About Stomach Pain and Abdominal Pain

Abdominal pain occurs in a wide range of conditions, from acute diseases that can become life-threatening in a short time to chronic diseases caused by functional disorders. Abdominal pain is mainly caused by digestive organs within the abdominal cavity, such as the stomach, small intestine, large intestine, liver, gallbladder, and pancreas. However, it is sometimes also caused by organs located outside the abdominal cavity, such as the heart, lungs, kidneys, uterus, and ovaries. When abdominal pain is the main symptom, the cause is first identified through medical history, physical examination, and general tests, and then appropriate treatment is provided.

Causes

The causes of abdominal pain are very diverse. Abdominal pain can occur not only from diseases within the abdomen but also from diseases outside the abdomen. In addition, abdominal pain can also be caused by systemic diseases or neurological diseases.

Causes within the abdomen

· Inflammation of the peritoneum: bacterial infection, perforation of the intestinal tract, pelvic inflammation

· Chemical irritation: perforation of an ulcer, pancreatitis

· Obstruction of the intestinal tract: small or large bowel obstruction, bile duct obstruction, ureteral obstruction

· Blood abnormalities: thrombosis, blood vessel rupture, sickle cell anemia

· Abdominal wall: abdominal wall muscle injury, torsion of the mesentery

· Distension of the intestinal wall: distension of the liver or kidney capsule

· Intestinal inflammation: appendicitis, typhoid fever, cecitis

Causes outside the abdomen

· Chest diseases: acute myocardial infarction, myocarditis, endocarditis, pericarditis, pneumonia, pulmonary embolism, pneumothorax, empyema, esophageal disease

· Reproductive diseases: testicular torsion

· Systemic diseases: renal failure (loss of kidney function), very severe hyperlipidemia, hyperparathyroidism, acute adrenal insufficiency,

porphyria

· Neurological diseases: herpes zoster, spinal or peripheral nerve tumors, degenerative spinal arthritis (disc disease)

· Others: mental illness, muscle contusion, heat stroke, lead poisoning

Diagnosis

When abdominal pain is the main symptom, the cause is diagnosed through the characteristics of the pain—such as when and where it started, the nature and duration of the pain—along with physical examination, blood tests, imaging tests, and endoscopic tests.

1. Characteristics of the pain

1. Onset of pain

When abdominal pain develops suddenly, it means the cause also occurred suddenly. For example, abdominal pain may appear suddenly when blood supply to the large intestine is suddenly cut off or when the bile duct becomes suddenly blocked.

2. Location of the pain

In typical cases, pain occurs near the organ where the disease has developed. Pain near the upper abdomen is mainly caused by diseases of the stomach, duodenum, or pancreas. Pain in the right upper abdomen is caused by the gallbladder, duodenum, pancreas, or right colon. Pain near the navel is often caused by the small intestine, aorta, or pancreas. Appendicitis causes pain in the lower right abdomen, where the appendix is located; diverticulitis causes pain in the lower right or lower left abdomen, where diverticula commonly occur; and pain from the gallbladder causes pain in the upper right abdomen.

3. Nature of the pain

Pain caused by obstruction of the gastrointestinal tract produces cramping pain due to intestinal contractions. Pain caused by obstruction of the bile duct by gallstones results in persistent pain, usually lasting from 30 minutes to several hours. Acute pancreatitis causes severe, persistent pain in the upper abdomen or across the back. Acute appendicitis initially presents as pain near the navel, but as the inflammation continues, the pain shifts to the lower right abdomen.

4. Duration of pain

Pain due to irritable bowel syndrome is characterized by repeated episodes of worsening and improvement over several months or years. Pain arising from the bile ducts generally does not last longer than 3–4 hours. Pain due to pancreatitis often persists continuously for more than a day. Pain caused by stomach acid, such as from gastric ulcers, duodenal ulcers, and reflux esophagitis, tends to show a cyclical pattern. Pain due to functional disorders also tends to be cyclical, but unlike pain caused by stomach acid, it follows a chronic course.

5. What worsens the pain

The typical pattern of pain caused by inflammation such as appendicitis, diverticulitis, cholecystitis, and pancreatitis is that it worsens with actions that increase abdominal pressure, such as blowing the nose or coughing.

6. What relieves the pain

Pain due to irritable bowel syndrome or constipation improves after a bowel movement. Pain caused by obstruction of the upper gastrointestinal tract is temporarily relieved by vomiting. If pain wakes a person from sleep in the middle of the night, the cause is unlikely to be a functional disorder.

7. Accompanying symptoms or signs

If there is a fever, inflammation is suspected. Diarrhea or bloody stools suggest an intestinal disease.

2. Examination findings

Healthcare professionals listen to bowel sounds to check whether the pain is caused by an intestinal obstruction. They also press on the abdomen and then release it to identify the location of the pain and to check whether inflammation has spread to the peritoneum. If the patient feels pain when a certain part of the abdomen is pressed, further tests are first performed to see whether there is an abnormality in the organs in that area. During the examination, they also check whether any mass can be felt.

3. Test findings

1. Blood and urine tests

Various blood tests may be performed to identify the cause of abdominal pain. An increase in white blood cell count in the blood suggests inflammation or infection, such as appendicitis, pancreatitis, diverticulitis, or colitis. In pancreatitis, the levels of enzymes secreted by the pancreas, such as amylase and lipase, rise in the blood. Liver enzyme levels are mainly elevated in hepatitis, and may also increase in diseases caused by gallstones. Blood in the urine indicates a problem in the kidneys, ureters, or bladder.

2. Plain X-ray

If the bowel is paralyzed or obstructed, dilated bowel loops can be seen. If perforation occurs due to a gastric ulcer or duodenal ulcer, free air in the abdominal cavity outside the intestine may be observed. Sometimes a white shadow may be seen in the kidneys or ureters, and in such cases the cause of pain may be a urinary tract disease.

3. Abdominal ultrasound

It can be useful for examining gallstones, cholecystitis, appendicitis, or ovarian problems.

4. Computed tomography (CT)

Computed tomography can provide an overall view of the organs inside the abdomen. It is especially useful for diagnosing abdominal pain caused by pancreatitis, pancreatic cancer, appendicitis, and diverticulitis. It is also useful for diagnosing intestinal disorders such as Crohn’s disease.

5. Magnetic resonance imaging (MRI)

Like computed tomography, magnetic resonance imaging can observe the entire inside of the abdomen, but it has limitations in observing moving organs. However, its advantage is that it does not expose the patient to radiation, unlike computed tomography.

6. Endoscopy

Upper gastrointestinal endoscopy can observe the esophagus, stomach, and part of the duodenum. It is especially useful in countries like Korea, where the prevalence of stomach cancer is high. Colonoscopy can observe diseases of the colon and the terminal ileum. However, performing colonoscopy in cases of acute intestinal disease requires caution. Endoscopic ultrasound, which has an ultrasound device attached to the end of the endoscope, is very useful for diagnosing pancreatic diseases or gallstones located deep in the abdomen. In particular, bile duct stones are sometimes not seen on abdominal ultrasound or computed tomography, so endoscopic ultrasound is very useful. The small intestine is located in the middle of the gastrointestinal tract and is long, making endoscopic access difficult. However, recent developments such as capsule endoscopy and small bowel endoscopy, which can observe the entire small intestine, have greatly helped diagnose small intestinal diseases compared with the past.

So far, I have explained abdominal pain.

In the next installment, we will look at stress, a chronic problem of modern people.

Source: Korea Centers for Disease Control and Prevention National Health Information Portal