Abdominal Pain
Description
- Parietal pain:
- Irritating material causing peritoneal inflammation
- Pain transmitted by somatic nerves
- Exacerbated by changes in tension of the peritoneum
- Pain characteristics:
- Sharp
- Well localized
- Abdominal tenderness
- Involuntary guarding
- Rebound tenderness
- Exacerbated by movement and coughing
- Visceral pain:
- Distention of a viscous or organ capsule or spasm of intestinal muscularis fibers:
- Pain is generally poorly localized.
- Colicky with intestinal distention
- Constant with a distended gallbladder or kidney
- Inflammation:
- Initially, the pain is poorly localized.
- Focal tenderness develops as the inflammation extends to the peritoneum or localizers.
- Ischemia from vascular disturbances:
- Pain is severe and diffuse with catastrophic vascular emergencies
- Pain is disproportional to the abdominal examination
- Referred pain:
- Felt at distant location from diseased organ
- Due to an overlapping supply by the affected neurosegment to the perceived location of pain
- Abdominal wall pain:
- Constant
- Aching
- Muscle spasm
- Involvement of other muscle groups
Etiology
- Peritoneal irritants:
- Gastric juice
- Fecal material
- Pus
- Blood
- Bile
- Pancreatic enzymes
- Visceral obstruction:
- Small intestines
- Large intestines
- Gallbladder
- Ureters and kidneys
- Visceral ischemia
- Intestinal
- Renal
- Splenic
- Visceral inflammation:
- Appendicitis
- Inflammatory bowel disorders
- Cholecystitis
- Hepatitis
- Peptic ulcer disease
- Pancreatitis
- Pelvic inflammatory disease
- Pyelonephritis
- Abdominal wall pain
- Referred pain:
- The possibility of intrathoracic disease must be considered in every patient with abdominal pain.
Diagnosis
Signs and Symptoms
- General:
- Anorexia
- Malaise
- Tachycardia
- Hypotension
- Fever
- Nausea
- Vomiting:
- Etiology requiring surgical intervention is less likely when vomiting precedes the onset of pain
- Abdominal:
- Diarrhea
- Constipation
- Distended abdomen
- Abnormal bowel sounds:
- High-pitched rushes with bowel obstruction
- Absence of sound with ileus or peritonitis
- Often unreliable
- Pulsatile abdominal mass
- Rovsing sign:
