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Types of abdominal pain


3 types of abdominal pain

Acute abdominal pain

: abdominal pain of sudden onset and somatic character (originated by the stimulation of pain receptors located in the parietal peritoneum and abdominal wall). It can progress in a few days. It is well localized, it is aggravated by movement, coughing, deep breathing or by changing the position of the body. It is more intense at the site of the injury, and may be accompanied by increased tension in the abdominal muscles (called muscular defense) and other peritoneal symptoms caused by inflammation of the parietal peritoneum. It is usually the symptom of acute diseases that can threaten health or life and that require urgent medical procedures, including emergency surgery (the so-called acute abdomen → below).


1) diseases of the stomach and intestines: penetrated or perforated gastroduodenal peptic ulcer, appendicitis, intestinal obstruction, gastritis and inflammatory bowel disease, perforation or diverticulitis of the colon, diverticulitis Meckel

2) diseases of the liver and bile ducts: biliary colic, acute cholecystitis, acute cholangitis, acute hepatic venous stasis (venous thrombosis of the liver, heart failure)

3) acute pancreatitis

4) rupture of the spleen

5) diseases of the urogenital system: kidney stones, acute pyelonephritis, acute cystitis, ectopic pregnancy, torsion or adnexal cyst, acute salpingitis

6) Metabolic diseases: diabetic ketoacidosis, porphyria, uremia

7) vascular diseases: embolism, mesenteric vascular occlusion, dissection of the abdominal aorta, systemic vasculitis (eg vasculitis associated with IgA antibodies [Henoch-Schönlein purpura])

8) Chest diseases: coronary disease (especially myocardial infarction of the lower wall of the heart), myocarditis and pericarditis, pneumonia and pleuritis, pulmonary embolism

9) endocrine diseases: thyrotoxicosis, diabetic enteropathy, adrenal pathology, hypercalcemic crisis

10) Allergic diseases: food hypersensitivity, angioedema

11) poisoning by exogenous toxins: lead, arsenic, mercury, mushrooms.

Acute abdominal pain is one of the symptoms of acute abdomen , a term that defines an involvement of the abdominal organs, characterized by a sudden onset, rapid evolution and that usually threatens life.

2. Chronic abdominal pain

: usually has a visceral character (originates from the stimulation of pain receptors of internal organs and visceral peritoneum) and lasts for months or years. It is a dull pain, poorly localized, that can increase and disappear gradually (colicky pain), often accompanied by vegetative symptoms (nausea, vomiting, sweating) or vague discomfort, it is usually distributed symmetrically on both sides of the midline of the body, it can increase at rest.


1) Functional disorders: irritable bowel syndrome, functional dyspepsia, chronic functional abdominal pain

2) diseases of the stomach and intestines: chronic gastritis and inflammation of the duodenal mucosa, gastric and duodenal peptic ulcer, gastroesophageal reflux disease, Crohn’s disease, ulcerative colitis, ischemic enteritis due to radiation, colitis in the course of tissue diseases connective, infectious and parasitic intestinal diseases (tuberculosis, actinomycosis, giardiasis, taeniasis, ascariasis, trichinosis, schistosomiasis, Whipple’s disease), diverticular disease, celiac disease

3) gallbladder and bile duct stones

4) chronic pancreatitis

5) abdominal neoplasms

6) diseases of the nervous system: multiple sclerosis, herpes zoster, neuralgia.

3. Reflex pain

: is a perception of pain in a superficial location of the skin or muscle, but distant from traumatized organs, p. ex. pain of the back and right shoulder blade that accompanies biliary diseases.


Determine the following characteristics of pain: location, type (acute, chronic), character (stabbing, lacerating, dull, oppressive, colic, spasmodic), intensity, factors that induce or modify pain (especially when eating, drinking, vomiting, excreting , intensity change or appearance with different body positions). The most common causes of abdominal pain, depending on its location → Table 1-1 and , fig. 2-1. During the physical examination, the general appearance of the patient, vital signs (respiration, heart rate, blood pressure), skin color, presence of hernia, ascites, abdominal distension, scars, collateral venous circulation, point of greatest sensitivity must be assessed. to palpation, presence of tumors, muscular defense and other peritoneal symptoms, presence and type of intestinal peristaltic tones, presence of hepatic dullness.

Table 1-1. Most common causes of abdominal pain, depending on its location



Right upper quadrant

Inflammation of the gallbladder or bile ducts, biliary colic, acute hepatitis, pancreatitis, esophagitis, gastric and duodenal peptic ulcer, non-specific inflammatory bowel disease, intestinal obstruction, retrocecal appendicitis, nephritic colic, pyelonephritis, infradiaphragmatic abscess, inflammation of the lower lobe of the right lung, congestive heart failure (hepatic venous stasis)


Functional dyspepsia, gastroesophageal reflux disease, alterations of the gastric and duodenal mucosa due to drug use, gastric and duodenal peptic ulcer, gastroenteritis, bile duct diseases, acute hepatitis, pancreatitis or pancreatic pseudocysts, malignant neoplasms (stomach, pancreas, colon) ), intestinal ischemia, aneurysm of the abdominal aorta, acute myocardial infarction

Top left quadrant

Rupture or splenic infarction, pancreatitis and pancreatic pseudocysts, ischemia of the splenic flexure of the colon, nephritic colic, pyelonephritis, infradiaphragmatic abscess, inflammation of the lower lobe of the left lung

Mesogastrium, right and left

Nephritic colic, pyelonephritis, renal infarction, non-specific inflammatory bowel disease, intestinal obstruction, hernia

Umbilical zone

Early stage of appendicitis, gastroenteritis, intestinal obstruction, non-specific inflammatory bowel disease, intestinal ischemia, pancreatitis, abdominal aortic aneurysm, hernia

Right lower quadrant

Appendicitis, small and large intestine (obstruction, non-specific inflammatory bowel disease, ileocecal intussusception), urogenital apparatus (nephritic colic, pyelonephritis, salpingitis, ovarian cyst, ovarian torsion, ovarian rupture, ectopic pregnancy), abscess (pelvic, lumbar), purulent inflammation of the sacroiliac joint, hernia


Appendicitis, diverticulitis, intestinal obstruction, non-specific inflammatory bowel disease, irritable bowel syndrome, salpingitis, pelvic inflammatory disease, nephritic colic, cystitis, pelvic abscess, hernia

Lower left quadrant

Acute diverticulitis, infectious diseases, non-specific inflammatory bowel disease, sigmoid colon intussusception, irritable bowel syndrome, nephritic colic, pyelonephritis, salpingitis, ovarian cyst, ovarian torsion, ovarian rupture, ectopic pregnancy, inflammation of the sacroiliac joint

Diffuse pain

Infectious and non-infectious gastroenteritis, intestinal obstruction, peritonitis, ischemic origin, urinary tract infection


Types of abdominal painsFig. 2-1. Characteristics of pain and muscular defense in some diseases that occur with obstruction due to paralytic ileus: perforation of peptic ulcer ( A ), biliary colic ( B ), acute cholecystitis ( C ), acute pancreatitis ( D ), appendicitis ( E ), adnexitis ( F ), perforation of diverticulum of the sigmoid colon ( G ), nephritic colic ( H )

Exclude signs that indicate the presence of an organic disease that requires a diagnosis or immediate surgical intervention:

1) Acute abdominal pain with vomiting or sudden cessation of gas and stool removal: suggests obstruction of the gastrointestinal tract

2) Acute abdominal pain with gastrointestinal tract hemorrhage: it may indicate gastric or duodenal ulcer, acute hemorrhagic gastropathy, intestinal ischemia or intestinal lumen hemorrhage (eg rupture of an abdominal aortic aneurysm)

3) Acute abdominal pain with a rapid worsening of the patient’s condition (hypotension, impaired consciousness, difficulty breathing), may indicate intra-abdominal hemorrhage, gastrointestinal perforation, acute pancreatitis, acute liver failure

4) chronic abdominal pain and presence of blood in the stool or weight loss: it could be a sign of cancer or non-specific inflammatory bowel disease

5) abdominal pain and alterations detected on physical examination (eg jaundice, abdominal tumor).

Perform basic complementary examinations: blood count, serum electrolyte concentration, creatinine and glucose, acid-base balance, basic urinalysis, ECG. Other complementary examinations of blood, urine and feces, depending on the previous diagnosis and the differential diagnosis: amylase and lipase concentration, bilirubin, CK-MB or cardiac troponin, activity of AST , ALT , GGT and  ALP, stool blood test. Initial studies: ultrasound (may show free fluid in the abdomen, urinary or biliary stones, abnormalities of the abdominal aorta or portal vein and its branches) and panoramic radiography of the abdomen (may show air in the abdominal cavity, fluid levels in the handles intestinal, urinary stones). Complement with abdomen and pelvis scanner, sometimes in endoscopic study. Consult a surgeon in case of acute abdomen or if the cause of acute abdominal pain is not clear.

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