Abdominal pain

By
Prof. Dr. Nabil Lymon
Professor of Internal Medicine
Mansoura University
Faculty of Medicine
 Abdominal pain often heralds gastrointestinal
disease and brings the patient to the attention of
the internist or surgeon.
Mechanism and causes of abdominal pain:

1. Distension and stretching of the wall of a hollow

organ e.g.: colonic distension.
2. Stretching of the capsule of a solid organ e.g.
splenomegaly, hepatomegaly and kidney
enlargement.
3. Spasm of viscous organ e.g.: intestinal colic, ureteric
colic or biliary colic.
4. Mucosal inflammation e.g.: Gastritis , oesophagitis
5. Peritoneal irritation e.g.: peritonitis
6. Ischaemia e.g.: ischaemic colitis.
 So abdominal pain may be visceral (Gut
organs), parietal (parietal peritoneum) which
is innervated by somatic nerves, referred
pain e.g. gall bladder pain right shoulder
or it may be psychogenic.

Non- alimentery causes of abdominal pain:

1. Myocardial infraction.
2. Dissecting aortic aneurysm.
3. Cord compression (thoracic segments).
4. Pleurisy.
5. Herpes zoster.
6. Diabetic Ketoacidosis.
7. Torsion testis/ovary.
Types of pain:
1. Colicky pain:
Renal or ureteric colic.
Biliary colic.
Intestinal colic.
Uterine colic.
2. Throbbing pain:
Inflammation with pus under tension.
3. Sawing pain:
Rheumatic disease of bones and joints.
This may affect the thoracic cage upper
abdominal pain.
4. Burning pain:
Reflux oesophagitis.
Peptic ulcer.
5. Dull aching pain:
Kidney swelling.
Splenomegaly or hepatomegaly.
6. Constricting pain (Tightness or compressing):
Ischaemic heart disease. (it may radiates to epigastrium)
7. Heaviness or dragging pain:
Splenomegaly or hepatomegaly.
8. Stitching or pricking:
Pleurisy. (It may radiates to upper abdomen)
 D.D. of Epigastric Pain
1) Diseases of lower end of esophagus:
Hiatus hernia oesophagitis carcinoma.
2) Gastro Duodenal:
peptic ulcer gastritis gastric carcinoma
pyloric stenosis.
3) Gall bladder:
Acute and chroic cholecystitis gall stones.
4) Pancreas:
Acute and chronic pancreatitis cancer
pancreas.
5) Hepatic:
congested liver amebic hepatitis viral
hepatitis carcinoma.
6) C.V.S.:
Angina infarction pericarditis
dissecting aneurysm.
7) chest:
Diaphragmatic pleurisy.
8) Miscellaneous:
Herpes Zoster fatty hernia of linea Alba
myositis diabetic ketoacidosis.
Analysis of some causes of abdominal pain:
Peptic ulcer:
Epigastric.
Burning.
Nocturnal.
By antacid and vomiting.
with stress, aspirin and smoking.
Its severity: mild to moderate.
Biliary colic:
Epigastric / right hypochondrium.
Radiated to right shoulder.
Colicky.
Severe.
 Renal colic:
Loin.
Radiated to genitalia and inner thigh.
Colicky.
Severe.
May follows periods of dehydration.
Acute pancreatitis:
Epigastrium / left hypochondrium.
Radiated to the back.
Severe.
May occur after heavy drinking.
 Colonic pain:
Colicky.
By the defecation or passing flatus.
Lower abdomen on either sides.
Appendicitis:
It is initially localized around the umbilicus
(visceral pain) then it shifts to the right iliac
fossa with peritoneal irritation (parietal or
somatic pain).
Medical conditions which may minic acute
abdomen.
Myocardial infraction.
Sickle cell disease.
Pleurisy.
Vasculitis.
Irritable bowel $
FMF.
Diabetic ketoacidosis.
Gastroenteritis.
Henoch schonlein purpura.
Herpes zoster
 DD of tender abdomen
Tender abdomen may originate from abdominal wall,
viscus organ or solid organ or peritoneum.
When the patient raises head and shoulders, the
tenderness of abdominal wall will persist, but tenderness
from a deeper lesions will decrease due to protection by
the tightened muscles. Abdominal wall tenderness may
be due to muscular strain, viral myositis or trauma.
Rigidity with rebound tenderness are associated with
peritoneal inflammation.
Absence of rigidity and rebound tenderness suggestive
to tender viscus or solid organs so, try to localize the site
of tenderness according to the surface anatomy of the
nine abdominal areas to determine the affected vsicus or
solid organ.
Thank
You