ABDOMINAL PAIN

2nd gastrointestinal department

Si xi-jian

Abdominal Pain
Abdominal pain is the pain between chest
and groin. It is often referred to as the
stomach region or belly.
Abdominal pain comes from organs within
the abdomen or organs adjacent to the
abdomen.

Abdominal Pain
Abdominal pain is a very common clinical
symptom. It is a great challenge for physicians.

Generally, there are two kinds of

abdominal pain, acute abdominal pain and
chronic abdominal pain.

Causes of acute abdominal pain

1) peritonitis

2) acute inflammation of abdominal organs

3) swelling or obstruction of cavum
4) torsion or rupture of abdominal organs

5) thoracic illnesses
6) belly diseases (trauma)
7) disease of abdominal wall
8) whole-length diseases

1) Peritonitis:
The perforation of stomach or duodenum
is the most common reasons of peritonitis .

2) Acute inflammation of abdominal organs:

for instant: acute gastritis
acute enteritis
acute pancreatitis
acute cholecystitis ,and so on

Acute pancreatitis: the pancreas is necrosed

and partially liquefied.

If a patient has a history of eating some

unclean or too cold foods, accompanied with
vomiting, diarrhea and acute abdominal pain.
Its highly suggestive of acute gastroenteritis.

3) Dilation or obstruction of cavum

for instant: cholelithiasis
ileus
4) Torsion or rupture of abdominal organs:
for instant: the torsion of intestine or ovary
the rupture of liver or spleen

5) Thoracic illness:
for instant: pneumonia
miocardial infarction
If a old people feels epigastric pain, you
should routinely take a Electirocardiogram
(ECG). It helps distinguish abdominal
diseases from myocardial infarction.

6) Belly diseases (trauma):

for instant: contusion of belly
7) Disease of abdominal wall
for instant: contusion of abdominal wall
herpes zoster

herpes zoster

8) whole-length diseases:
for instant: uraemia
diabetic acidosis
abdominal allergic purpura

blutene chloaide

Causes of chronic abdominal pain

1) Chronic inflammation of abdominal organs
for instant : chronic gastritis
chronic cholecystitis
chronic pancreatitis
2) Gastric or duodenal ulcer (common )
3) Chronic torsion and obstruction of stomach
or intestine

ULCER

Barium meal examination showing an ulcer

crater with radiating mucosal folds reaching to
its rim, this suggests the ulcer is benign.

Gastric endoscopy

4) Increased tension of an envelope

for instant: liver cancer
liver abscess
hepatic gore
5) Toxicosis and metabolic disfunction: uremia
6) Encroachment and oppression of tumor

The dilation of visceral organs (such as liver)

can increase the tension of organs envelope, so
causes pain and other discomfort.

Pathogenesis
Abdominal pain may be classified as:
visceral pain,
somatic pain,
referred pain.

1. Visceral pain:
Visceral pain originates from internal
organs. Most visceral fibers have slow
conduction, and the abdominal viscera lake the
dense network of somatic afferent fibers. So
usually no distinct location, and may have
referred pain.

1. Visceral pain:
a. dull
b. no distinct location
c. accompanied symptom: nausea, vomiting,
sweating
such as: Pain derived from stomach, duodenum,
liver, biliary system or pancreas most often
presents with midline pain in the epigastrium.

2.Somatic pain:
Somatic pain originates from the
abdominal wall and parietal peritoneum.
The density of nerve fibers in the parietal
peritoneum is significantly greater than in
abdominal viscera. So somatic afferent
fibers allow more precise location of
stimulation.

2.Somatic pain:
a. Sharp, severe and continuous
b. Distinct location
c. Coughing and the change of body posture
can aggravate the pain.
Such as: peritonitis

3. Referred pain :
It is a pain localized to a site distant from
the abdominal organ from which the pain
originates.

3. Referred pain :
Referred pain originates from the internal
organs. It occurs because cutaneous and
visceral afferents terminate on the same
secondary neuron within the dorsal horn of the
spinal cord, resulting in wrong interpretation
by the brain of the correct origin of the
stimulations. It has distinct location.
Such as: right upper shoulder pain may result
from
cholecystitis.

Common
areas of
referred pain,
the dotted
area is on the
posterior
chest

Summary
visceral pain
dull

somatic pain
referred pain
sharp, severe
continuous
no distinct location distinct location distinct location
internal organs

peritonitis

cholecystitis

 Clinical features:
1) location:
2) character and intensity :
3) time course:
4) aggravating or alleviating factors:

5) inducement:

SHORT SUMMARY

We can sum-up inquire points in PQRST

P: provocative - palliative factors
(aggravating -alleviated factors )
Q: quality
R: region
S: severity
T: temporal characteristic

Review
1.Pathogenesis classification of abdominal pain.
2.What is referred pain, where does referred pain
locate in disease? such as heart infarction,
cholecystitis, appendicitis and so on.
3.The character of visceral pain, somatic pain,
referred pain.
4.The inquire points for abdominal pain.

Thank you for

you attention

1) location:
Pain site often indicates the organ responsible
for the problem.
A. Right upper quadrant pain is more typical of
cholecystitis.
B. Tenderness over McBurney s point should be
considered strong evidence of appendicitis.

C. Pain caused by colon diseases most often

presents in the midline lower abdomen.
D. Pain arising from the small intestine is
commonly localized to the surrounding region
of umbilicus.

2) character and intensity:

A. Extremely intense pain of sudden onset
caused by the perforation of gastric ulcer is
often described as burning or cutting.
B. Biliary or renal calculus is often described
as cramp constricting.

C. Persisting, wide-ranging severe pain

accompanied with high intensity of abdominal
muscles is highly suggestive of acute
peritonitis.
D. Intestinal obstruction is often described as
gripping.
E. The pain of peptic ulcer is usually described
as a dull, gnawing sensation of mild to
moderate severity.

Its a hungry pain and nocturnal pain.

Periodic epigastric pain occuring 1/2 hour
after eating is a typical symptom of gastric
peptic ulcer
Patients with a duodenal peptic ulcer have
pain 2-3 hours after eating or before the next
meal. So food tends to lessen the pain of
duodenal peptic ulcer.

3) time course:
Sudden onset: (over seconds to minutes)
rupture of liver or spleen
perforation of peptic ulcer
rapidly progressive: (over 1-2 hours)
pancreatitis, cholecystitis
bowel obstruction
renal or biliary colic
gradual onset: (over several hours)
typical peptic ulcer, chronic appendicitis

4) aggravating or alleviating factors:

A. Pain worsened by movement suggests
peritonitis.
B. Patients with a retroperitoneal process (such
as pancreatitis) commonly find partial relief by
leaning forward, and aggravation by lying
supine.

5) inducement :
a. heavy and fatty food ------- cholecystitis
b. heavy food and drinking ------- acute
pancreatitis
c. Trauma ------ rupture of liver or spleen.

 Accompanied symptoms:
1. fever, chill: the sign of inflammation
For instant: acute cholangitis
2. jaundice: biliary system and pancreas
diseases.

3. shock or hypotension: acute internal

organs bleeding
4. blood urine:
Blood urine is highly suggestive of the
calculus of urogenital system diseases.

Inquire points :
1. onset of the abdominal pain
Did the pain start suddenly?
2. severity and character
Can you describe the pain ? Is it sharp? burning?
cramp?
Is the pain continuous?
Has there been any change in the severity or nature of
the pain since it began?
What makes it worse?
What makes it better?

3. site
Where is the pain?
Has the pain changed its location since it started?

Do you feel the pain in any other part of your

body?
4. time course
How long have you had the pain ?
5. accompanied symptoms
Is the pain associated with nausea? vomiting ?
sweating? diarrhea? blood stools? fever? chills?