Abdominal pain is a frequent complaint in both outpatient and emergency settings, encompassing a diverse range of conditions from benign to life-threatening. It can be acute or chronic, localised or diffuse. A thorough understanding of the underlying pathophysiological mechanisms and potential causes is crucial for accurate diagnosis and effective management.
The abdominal cavity contains various organs including the stomach, liver, gallbladder, spleen, pancreas, kidneys, intestines and reproductive organs. Pain can originate from any of these structures or from the abdominal wall itself. The innervation of these organs is complex and involves somatic and visceral nerves which contribute to the nature and perception of pain.
The table below gives characteristic exam question features for conditions causing abdominal pain. Unusual and 'medical' causes of abdominal pain should also be remembered:
| Condition | Characteristic exam feature |
|---|---|
| Peptic ulcer disease | Duodenal ulcers: more common than gastric ulcers, epigastric pain relieved by eating |
| Gastric ulcers: epigastric pain worsened by eating | |
| Features of upper gastrointestinal haemorrhage may be seen (haematemesis, melena etc) | |
| Appendicitis | Pain initial in the central abdomen before localising to the right iliac fossa |
| Anorexia is common | |
| Tachycardia, low-grade pyrexia, tenderness in RIF | |
| Rovsing's sign: more pain in RIF than LIF when palpating LIF | |
| Acute pancreatitis | Usually due to alcohol or gallstones |
| Severe epigastric pain | |
| Vomiting is common | |
| Examination may reveal tenderness, ileus and low-grade fever | |
| Periumbilical discolouration (Cullen's sign) and flank discolouration (Grey-Turner's sign) is described but rare | |
| Biliary colic | Pain in the RUQ radiating to the back and interscapular region, may be following a fatty meal. Slight misnomer as the pain may persist for hours |
| Obstructive jaundice may cause pale stools and dark urine | |
| It is sometimes taught that patients are female, forties, fat and fair although this is obviously a generalisation | |
| Acute cholecystitis | History of gallstones symptoms (see above) |
| Continuous RUQ pain | |
| Fever, raised inflammatory markers and white cells | |
| Murphy's sign positive (arrest of inspiration on palpation of the RUQ) | |
| Diverticulitis | Colicky pain typically in the LLQ |
| Fever, raised inflammatory markers and white cells | |
| Abdominal aortic aneurysm | Severe central abdominal pain radiating to the back |
| Presentation may be catastrophic (e.g. Sudden collapse) or sub-acute (persistent severe central abdominal pain with developing shock) | |
| Patients may have a history of cardiovascular disease | |
| Intestinal obstruction | History of malignancy/previous operations |
| Vomiting | |
| Not opened bowels recently | |
| 'Tinkling' bowel sounds |
Diagram showing stereotypical areas where particular conditions present. The diagram is not exhaustive and only lists the more common conditions seen in clinical practice. Note how pain from renal causes such as renal/ureteric colic and pyelonephritis may radiate and move from the loins towards the suprapubic area.
Credit to အစ်မ Professor ဒေါ်သန်းသန်းအေးပါ။ Abdominal pain နဲ့ ပက်သက်ပြီး အရမ်းအသုံးဝင်သော practical tips များဖြစ်ပါတယ်။အစ်မ comment ပေးတဲ့အတိုင်းပဲ copy and paste လုပ်ပြီး ပြန်မျှဝေလိုက်ပါတယ်။ ပညာဝေမျှပေးတာ ဝမ်းသာလှပါတယ် ။ ဖတ်ထားတဲ့စာတွေကို လက်တွေ့ apply လုပ်တတ်ဖို့ပဲလိုပါတယ်။ အခုလို မျှဝေပေးတာ အားပေးပါတယ် ။ မမတို့ 9 S approach in Abdominal pain ကိုလည်း apply လုပ်ရင် လူရဲ့ ဘိုက်ထဲကို ထိုးထွင်းမြင်နိုင်ပါတယ် ။ When you assess Abdominal pain ,Go with 9 S approach. S1 + S2 = Identify the pain producing organ S1-Site of pain and S2-style of pain ( which means type of pain whether visceral or somatic pain)( centralized ဘိုက်နှစ်ဘက်ကို မျှမျှတတ နာခြင်း colicky တချက်တချက်ထိုးနာခြင်း၊without local tenderness…နာသောနေရာမှာ tenderness မရှိခြင်း သည် = visceral pain . Which organ ? ဆိုရင် ဘိုက်အလယ်တည့်တည့် ကနေ epigastrium ဆိုရင် Stomach, gall bladder stone colic, common bile duct , duodenum, Near to umbilicus ဆိုရင် small intestine and appendix, Below umbilicus up to suprapubic ဆိုရင် large intestine, rectum,Uterus, urinary bladder… Laterally loin to groin on each side colicky without local tenderness။ ဆိုရင် lateral visceral pain which is is originated from ureter on each side of abdomen. Somatic style of pain ဆိုရင် နာတဲ့နေရာ ဖိရင်နာ ခြင်း … Organ effected is immediately adjacent to that area of pain (Any area over abdomen with local tenderness/rebound tenderness is somatic or peritoneal involvement at that nearby organ) ( retro peritoneal organs) များ Retocaecal appendix, pancreas, pelvic organs eg overy ပေါက်တာ၊ sigmoid colon diverticulitis,Aorta ကွဲတာ၊ duodenum အနောက်ဘက်ပေါက်တာ eg post ERCP ) အထူးသတိ ၊ Neuralgic pain ဆိုရင် ဘာမျှအနာမရှိ ၊ nerve လမ်းကြောင်းမှာ ရှာကြည့် S3- how it starts (abrupt onset or slow onset) S4- Severity ( abrupt closure or abrupt rupture) S5 - sequence ( off and on or continuous) S6- Spread ( referral pain to other parts of the)S7-supporting facts ( past stories,systemic symptoms, other symptoms /signs)S8- Sepsis features S9- shock ? ( vascular or septic or volume loss) ဒီလို အမြဲစဉ်းစားထားရင် second nature မလွတ်တော့ဘူး