हिंदी के लिए यहां क्लिक करें

Definition: Discomfort or pain in the region of the abdominal wall or abdominal cavity.

Aetiology

  • Oesophageal : Hiatus Hernia, Reflux, Oesophagitis, Tumours, Ulcers
  • Gastro-duodenal : Gastritis, Ulcers, Tumours
  • Pancreatic : Pancreatitis, Malignancy
  • Hepatobiliary : Cholelithiasis, Infection (e.g.Hepatitis, Cholecystitis), Biliary Tract Obstruction, Tumours (benign or malignant)
  • Cardiorespiratory : Inflammation (e.g.Pneumonia, Pleurisy), Ischaemic heart disease, Carcinoma, Pneumothorax, Pulmonary Embolism
  • Intestinal : Inflammatory (e.g.ulcerativecolitis, Crohn’s disease, Appendicitis, Diverticulitis), Tumours, Intestinal obstruction, Irritable Bowel Syndrome, Malabsorption syndromes
  • Renal : Ureteric Calculus, Pyelonephritis, Cystitis, Tumours
  • Gynaecological : Endometriosis, Infections (e.g.Salpingitis, Endometritis), Dysmenorrhoea, Ectopic Pregnancy, Ovarian Cysts (from haemorrhage, Torsion, Rupture, Infection), Tumours
  • Testes/Epididymis : Epididymitis, Orchitis, Epididymo-orchitis, Torsion of Testes

Pathophysiology:  Abdominal pain may be a result of either:

  • Stimulation of pain receptors in the abdominal wall
  • Neural irritation.
  • Referred pain from another source.
  • Pathological processes which cause stimulation of pain receptors in the parietal peritoneum.
  • The parietal peritoneum is innervated by somatic sensory fibres. Therefore, pain arising from damaged or inflamed parietal
  • Pathological processes which cause stimulation of pain receptors in an abdominal viscus.
  • Visceral pain is caused by stretching or inflammation of intra-abdominal organs such as gut, gallbladder, bile duct, pancreas, ureters and uterus. Stimulation of pain receptors does not occur with every type of pathology. Common stimuli causing visceral pain include: Distension of the wall of a hollow viscus; a build-up to metabolites in a tissue as a result of ischaemia; acute stretching of the capsule of a solid viscera; tension on the mesentery;or exaggerated contraction of a hollow viscus.

Depending on the cause, visceral pain can be described as deep. continuous, dull ache/gnawing or intermittent cramping sensation. Visceral pain tends to be perceived near the midline, irrespective of the location of the organ.This is because the afferent fibres of the autonomic nervous system that carry pain impulses into the brain from the abdominal organs and visceral peritoneum are poorly mapped in the brain.This explains why the pain can usually(but not always)be localised to the epigastric, periumbilical or suprapubic areas.

Pain arising from:

  • Foregut(stomach and duodenum)is felt in the Epigastrium
  • Midgut(small intestine and proximal colon)is felt in the peri-umbilical region
  • Hindgut(distal colon)in felt in the suprapubic area.

Discriminating features

S.No.

DISCRIMINATING FEATURE

SIGNIFICANCE

1.

Pain in iliac fossa in middle of menstrual cycle

‘Ovulatory pain

2.

Pain worse on movement,coughing.sneezing.etc.

Inflamed peritoneum or abdominal wall pathology or referred pain from vertebrae

3.

Pain accompanied by constant writhing and movement of patient

Obstruction of a hollow viscera

4.

Burning pain,in a dermatomal distribution,with sensitivity of skin to touch.

Neurogenic cause of pain (e.g.herpes zoster)or referred pain from vertebrae

5.

Pain accompanied by dysuria, frequency,pyuria,etc.

Urinary tract disorder

6.

Localised pain with tenderness on palpation,guarding and rigidity

Localised inflammation of parietalperitoneum (e.g.appendicitis)

7.

Pain over entire abdomen plus tenderness,guarding and rigidity

Generalised peritonitis

8.

Pain improved by leaning forward

pancreatic pathology or musculoskeletal disorder

9.

Pain better with lying still

Inflamed peritoneum

10.

Pain prior to or accompanying menses

Dysmenorrhoea

11.

Upper abdominal pain in conjunction with respiratory symptoms,no tenderness, but worse on deep inspiration

Referred pain from                 thorax (e.g.pneumonia)

12.

Pain in abdomen and pain or discomfort in scrotum/testes

Referred pain from genitalia                                                          

(e.g.torsion of testes)

13.

Pain around umbilicus

Small intestinal pathology or pathology from parts of the large intestine that are

derived from the midgut (i.e.proximal parts)

14.

Pain in upper abdomen radiating through to the back.                                

Pancreatic disease

15.

Pain in upper abdomen on right side radiating around to the back and between

the scapulae

Gall bladder/biliary tract disease

                              

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