ABDOMINAL PAIN

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Alternative names:

abdominal cramps; belly ache; pain in the abdomen; stomach pain

Definition:

Pain in the belly (often referred to as stomach pain) or in the abdominal area. 

Considerations:

Abdominal pain is a nonspecific symptom that may be associated with a multitude of conditions. Some do not occur within the abdomen itself but cause abdominal discomfort; an example would be the abdominal pain associated with strep throat. Some originate within the abdomen but are not related to the gastrointestinal tract, such as a dissecting aortic aneurysm. Other pain is related directly to the gastrointestinal tract. 

The severity of the pain does not always reflect the severity of the condition causing the pain. Severe abdominal pain can be associated with mild conditions such as gas or the cramping of viral gastroenteritis, while relatively mild pain (or no pain) may be present with severe and life-threatening conditions such as cancer of the colon or early appendicitis. 

Abdominal pain can be cause by toxins, infection, biliary tract disease, liver disease, renal disease, bladder infections, menstruation, ovulation, female and male genitourinary disease, vascular problems, malignancy, ulcers, perforation, pancreatic disease, hernias, trauma, and metabolic diseases. The list is so extensive that it would be impossible to name all the possible diseases in each of the above groups. 

Because abdominal pain is nonspecific, the health care provider will require much more information regarding the time of onset, duration of pain (minutes, hours, days, or even months), location of pain, nature of pain (dull, sharp, steady, crampy, off and on), severity of pain and relationship to normal functions such as menstruation and ovulation. 

The location of pain and its time pattern may be helpful in suggesting its cause. During physical examination, the health care provider will try to determine if the pain is localized to a single area (point tenderness) or diffuse and if the pain is related to inflammation of the peritoneum or of the abdomen. If the health care provider finds evidence of peritoneal inflammation, the abdominal pain may be classified as an "acute abdomen" which often requires prompt surgical intervention. 

In addition the health care provider will try to relate the abdominal tenderness to other general symptoms such as fever, fatigue, general ill feeling (malaise), nausea, vomiting, or changes in stool. Then the provider will ask about increasingly specific symptoms as the diagnostic considerations are narrowed. 

In infants, prolonged unexplained crying (often called "colic") may be caused by abdominal pain that often ends with the passage of gas or stool. Usually, colic begins around the 3rd week of life and peaks at about 3 to 4 months. Colic is often worse in the evening. Cuddling and rocking the child may bring some relief. 

Severe abdominal pain that occurs during menstruation may indicate a problem in a reproductive organ. This includes conditions such as endometriosis, uterine fibroids, ovarian cysts, ovarian cancer (rare), or pelvic inflammatory disease (PID). 

Abdominal pain that may indicate a potential emergency condition includes: 

  •  severe abdominal pain with nausea and a fever
  •  it may indicate appendicitis or complications of diverticulitis
  •  abdominal pain, nausea, fever, and bloating or constipation
  •  may indicate a bowel obstruction
  •  abdominal pain that is accompanied by a stiff ("board-like") abdomen
  •  may indicate peritonitis
  •  abdominal pain is accompanied by bloody stools or vomiting blood
  •  gastrointestinal bleeding from any cause can be dangerous

Common causes:

The following is a list of the most common causes of abdominal pain. It is important to note that among this list there are relatively few serious diseases.

  • bladder infections
  • cholecystitis and/or gallstones
  • colic in infants (infants to 4 months)
  • excessive gas
  • endometriosis
  • food allergy
  • food poisoning (salmonella, shigella)
  • hernia
  • indigestion
  • kidney stones
  • lactose intolerance (milk intolerance)
  • menstrual cramping
  • ovarian cysts
  • pelvic inflammatory disease (PID)
  • pneumonia (in children)
  • recurrent abdominal pain (usually in children and adolescents; a type of somatization disorder where emotional upset is reflected as physical discomfort)
  • streptococcal pharyngitis (strep throat, in children this can cause abdominal pain)
  • ulcers
  • uterine fibroids
  • viral gastroenteritis (stomach flu)

Less common, but serious:

  • ovarian cancer
  • colon cancer or other abdominal cancer
  • appendicitis
  • diverticulitis
  • bowel obstruction
  • peritonitis 

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