Abdominal pain the headache for doctors

Introduction

Abdominal pain is pain that is felt in the abdomen. The abdomen is an anatomical area that is bounded by the lower margin of the ribs and diaphragm above, the pelvic bone (pubic ramus} below and the flanks on each side. Although abdominal pain can arise from the tissues of the abdominal wall that surround the abdominal cavity (such as the skin and abdominal wall muscles), the term abdominal pain generally is used to describe pain originating from organs within the abdominal cavity.

Etiology

Abdominal pain is caused by inflammation, by stretching or distention of an organ (for example, obstruction of the intestine, blockage swelling of the liver with hepatitis), or by loss of the supply of blood to an organ (for example, ischemic colitis).

To complicate matters, however, abdominal pain also can occur without inflammation, distention or loss of blood supply. An important example of this latter type of pain is the irritable bowel syndrome (IBS). It is not clear what causes the abdominal pain in IBS, but it is believed to be due either to abnormal contractions of the intestinal muscles (for example, spasm) or abnormally sensitive nerves within the intestines that give rise to painful sensations inappropriately (visceral hyper-sensitivity). These latter types of pain are often referred to as functional pain because no recognizable (visible) causes for the pain have been found - at least not yet.

Clinical features

• The presence of fever suggests inflammation.
• Diarrhea or rectal bleeding suggests an intestinal cause of the pain.
• The presence of fever and diarrhea suggest inflammation of the intestines that may be infectious or non-infectious (ulcerative colitis or Crohn's disease).

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.

After the visit to the doctor, do not expect an instant cure or immediate diagnosis, and remember:

• Multiple office visits and tests (blood tests, radiographic studies, or endoscopic procedures) are often necessary to establish the diagnosis and/or to exclude serious illnesses.

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