In
the following I will mention some general guidelines that the physician follows
when analyzing a patient with abdominal pain. Details about the symptoms and treatment
modalities for the conditions listed in the table above can be found by clicking
on these links. Abdominal Pain
Introduction: Abdominal pain always
has to be taken seriously as life threatening situations can arise out of it.
Different organs within the abdominal cavity can be the cause of pain, but on
the other hand often severe pain that appears organic in nature, can turn out
to be psychosomatic. In other words, when a thorough work-up has been done, the
physician often comes to the conclusion that there is nothing organically wrong,
but that the pain is due to psychological reasons (this is also termed "psychogenic
abdominal pain"). The physician needs to think: what diagnoses could
be behind this type of abdominal pain? We call this "differential
diagnosis". In other words the physician makes a mental list
of all the possible diagnoses and then one by one is excluded until the real diagnosis
is left behind. This way nothing is overlooked. Abdominal pain can be divided
into various locations of the abdomen and then the differential diagnoses can
be listed. I attempted to do this in the following table. It contains most of
the important causes of abdominal pain, but can not claim to be complete as there
are many less common causes that were left out. Signs and
symptoms: All of the conditions above will be associated
with some abdominal pain. However, depending on the location of the organ the
pain will be located and will irradiate into different areas. Also the quality
of pain will vary and there will be different associated symptoms and findings
depending on the underlying pathophysiology. The conditions that were described
earlier in the chapter will not be repeated below. The other conditions of the
differential diagnosis table of abdominal pain above will be briefly explained
below. Treatment: As all of the
diseases listed above in the table have a different pathophysiology, it is clear
that treatment must be individualized. I have described specific treatments below
for those conditions not already mentioned above in the chapter. However, there
are some common themes. If there is an infectious process such as with PID (=pelvic
inflammatory disease) or diverticulitis, then intravenous antibiotics are given. If
there is an abscess such as a liver abscess or a perforated appendicitis, then
this has to be surgically drained and also be treated with antibiotics. A cancerous
growth needs to be removed surgically. An incarcerated hernia or a volvulus needs
to be surgically reduced before it leads to gangrene of a segment of the bowel.
Acute pancreatitis needs to be supportively treated and the pain needs to be suppressed
with narcotics, the same is true for kidney stones. Quite a number of diseases
are treated by not giving anything by mouth and resting the gut through the use
of intravenous fluids for a period of time. This is true for pancreatitis, for
acute cholecystitis, ileus and ulcerative colitis just to mention a few. Disclaimer This
outline is only a teaching aid to patients and should stimulate you to ask the
right questions when seeing your doctor. However, the responsibility of treatment
stays in the hands of your doctor and you. References 1.
DM Thompson: The 46th Annual St. Paul's Hospital CME Conference for Primary Physicians,
Nov. 14-17, 2000, Vancouver/B.C./Canada 2. C Ritenbaugh Curr Oncol Rep
2000 May 2(3): 225-233. 3. PA Totten et al. J Infect Dis 2001 Jan 183(2):
269-276. 4. M Ohkawa et al. Br J Urol 1993 Dec 72(6):918-921. 5.
Textbook of Primary Care Medicine, 3rd ed., Copyright © 2001 Mosby, Inc., pages
976-983: "Chapter 107 - Acute Abdomen and Common Surgical Abdominal Problems". 6.
Marx: Rosen's Emergency Medicine: Concepts and Clinical Practice, 5th ed., Copyright
© 2002 Mosby, Inc. , p. 185:"Abdominal pain". 7. Feldman: Sleisenger
& Fordtran's Gastrointestinal and Liver Disease, 7th ed., Copyright © 2002
Elsevier, p. 71: "Chapter 4 - Abdominal Pain, Including the Acute Abdomen".
8. Ferri: Ferri's Clinical Advisor: Instant Diagnosis and Treatment, 2004
ed., Copyright © 2004 Mosby, Inc. Last Modified:
Feb. 21, 2012 | 
