Abdominal Pain: General
DEFINITION:
No clear definitions of acute vs. chronic abdominal pain
Pain less than a few days that has worsened progressively until time of presentation is ‘acute’
Characterized by severe pain, often rapid onset, that prevents bodily movement; surgical intervention may be necessary
Pain that has remained unchanged for months or years can be safely classified as ‘chronic’
Pain that does not clearly fit either category may be called ‘subacute’ and requires consideration of differential for both acute/chronic
ETIOLOGIES:
Most gut (visceral) nociceptors are sensitive to stretch: distention of hollow viscus (i.e. obstruction), muscular contractions (i.e. biliary/renal colic), stretching of solid organ serosa or capsule (i.e. hepatic congestion), torsion of mesentery (i.e. cecal volvulus), tension from traction of the mesentery (i.e. retroperitoneal or pancreatic tumors)
Abdominal pain may be classified into three categories: Visceral, Somatoparietal, Referred
Visceral pain: occurs when noxious stimuli affect the abdominal viscus
Usually dull (cramping, gnawing, burning) and poorly localized to the ventral midline due to innervation being multisegmental
Secondary autonomic effects such as diaphoresis, restlessness, nausea, vomiting, and pallor are common
Somatoparietal pain: occurs when noxious stimuli irritate the parietal peritoneum
Usually more intense and more precisely localized on the side of the lesion (i.e. McBurney’s point inflaming the parietal peritoneum)
Pain is likely to be aggravated by coughing or movement
Referred pain: experienced in areas remote from the site of injury
The remote pain site is supplied by the same neurosegment as the involved organ
Examples include gallbladder pain referred to right scapula, pancreatic pain referred and radiates to the mid back
Thoracic: pneumonia, pulmonary embolism, pneumothorax, MI, esophageal spasm or perforation
Neurogenic: tabes dorsalis, radicular pain (cord compression from tumor, abscess, varicella zoster)
Metabolic: uremia, porphyria, acute adrenal insufficiency
Toxins: insect bites (scorpion bite-induced pancreatitis), lead poisoning
Common causes of acute abdominal pain in gravid women
Appendicitis, cholecystitis, pyelonephritis, ovarian cysts complicated by torsion/rupture, ectopic pregnancy
If suspected appendicitis proves to be a normal appendix during laparotomy, removal triples the risk of fetal loss
Common cause of acute abdominal pain in elderly
Biliary tract disease responsible ˜25% of cases; Followed by malignancy, bowel obstruction, PUD, incarcerated hernia, appendicitisRelated posts:
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