will find out why at this moment the uterus increases in size, although this should not be so. If pain occurs during or after urination, this indicates an infection in the bladder. It can be pyelonephritis or cystitis, which is common in women. Then you urgently need to see a urologist and take a urine test.Do not bring the disease to kidney stones.

Try to tell your doctor clearly what kind of pain you are feeling: pulling and cramping. This will help make the diagnosis faster.

Men

It is important for the doctor to understand exactly where and under what conditions you are experiencing pain. In addition to genital infections, it can be inflammation of the prostate and urinary tract, intestinal lesions.

Such pains indicate chronic prostatitis.They are fraught with problems in sex life and urinary incontinence.
Remember that if you go to the toilet at least once at night, this indicates problems with the genitourinary system. For any pain or discomfort when urinating, see your urologist. Do not bring up to surgery.

If it hurts on the right, then it is appendicitis. Go to the hospital urgently. It can “burst” and then blood poisoning will occur.

Also, pain on the right can indicate a malignant tumor in the intestine.To establish it, an X-ray examination of the intestine is necessary. If pain occurs on the left when walking or shaking in a car, it is also an inflammation of the intestines.

The specialists of the Eleos clinic will answer all your questions. We know how to help you.

Pain in the lower abdomen: causes and treatment

Lower abdominal pain can have a variety of causes and symptoms.

According to the duration, the pain is divided into constant and periodic.Periodic pain occurs, for example, during menstruation, constant pain occurs as a consequence of the disease.

Sensations also differ in the strength of pain. This is usually a subjective assessment, since the pain threshold is different for all people. Mild pain sensations, tolerable pain and severe pain can be distinguished.

By localization, pain in the lower abdomen can be:

The localization of the area of ​​pain is very important for diagnosis. For example, pain in the lower right side in most cases occurs as a result of appendicitis, and pain in the lower part just below the navel is a symptom of bowel problems.The location of the pain often indicates its cause. Pain in the center indicates inflammation of the uterus, in the area to the right or left of it – inflammation of the ovary. Aching pain is more difficult to localize, it often seems that it affects the entire lower abdomen, and not small areas.

In addition to the localization of pain, it is important to determine which organs it is giving off, which areas of the body especially respond to this pain. For example, with menstrual pain, they are given from the abdomen in the lower back, and with prostatitis, they are given down to the groin.

What causes pain in the lower abdomen

Lower abdominal pain isn’t always caused by disease. Of course, pain cannot be called the norm, but sometimes it is caused by rather harmless reasons. Among them are heaviness in the intestines after overeating or heavy food, tension of the muscles of the lower press after hard work or sports activities, in women – premenstrual syndrome, ovulation or menstruation. These pains go away on their own and do not require treatment.However, if severe pain appears every time during menstruation, an examination of the uterus and ovaries is necessary.

In most cases, lower abdominal pain is a symptom of an illness or an abnormal course of the physiological process.

In men and women, similar pain can be caused by:

  • inflammation of the bladder;
  • inflammation of the urethra;
  • 90,054 stones in the bladder or ureter;

  • neoplasms in the bladder;
  • appendicitis;
  • intestinal obstruction;
  • 90,054 parasites in the intestines;

  • poisoning;
  • pinched hernia;
  • 90,054 injuries to internal organs.

In women, the causes of lower abdominal pain are most often:

In uterine pregnancy in women, the causes of pain can be:

  • uterine hypertonicity;
  • placental abruption;
  • labor pains.

Any pain during pregnancy should be considered dangerous and requires an urgent visit to a gynecologist.

In men, the causes of lower abdominal pain are:

  • prostatitis;
  • inflammation of the testicles and their appendages;
  • prostate adenoma.

Infections can also cause abdominal pain, but less frequently than in women. In men, the main symptoms are discharge, a decrease in the ability to conceive and an erectile dysfunction.

What is the diagnosis for lower abdominal pain

Lower abdominal pain is a vague concept, it is difficult for a doctor to make a diagnosis based on this one complaint alone, so additional diagnostics are required.

When pain in the lower abdomen appears, patients do not always know which doctor to consult.If the reason is not at all clear, you should start with a therapist. He will conduct an initial examination and refer you to a narrower specialist. In case of problems with the genital area, women will be referred to a gynecologist, and men – to a urologist. In case of kidney problems – to a nephrologist. A gastroenterologist will deal with the diagnosis of intestinal diseases. In case of infectious diseases, the help of an infectious disease specialist will be required. When neoplasms are found, a thorough examination by an oncologist is important. With appendicitis, ectopic pregnancy, uterine abscess, surgical intervention is necessary.

The doctor begins by interviewing the patient, asks what other symptoms are manifested, what kind of pain is.

A problem with urination can tell your doctor about a bladder problem or a genital infection that affects the genitourinary system. If this is accompanied by a burning sensation, itching, it is most likely an infection.

Fever, chills, fever can be an indicator of the inflammatory process.

Discharge with an unusual color and smell are symptoms of bacterial, fungal or viral damage to the genital tissues. This also includes the formation of ulcers or neoplasms on the genitals, itching.

Nausea, vomiting, diarrhea, gas, excessive sweating will indicate poisoning or indigestion. Morning vomiting is a possible pregnancy symptom.

A delay in menstruation can be a reason to suspect pregnancy, and sharp pains below with smearing brown discharge may indicate an ectopic pregnancy and require immediate hospitalization.

Narrow specialists carry out additional diagnostics after interviewing the patient based on what symptoms he described. Palpation of the abdomen helps to determine the exact place of pain, to identify tissue compaction. Further, the doctor finds out the general condition of the body: he measures the temperature, pulse, pressure. If necessary, laboratory tests are prescribed – blood, urine, feces, secretions.

Ultrasound examination is necessary to determine the size of the pelvic organs, their position, the size of the cavities, as well as to search for neoplasms or to determine pregnancy.Ultrasound in women is often used to measure the thickness of the endometrium inside the uterus, as well as to identify hormonal disorders, pregnancy, and inflammation.

Also, for diagnostics, radiography, MRI, endoscopy, sigmoidoscopy, laparoscopy and other research methods can be used.

Treatment for pain in the lower abdomen

Treatment for pain in the lower abdomen directly depends on the causes of their occurrence:

Infectious diseases of the genitourinary tract are treated mainly with antibiotics.They are used in the form of tablets or locally in the form of suppositories, creams, ointments. Physiotherapy is used to relieve inflammation. It is important to observe hygiene, wash the genitals more often with anti-inflammatory broths, infusions or solutions, and change clothes more often. Immunotherapy may be required. If the inflammatory processes are delayed, hospitalization is required.

Bladder or ureteral stones require removal. Small stones and sand often come out on their own, after the appointment of diuretics.Large stones are crushed or removed surgically, the treatment process depends on the severity of the patient’s condition. Additionally, anti-inflammatory drugs are prescribed, since the sharp edges of the stones scratch the tissue and cause inflammation.

  • Neoplasms

When treating neoplasms, first of all, the benign quality of the pathology, the rate of its growth, as well as localization are assessed. Small cysts that do not increase in size and do not disturb the patient are not removed (subject to regular observation).Over time, the cyst may disappear on its own, or it may persist for life without causing complaints. Fast-growing neoplasms are subject to surgical removal. Also, with neoplasms, hormonal treatment is often prescribed.

For appendicitis, immediate surgical attention is required. The operation can be performed either through an abdominal incision or laparoscopically. In the postoperative period, antibiotics are prescribed.

  • Intestinal obstruction

At the initial stage, intestinal obstruction is treated with medication, enemas are also used.At this stage, nutritional adjustments can help. In case of complete obstruction complicated by peritonitis, an operation is required.

In a mild form, poisoning is treated at home with medicines and drinking plenty of fluids. In a severe form, the disease requires hospitalization. In the hospital, they wash the stomach, give enemas, make droppers to cleanse the blood and replenish the volume of fluid. After that, a special diet and a strict diet are prescribed.

Endometritis is treated in a hospital setting.Prescribe antibiotics, droppers, it is also possible to administer the drug directly into the uterine cavity. A gentle regimen and good nutrition are important for a woman. After the elimination of the acute process, physiotherapy is prescribed.

Endometriosis is treated primarily with hormone therapy. With profuse prolonged bleeding, an operation is necessary to remove the overgrown endometrium. After the operation, antibiotics and hormones are prescribed.

  • Ectopic pregnancy

An ectopic pregnancy is a direct threat to a woman’s life, with this pathology, urgent removal of the ovum is necessary.An operation is performed, then antibiotics, analgesics and hormonal therapy are prescribed. At the same time, they determine the cause of an ectopic pregnancy in a woman and try to eliminate it.

  • Uterine hypertonicity in pregnant women

In the absence of other symptoms, the pregnant woman is prescribed a gentle regimen, natural sedatives, vitamins, and special gymnastics. If bleeding or severe pain occurs, the woman is sent to the hospital for storage, where she is treated with medications.

Prostatitis is treated with medication; acute prostatitis with fever and acute pain requires hospitalization. Hormone therapy can be used; analgesics are indicated for severe pain. With a bacterial form of the disease, antibiotics are needed, with a non-bacterial form, alpha-blockers are needed. Physiotherapy is also prescribed for prostate massage.

  • Prostate adenoma

Adenoma of the prostate is treated with either medication or surgery.The choice is determined by the degree of disease progression. Drugs can be used to relieve muscle spasm and abdominal pain and improve urinary tract peristalsis.

Pain in the lower abdomen in women

Pain in the lower abdomen in women is considered one of the main symptoms of various diseases in gynecology. Most often the cause of pain is inflammatory processes in the pelvic organs (acute or chronic adnexitis, cystitis, etc.).

Unpleasant sensations are also associated with diseases not from the field of gynecology : diseases of the spine ( neuritis, radiculitis, intervertebral hernia), pathologies in the field of proctology .

One of the consequences of diseases of the reproductive organs of women can be infertility, so it is important to identify and treat them in time.

Pain in the lower abdomen, depending on the reasons, can be acute and chronic .The tactics of treatment depend on this.

In case of acute pain

In case of acute pain, it is better to call an ambulance immediately, since there is a high probability of a threat to life and urgent surgery may be required.

In case of acute abdominal pain, it is not recommended to drink anesthetic pills before the doctor arrives, they will only drown out the pain and complicate the diagnosis.

Causes of acute pain

Factors that provoke acute pain in the lower abdomen in women are divided into organic and functional .

The organic includes diseases of the genital organs:

  • oophoritis,
  • salpingitis,
  • torsion of the leg or rupture of cystic formation,
  • ovarian tumors.

When carrying a child, acute pain can mean:

  • ectopic pregnancy,
  • spontaneous abortion (miscarriage).

listed gynecological diseases should be distinguished from pathologies of other internal organs, manifested by similar abdominal pain: appendicitis, intestinal obstruction, cholecystitis, cystitis, enteritis, pyelonephritis, urolithiasis .

Functional problems that lead to acute pain are mainly menstrual irregularities ( algomenorrhea and menstrual congestion ).

Acute pain is often accompanied by general malaise, weakness, fever, nausea, vomiting and upset stools.

Chronic pain

Causes of chronic pain

Chronic pain syndrome is caused by such organic causes as:

  • cyst or ovarian tumor,
  • endometriosis,
  • prolapse of the uterus,
  • endometrial polyposis,
  • vulvodynia,
  • uterus,
  • adhesions,
  • as well as chronic inflammatory diseases (adnexitis, diverticulitis, endometritis).

Persistent aching pain can be caused by the use of intrauterine contraceptives. In this case, we recommend that you urgently consult with our gynecologist, who will help you choose the methods of contraception that are right for you.

Functional abnormalities that can cause you to develop chronic pain in the lower abdomen include:

  • poor circulation in the pelvis (varicose veins),
  • irritable bowel syndrome,
  • psychogenic factor, for example, against the background of a depressive state or problems in sexual life,
  • features of the anatomical structure of the reproductive organs,
  • malformations,
  • hormonal disorders.

Sometimes chronic pain causes urological pathologies (urolithiasis, tumors and infections), proctological ailments (proctitis, hemorrhoids, intestinal tumors), as well as radiculitis, neuritis, intervertebral hernia, pelvic floor muscle spasms, etc.

You can feel chronic pain persistently or intermittently for several months or even years. As a rule, they appear when several reasons are combined. Such pain requires detailed diagnostic studies.It may be necessary to visit a urologist, proctologist, gastroenterologist, psychotherapist, etc.

Diagnostics and treatment

If you complain of lower abdominal pain to our clinic, the doctors will do everything possible to save you from this problem. For the diagnosis of chronic pain, our gynecologist will certainly take an anamnesis and analyze your complaints, while finding out the nature of the pain and the location, duration, frequency of occurrence and connection with the phases of the menstrual cycle.

Then you have to undergo a gynecological examination, which allows you to detect large neoplasms in the small pelvis and to clarify the place of pain. For additional studies, the specialist will send a smear for analysis, and, if necessary, prescribe a microscopic examination of the cervical scraping, magnetic resonance imaging, ultrasound of the pelvic organs, diagnostic laparoscopy.

Treatment depends primarily on the cause of the symptom; in severe cases, hospitalization is possible.In any case, the gynecological office of our clinic in St. Petersburg has everything you need to help you.

Pain in the lower abdomen – Women’s Medical Center MedOK

Chronic pain in the lower abdomen in women can be cyclic (associated with the menstrual cycle) and acyclic (not associated with it).

Cyclic chronic pain in the lower abdomen.
Algodismenorrhea is pain in the lower abdomen that accompanies menstruation.

1. Primary dysmenorrhea – painful menstruation without organic changes in the pelvic organs.
Primary dysmenorrhea occurs only in ovulatory menstrual cycles: cramping or throbbing pains usually occur, localized in the lower abdomen, often these pains radiate to the lower back and to the front of the thighs.
Painful sensations begin with the first manifestations of menstruation and lasts about 48 hours; they are sometimes accompanied by back pain, nausea, vomiting, diarrhea, headache, and increased fatigue.
Psychological and somatic factors are involved in the development of algodismenorrhea.During menstruation, the uterus contracts, and local areas of ischemia (insufficient blood supply) occur, which causes painful sensations.
Treatment for lower abdominal pain during menstruation includes the use of NSAID pain relievers and sometimes psychotherapy. Monophasic combined oral contraceptives are also prescribed to suppress ovulation.

2. Secondary dysmenorrhea – painful menstruation against the background of organic changes that occur more than two years after menarche (first menstruation).
Acyclic chronic pain in the lower abdomen.
Acyclic chronic pain in the lower abdomen is that long-term pain that is not associated with menstruation.
Acyclic chronic pain in the lower abdomen can be caused by organic causes:

  • endometriosis;
  • adhesions (adhesive disease),
  • residual ovary syndrome;
  • syndrome of stagnation in the small pelvis, often occurs with widespread varicose veins of the small pelvis;

1.Endometriosis is a gynecological disease in which the mucous membrane of the uterine cavity – the endometrium in the form of separate foci is located not in the uterine cavity itself, but in other parts of the body – most often on the peritoneum (a thin membrane that lines the abdominal cavity from the inside and covers the internal organs), on the ovaries, tubes, uterine ligaments and in the abdominal cavity.
The most common manifestation of endometriosis is pain. Pain can intensify immediately before or during menstruation, pain can occur during intercourse and during bowel movements.In its intensity, pain in endometriosis ranges from minor pain to extremely severe, often it manifests itself as a painful sensation of pressure in the rectal region, which can be given to the lower back or leg.
Endometriosis can cause local damage, deformity, tubal obstruction, adhesions, and scarring.
The intensity of pain in endometriosis depends on the localization of endometrioid heterotopies (atypically located tissues).

2.Adhesions or adhesive disease occurs secondarily in chronic inflammatory diseases of the genital organs or is formed after surgery. Cervical stenosis usually develops after surgery and requires surgical treatment.

3. Fibroids of the uterus and uterine fibroids – benign tumors, consisting of muscle and connective tissue; usually accompanied by pain and uterine bleeding.

4. Congenital anomalies of the genitals – a common cause of false amenorrhea, with the accumulation of menstrual blood in the uterus due to obstruction of the cervical canal or in the vagina due to hymen infection.This dysfunctional course of menstruation is painful.

5. The residual ovary syndrome occurs when the ovarian tissue is not completely removed after bilateral oophorectomy (removal of the ovaries). In this case, pain is caused by obstruction of the ureter, which is pinched by the tissue of the ovary.

Acyclic chronic lower abdominal pain can be caused by inorganic causes.
Some people have tender points, irritation of which causes pain symptoms.Probable causes:

  • chronic systemic diseases,
  • immune dysfunction,
  • infectious diseases,
  • consequences of a postponed abortion.

In some cases, acyclic chronic pain in the lower abdomen can be caused by psychogenic factors. Therefore, after excluding the organic causes of pain, it is necessary to examine the woman by a psychotherapist in order to identify possible borderline states of the psyche: hypochondria, depression, hysteria.90,000 reasons for the appearance and diagnosis || Medical center “Centromed”

Discomfort in the abdominal cavity is the result of the course of the pathological process of various organs of the abdominal cavity and small pelvis. To begin adequate treatment aimed at eliminating the cause, it is necessary to conduct an accurate and objective diagnosis. An urgent method of modern instrumental diagnostics of diseases of the abdominal organs is an ultrasound examination of its organs (ultrasound).

Localization and nature of abdominal pain depending on the disease

The location of unpleasant sensations and their nature will help to suspect a pathological process of this or that organ. It will also help the doctor to purposefully conduct ultrasound diagnostics. There are several main localizations of abdominal discomfort sensations:

  • Right Section.
  • Left section.
  • Lower section.
  • Without any clear localization.

Right discomfort

There are several major pathological conditions causing pain. The right side of the abdomen contains the hepatobiliary system (liver and bile ducts), the ascending colon (large intestine), and the appendix. The most commonly diagnosed diseases are:

  • Hepatitis is an inflammatory process of the liver, which can be caused by various causes (viruses, toxic substances). It is characterized by bursting sensations in the upper right (right hypochondrium).On ultrasound, an enlarged liver is visualized, its heterogeneous structure, which indicates an inflammatory process.
  • Cholecystitis is an inflammation of the gallbladder that causes abdominal pain after fatty fried foods. With the help of ultrasound, a thickening of the wall of the gallbladder, an increase in its size, is determined. With the formation of stones in the lumen of the gallbladder, the discomfort becomes intense, paroxysmal (hepatic colic), with ultrasound examination, inclusions of various sizes are visible.
  • Appendicitis – characterized by discomfort in the appendix region (bottom right), which increases with movement, ultrasound reveals an inflammatory infiltrate of the appendix region.

Pain in the left side of the abdomen

The development of symptoms is provoked by the following pathological conditions:

  • Sigmoiditis is an inflammation of the sigmoid colon, which is located in the lower left.
  • Gastritis or gastric ulcer is an inflammation of the mucous membrane with the subsequent development of a peptic ulcer.Discomfort is of a point nature with a predominant localization at the top left (sometimes localization is at the top in the middle). With the help of modern ultrasound techniques, it is possible to determine the size, exact localization of the ulcer.

Pain in the lower abdomen

The development of discomfort of such localization is more common in women, which is associated with the following diseases of the genital area:

  • Adnexitis is an inflammation of the ovaries, more often the process is one-sided, therefore pulling pains in the lower abdomen give in one direction.An ultrasound scan helps to determine the increase in the inflamed ovary and changes in its structure.
  • Ovarian cyst – has similar symptoms with inflammation, when it ruptures, sharp unpleasant sensations arise, ultrasound detects a rounded cavity formation of the ovary with clear boundaries.

Discomfort, without any clear localization

The appearance of discomfort over the entire surface of the abdominal cavity occurs with inflammation of the peritoneum (peritonitis) or spasm of the small intestine.

The leading method of objective diagnosis of the cause of pain is ultrasound, which determines the type and degree of changes in the affected organ or tissue.

90,000 varieties, causes, diagnosis and treatment

Irritable Bowel Syndrome and Abdominal Pain

If you suffer from recurrent abdominal cramps and pains, which are accompanied by intestinal disturbances (constipation, diarrhea, or alternating between them), it is worth considering Irritable Bowel Syndrome.

Irritable Bowel Syndrome is one of the most common bowel diseases 1 . IBS is associated with impaired bowel movement. What does it mean? The cells of a healthy intestine contract rhythmically, making its walls mobile. This movement is necessary for proper digestion and food promotion, i.e. the intestine has a “motor” function. In IBS, this function is impaired: the contractions of the walls can become slower (this provokes the development of constipation) or, conversely, more intense (leads to diarrhea).Both diarrhea and constipation are accompanied by pain, bloating, and flatulence.

Irritable Bowel Syndrome is becoming more and more common today. Irritable Bowel Syndrome mainly affects young people, 25-45 years old 2 who work a lot, experience psychological overload, eat improperly and irregularly. Moreover, women suffer from IBS more often than men 2 .

However, most people who experience these symptoms do not know that they can be a manifestation of a disease such as Irritable Bowel Syndrome and try to treat them separately.

  • People with irritable bowel syndrome complain of recurrent cramps and cramping, twisting or cutting pains in the abdomen.
  • The hallmark of the disease is the reduction or disappearance of abdominal pain after visiting the toilet.
  • Pain symptoms do not bother at night.
  • Pain in IBS may be accompanied by diarrhea, constipation or alternation, as well as bloating and flatulence.The desire to quickly relieve discomfort often interferes with observing your body and choosing the right treatment 3 .
Duspatalin® 135 mg – a comprehensive approach to eliminating irritable bowel symptoms

Firstly, Duspatalin® 135 mg relieves pain and spasm in the abdominal region, and secondly, with a course of 28 days or more 4 normalizes the functioning of irritable bowel 5 . This relieves symptoms such as bloating, gas and stool disturbances such as diarrhea or constipation.

Here you can learn more about the composition and mechanism of action of the drug Duspatalin® 135 mg.

Treatment of lower abdominal pain

Why does the lower abdomen hurt and what to do about it The uterus is the most important organ of the reproductive system of every woman. The most common complaint in the practice of a gynecologist is pain in the lower abdomen. This symptom can occur with various diseases (endometriosis, menstruation, the presence of tumors, etc.).Pain in the lower abdomen can develop with an increase in the uterus, which presses on neighboring organs – the bladder, intestines. If pain in the lower abdomen appears, you should immediately consult a gynecologist to determine the causes of the pain syndrome and prescribe the necessary treatment.

Symptoms Various diseases of the female reproductive system cause severe muscle spasms, which lead to pain in the lower abdomen. The pain can be sharp, pulling, aching, increasing and recurring regularly.After a detailed examination, the doctor will be able to establish the correct diagnosis and prescribe treatment.

If you experience similar symptoms, we advise you to make an appointment with a gynecologist at the Federal Research Center for Clinical Center FMBA. Timely diagnostics will prevent negative consequences for your health!

Treatment of pain in the lower abdomen Pain in the lower abdomen can be caused by various reasons (endometriosis, menstruation, inflammatory diseases, cysts, etc.), in order to select the optimal method of treatment, it is always necessary to first determine the root cause of the pain.Self-medication for such pain is contraindicated.
Only a gynecologist can choose the most suitable method of pain treatment after a complete examination of the patient and determining the cause of the pain. Each disease requires careful treatment and an integrated approach. Doctors of the Gatling-Med Medical Center have extensive experience in the treatment of diseases of the reproductive system and regularly undergo training in leading European clinics.

Treatment Gatling-Med Medical Center uses all methods of treatment of diseases of the reproductive system of women, including minimally invasive methods of operations.