Abdominal Pain

Abdominal Pain

Nadine Z. Villarin

Acute Abdominal Pain It is important to understand the physiology of pain specific to each organ and site in the abdomen. For instance, distention of the bowel produces pain, whereas mechanical laceration does not.

pain arising in the viscera vagal visceral afferent nerves and sympathetic afferent nerves sensations: • Deep • Boring • poorly localized – frequently accompanied by autonomic features such as nausea, vomiting, and diaphoresis.

Pain transmitted via the spinal somatic afferent nerves innervating the body wall and peritoneum generally described as: • sharp • well localized to the anatomic site of the inflammation or injury.

knowledge of the innervation of each abdominal organ will help the examiner understand the nature and pattern of the patient's pain history.

Severe, acute abdominal pain can lead to a variety of disorders from the benign to the Immanently life-threatening. The specific diagnosis must be sought with a sense of urgency, because early surgical intervention may be lifesaving in some disorders: • leaking abdominal aortic aneurysm • appendicitis

and contraindicated in others: • acute intermittent porphyria • sickle cell crisis.

Some assistance is obtained from Imaging examinations, while laboratory tests are less important. A careful history and personally repeated examinations over a few hours are mandatory. Important in Examination: – Location of pain – Tenderness – Variations in quality – Severity of symptoms

Fig. 9-19 Common Locations of Acute Abdominal Pain. In general, the painful spot is also tender, but not always. Note especially that the pain of acute appendicitis is in the epigastrium early and later in the right lower quadrant. Pain in the spleen commonly radiates to the top of the left shoulder. These pains are ordinarily constant, in contrast to the intermittent pain of colic.

Chronic and Recurrent Abdominal Pain • Chronic pain is physiologically different from acute pain. • The pattern of pain and associated symptoms will help to make inferences about the possible pathophysiology, while the location of the pain suggests the organs involved.

Pain that is vague in onset but steadily worsens over time suggests a progressive anatomically advancing obstructive lesion or mass effect. Intermittent pain separated by periods free of pain suggests painful smooth-muscle contraction or dynamic obstruction, recurrent inflammation or ulceration, and relapsing infection.

Careful history is required to identify: • • • •

precipitating factors Timing previous surgeries symptoms, or illnesses that could help explain the current problem

It is important to recognize that nonspecific abdominal and pelvic pain is a common symptom in persons with histories of current or previous abuse. If the history and physical exam do not suggest specific leads for further investigation, a barrage of laboratory and imaging tests are extremely unlikely to be helpful. There is a tendency to project pain inward to intraabdominal structures when it actually arises from the abdominal wall.