Abdominal pain can be a challenging complaint, especially for those of us who specialize in natural medicine. This type of pain is frequently a benign complaint, but can also herald serious acute pathologies. At least some type of abdominal pain is present in more than 60 percent of an otherwise healthy adolescent and adult population. Here are the most significant sources of pain, their location and when you should seek treatment.
The history and physical examination are central to narrowing the differential diagnosis of abdominal pain and guiding the evaluation.
The history is the most important clue to the source of abdominal pain. The pain may be categorized by its underlying mechanism:
· Visceral pain is usually dull and aching in character, although it can be colicky; it is often poorly localized. It arises from distention or spasm of a hollow organ such as the discomfort
experienced early in intestinal obstruction or cholecystitis.
· Parietal pain is sharp and very well localized. It arises from peritoneal irritation such as the pain of acute appendicitis with spread of inflammation to the parietal peritoneum.
· Referred pain is aching and perceived to be near the surface of the body.
The location, chronology, severity, aggravating and alleviating factors, and associated symptoms helps your health practitioner assess the exact diagnosis.
The evaluation of abdominal pain requires an understanding of the possible mechanisms responsible for pain, a broad differential of common causes, and recognition of typical patterns and clinical presentations. All patients do not have classic presentations.
9 Diagnostic Areas For Pain
There are typically 9 diagnostic groups (see image above) can be classified in patients complaining of abdominal pain: epigastric, right subcostal, left subcostal, right flank, left flank, periumbilical, right-lower, mid-lower, and left-lower.
A diagnostic approach appropriate for most patients with abdominal pain is aimed at appropriately distinguishing functional disorders from more serious etiologies of abdominal pain.
Since the causes of the following disorders are extensive, I will briefly outline the symptoms of each of 16 primary sources of abdominal pain without detailing the root cause of each (to be covered in a follow-up report).
1. Gall Stones
If you have symptoms, you most likely will have mild pain in the pit of your stomach or in the upper right part of your belly. Pain may spread to your right upper back or shoulder blade area. Sometimes the pain is more severe. It may be steady, or it may come and go. Or it may get worse when you eat.
When gallstones keep blocking a bile duct, you may have pain with fever and chills. Or your skin or the whites of your eyes may turn yellow. Call your health practitioner right away. Having stones in your bile duct increases your chance of having a swollen pancreas (pancreatitis). These symptoms may also be a sign of an infected gallbladder.
2. Stomach (Peptic) Ulcer
Peptic ulcers are open sores that develop on the inside lining of your stomach and the upper portion of your small intestine. The most common symptom of a peptic ulcer is abdominal pain. While excessive stomach acid secretion certainly plays a role in the development of ulcers, a relatively recent theory holds that bacterial infection is the primary cause of peptic ulcers. Indeed, research conducted since the mid-1980s has persuasively demonstrated that the bacterium Helicobacter pylori (H. pylori) is present in more than 90% of duodenal ulcers and about 80% of stomach ulcers.
There are also millions of misdiagnoses for ulcers and gastrointestinal (GI) distress which are caused by too little acid rather than too much causing making problems far worse for patients once medical intervention of this kind is followed. Meanwhile, natural foods have the power to heal many ulcer and GI related issues with no side effects and virtually no recurrence of symptoms.
Pancreatitis is a disease in which the pancreas becomes inflamed. Pancreatic damage occurs when the digestive enzymes are activated before they are secreted into the duodenum and begin attacking the pancreas.
Symptoms include upper abdominal pain that radiates into the back; patients may describe this as a "boring sensation" that may be aggravated by eating, especially foods high in fat. Swollen and tender abdomen as well as nausea and vomiting may also exist.
The symptoms of chronic pancreatitis are similar to those of acute pancreatitis. Patients frequently experience constant pain in the upper abdomen that radiates to the back. In some patients, the pain may be disabling. Other symptoms may include weight loss caused by poor absorption (malabsorption) of food. This malabsorption occurs because the gland is not secreting enough enzymes to break down the food normally.
Most people have felt heartburn ir indigestion at one time or another. In fact, the American Gastroenterological Association reports that more than 60 million Americans experience heartburn/GERD (gastroesophageal reflux disease) symptoms at least once each month. Though uncomfortable, heartburn does not usually pose a serious health problem for most people.
However, if heartburn symptoms occur frequently and persistently, it may be a sign of a more serious problem, such as GERD. GERD is a chronic reflux of acid into the esophagus.
Symptoms include a burning feeling in the chest just behind the breastbone that occurs after eating and lasts a few minutes to several hours. Chest pain, especially after bending over, lying down, or eating. Burning in the throat -- or hot, sour, acidic, or salty-tasting fluid at the back of the throat. Difficulty swallowing. Feeling of food "sticking" in the middle of the chest or throat.
5. Epigastric Hernia
An epigastric hernia occurs when fat pushes through a weak part of the belly wall. It occurs in the middle of the belly between the breastbone and the belly button, or navel. Most of the time, these hernias are small. You can have more than one at a time. Epigastric hernias often have no symptoms. But they can cause pain in the upper belly.
6. Duodenal Ulcer
When the ulcer is in the duodenum, it is called a duodenal ulcer. The symptoms are similar to stomach ulcers. That gnawing or burning pain in the abdomen between the breastbone and the navel. The pain often occurs between meals and in the early hours of the morning. It may last from a few minutes to a few hours. Less common ulcer symptoms may include: belching, nausea, vomiting, poor appetite, loss of weight, feeling tired and weak.
7. Biliary Colic
Biliary colic is the term used to describe a type of pain related to the gallbladder that occurs when a gallstone transiently obstructs the cystic duct and the gallbladder contracts. Pain is the most common presenting symptom. It is usually described as sharp right upper quadrant pain that radiates to the right shoulder, or less commonly, retrosternal. Nausea and vomiting can be associated with biliary colic. Individuals may also present with pain that is induced following a fatty meal and the symptom of indigestion. The pain often lasts longer than 30 minutes, up to a few hours
8. Kidney Stones
Kidney stones (renal lithiasis) are small, hard deposits that form inside your kidneys. The stones are made of mineral and acid salts. Kidney stones have many causes and can affect any part of your urinary tract -- from your kidneys to your bladder. Often, stones form when the urine becomes concentrated, allowing minerals to crystallize and stick together.
The hallmark of stones that obstruct the ureter or renal pelvis is excruciating, intermittent pain that radiates from the flank to the groin or to the genital area and inner thigh. This particular type of pain, known as renal colic, is often described as one of the strongest pain sensations known.
9. Urinary Tract Infection
A urinary tract infection (UTI) (also known as acute cystitis or bladder infection) is an infection that affects part of the urinary tract. Symptoms from a lower urinary tract include painful urination and either frequent urination or urge to urinate (or both), while those of pyelonephritis include fever and flank pain in addition to the symptoms of a lower UTI. Some pain above the pubic bone or in the lower back may be present.
Constipation occurs when bowel movements become difficult or less frequent. Going longer than three days without a bowel movement is too long. After three days, the stool or feces become harder and more difficult to pass. You are considered constipated if you have two or more of the following for at least 3 months: Straining during a bowel movement more than 25% of the time; Hard stools more than 25% of the time; Incomplete evacuation more than 25% of the time; or Two or fewer bowel movements in a week. Symptoms may include infrequent bowel movements and/or difficulty having bowel movements and swollen abdomen or abdominal pain.
11. Lumbar Hernia
A hernia is the protrusion of an organ or the fascia of an organ through the wall of the cavity that normally contains it. Lumbar hernias occur through defects in the lumbar muscles or the posterior fascia, below the 12th rib. Patients with lumbar hernias can present with a variety of symptoms, including a back pain, bowel obstruction (if contents contain bowel), or urinary obstruction (if contents are kidney / ureter).
12. Umbilical Hernia
An umbilical hernia occurs when part of the intestine protrudes through an opening in the abdominal muscles. Umbilical hernias often develop in infants but may also develop in adults, especially if they are very overweight, lifting heavy objects, or have a persistent cough. Women who have had multiple pregnancies have a higher risk of developing an umbilical hernia. The hernia looks like a lump in the navel, which may become more evident when laughing, crying, heaving (going to the toilet), or coughing.
Diverticulosis happens when pouches (diverticula) form in the wall of the colon. If these pouches get inflamed or infected it can be very painful. Symptoms of diverticulitis may last from a few hours to a week or more. The primary symptoms is belly pain, usually in the lower left side, that is sometimes worse when you move. This is the most common symptom.
14. Inflammatory Bowel
Inflammatory bowel disease (IBD) involves chronic inflammation of all or part of your digestive tract. IBD primarily includes ulcerative colitis and Crohn's disease. IBD can be painful and debilitating, and sometimes leads to life-threatening complications. Ulcerative colitis is an inflammatory bowel disease that causes long-lasting inflammation in part of your digestive tract. Symptoms usually develop over time, rather than suddenly. Ulcerative colitis usually affects only the innermost lining of your large intestine (colon) and rectum. It occurs only through continuous stretches of your colon. Crohn's disease is an inflammatory bowel disease that causes inflammation anywhere along the lining of your digestive tract, and often spreads deep into affected tissues.
All of these may present with any of the following symptoms: abdominal pain, vomiting, diarrhea, rectal bleeding, severe internal cramps/muscle spasms in the region of the pelvis and weight loss. Anemia is the most prevalent extraintestinal complication of inflammatory bowel disease.
Appendicitis is an inflammation of the appendix, a 3 1/2-inch-long tube of tissue that extends from the large intestine. Appendicitis can lead to a medical emergency that requires prompt surgery to remove the appendix (but this is rare).
The classic symptoms of appendicitis include: Dull pain near the navel or the upper abdomen that becomes sharp as it moves to the lower right abdomen. This is usually the first sign.
Almost half the time, other symptoms of appendicitis appear, including: Dull or sharp pain anywhere in the upper or lower abdomen, back, or rectum; Painful urination; Vomiting that precedes the abdominal pain; Severe cramps; Constipation or diarrhea with gas.
16. Inguinal Hernia
An inguinal hernia is a protrusion of abdominal-cavity contents through the inguinal canal. Hernias present as bulges in the groin area that can become more prominent when coughing, straining, or standing up. They are rarely painful, and the bulge commonly disappears on lying down. Significant pain is suggestive of strangulated bowel (an incarcerated indirect inguinal hernia). As the hernia progresses, contents of the abdominal cavity, such as the intestines, can descend into the hernia and run the risk of being pinched within the hernia, causing an intestinal obstruction.
Once you detect any of the above signs or symptoms for these conditions, you should seek the advice of your primary care physician to obtain a proper diagnosis.