We can hardly find a person who has not suffered abdominal pain at least once in their life. Abdominal pain can be of different types, caused by a variety of causes ranging from simple diseases to life-threatening diseases. Regardless of cause and severity, this poses a problem for patients who need to see a doctor.
The abdomen is the part of the body located between the thorax and the pelvis, which is separated from the thorax by a diaphragm and the true pelvis by an imaginary plane. Previously, the anterior abdominal wall supports it, then the spine and back muscles. Skin, superficial fascia, deep fascia, muscles, layers of fascia (transverse fascia), extra peritoneal connective tissue and the outer layer of the peritoneum of the anterior abdominal wall. The abdominal cavity extends into the concavity of the diaphragm and descends into the pelvic cavity. Since the ribs overlap at the top and the pelvic bones at the bottom, the exact size of the abdominal cavity is masked.
The abdomen contains digestive organs such as the stomach, small intestine, large intestine, liver, gallbladder, pancreas and genitourinary organs, such as kidneys, ureters, bladder, fallopian tubes, ovaries and blood vessels. It also contains organs such as the spleen, adrenal glands, mesenteric lymph nodes, blood vessels and lymphatic vessels, and so on. The ligaments formed by the peritoneal tissue adhere to these organs and hold them in position. The peritoneum is a large serous membrane lining the abdominal cavity and has two layers. The outer layer is called parietal peritoneum and covers the inner surface of the abdominal wall and the inner layer is called visceral peritoneum, which covers the organs and limits their mobility. These two layers of the peritoneum are connected by an omentum and a mesentery through which the organs obtain the blood supply and the feeding of the nerves. The cavity formed by the two layers of the peritoneum is a potential space, called the peritoneal cavity, which is moistened with a serous fluid to avoid friction of the abdominal contents.
Types of abdominal pain:
Depending on the origin, there may be different types of abdominal pain.
- Visceral pain (splanchnic pain): It is caused by the stimulation of the visceral nerves by a harmful agent, which may be a living organism, toxins, mechanical stimuli such as stretching, excessive muscular contraction or ischemia. Visceral pain is dull by nature, poorly located and in the midline.
- Pain on the wall: it is also called somatic pain. Some harmful agents stimulate the parietal peritoneum by causing acute and localized pains. This type of pain is worse because of the movements.
- Referred pain: here, the pain, which comes from other sources, is felt in the abdomen by the feeding of the common nerves. Example: conditions such as pleuritis, pericarditis, torsion tests, etc. They cause pain in the abdominal area due to the presence of nerves with the same value as the root (segments of the spine).
It has already been mentioned that abdominal pain has died for the affected person and their family members, regardless of their cause and severity. The intensity of the pain may not always indicate the severity of the condition, as severe pain may be due to mild conditions such as indigestion and flatulence, while mild pain may occur in such situations.
Modes of presentation of abdominal pain:
- Acute abdominal pain: here the pain is sudden, with a rapid onset and a short course, which may be due to serious or minor injuries. The term “acute abdomen” is used in conditions in which the patient complains of acute abdominal symptoms that suggest a life-threatening illness or that may or may not require urgent surgery. Acute pain may be of a colonic nature or not.
- Chronic abdominal pain: the pain is persistent and recurrent or is characterized by long-suffering. The complaints persist for a long time with fluctuations in the intensity of the symptoms.
- Sub-acute abdominal pain: as its name suggests, the duration of pain varies between acute and chronic conditions.
- Acute exacerbation: in this state, a person with chronic symptoms is manifested by the sudden onset of symptoms that simulate an acute condition. In such cases, the patient or witnesses present the history of chronic suffering.
Causes of abdominal pain:
The etiology of abdominal pain can be discussed under the following headings.
- Pain caused by abdominal injury: Example: gastritis, duodenitis, appendicitis, peritonitis, pancreatitis, intestinal obstruction, renal colic, cholecystitis, obstructed gallstones, peptic ulcer, intestinal perforation, non-ulcer dyspepsia, food allergy, hepatitis, liver, hepatitis , mesenteric lymphadenitis, inflammatory bowel diseases (ulcerative colitis, Crohn’s disease), dysentery, cancer of the gastrointestinal tract (GIST), abdominal tuberculosis, abdominal migraine, acute regional ileitis, etc.
- Pain related to metabolic and general problems: Example: intoxication, kidney failure, diabetes, thyroid problems, hyperparathyroidism, porphyria, medication, lead colic, black widow spider bite, blood diseases, malaria, leukemia, nodular, periarteritis, hereditary angioedema, hereditary angioedema, cystic fibrosis.
- Pain due to lesions located outside the abdomen (referred pains and neuralgic pains): pain is evoked here by other sites due to common in nominations. Example: pneumonia, myocardial infarction, subacute bacterial endocarditis, torsion test, etc. The pain resulting from certain neurogenic lesions is also included in this category. Example: shingles, spinal nerve pain, dorsal tabs, a column for tuberculosis, abdominal epilepsy, etc.
- Functional pain: pain does not cause injuries, mainly due to certain psychological causes. Example: panic disorder, school stress, somatization disorder, history of sexual abuse, irritable bowel syndrome.
- Pain associated with urinary tract injury: injuries of the upper and lower urinary tract cause abdominal pain. Example: urinary tract infection, cystitis, pyelonephritis, urinary retention, renal colic, ureteral colic.
- Pain related to gynecological and obstetric problems: although the gynecological organs are found in the pelvis, most lesions are manifested by low abdominal pain. Examples: menstrual colic, broken ectopic pregnancy, acute salpingitis, endometriosis, endometritis, pelvic inflammatory disease, polyp’s torsion, pelvic abscess, pain related to UICD, puerperal infection.
- Causes in children: In children, some common causes should be mentioned. Examples: baby colic, lactose intolerance, milk allergy, intussusception, volvulus, testicular torsion, accidental ingestion, streptococcal throat infection, congenital megacolon, food excess, food allergy, aerophagia.
- Non-specific abdominal pain: no immediate cause is found here, even after taking antecedents and investigations.
In approximately 35-40% of cases of abdominal pain, the cause may not be easily identified and, therefore, treated symptomatically. However, if the pain persists with the appearance of other signs and symptoms that indicate the underlying cause, it should be identified as soon as possible to properly manage the case.
A provisional diagnosis of the disease:
Here, the probable condition that causes abdominal pain is diagnosed taking into account clinical history, signs and symptoms, as well as other clinical findings.
This includes several diagnostic procedures that can help in the final diagnosis of the disease. The choice of research depends on the signs and symptoms that indicate a probable condition. Good research helps to make a final diagnosis.
Example: routine blood, routine urine, blood biochemistry, stool examination, X-rays, barium X-ray ultrasound, GIT endoscopy, computed tomography, magnetic resonance, gastric acid secretion studies, laparoscopy, mucosal biopsy, ECG, excretory urography, nephropathy, VIP, exploratory laparotomy, etc. These are useful surveys.
The final diagnosis of the disease:
After performing the necessary investigations, the disease or condition causing the abdominal pain is diagnosed by correlation with the clinical outcome and the patient’s medical history. In the case of a diagnostic problem, a team of doctors is involved in the diagnosis and management.