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    1.10 Abdominal Pain

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    Ahmed Nazar
    Abdominal pain is a common chief complaint presenting to emergency departments, comprising over 5% of all ED visits. Determining the cause of abdominal pain can be challenging due to the complex anatomy of the abdomen and its many organs. Abdominal pain can be classified as visceral, parietal, referred, or psychogenic based on its characteristics and location. An accurate assessment requires consideration of multiple factors including duration, location, severity, relieving/precipitating factors, and associated symptoms to determine if the cause is likely surgical versus nonsurgical and to guide appropriate investigations.

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    1.10 Abdominal Pain

    Uploaded by

    Ahmed Nazar
    29 views20 pages
    Abdominal pain is a common chief complaint presenting to emergency departments, comprising over 5% of all ED visits. Determining the cause of abdominal pain can be challenging due to the complex anatomy of the abdomen and its many organs. Abdominal pain can be classified as visceral, parietal, referred, or psychogenic based on its characteristics and location. An accurate assessment requires consideration of multiple factors including duration, location, severity, relieving/precipitating factors, and associated symptoms to determine if the cause is likely surgical versus nonsurgical and to guide appropriate investigations.

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    Abdominal pain is a common chief complaint presenting to emergency departments, comprising over 5% of all ED visits. Determining the cause of abdominal pain can be challenging due to the complex anatomy of the abdomen and its many organs. Abdominal pain can be classified as visceral, parietal, referred, or psychogenic based on its characteristics and location. An accurate assessment requires consideration of multiple factors including duration, location, severity, relieving/precipitating factors, and associated symptoms to determine if the cause is likely surgical versus nonsurgical and to guide appropriate investigations.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    29 views20 pages

    1.10 Abdominal Pain

    Uploaded by

    Ahmed Nazar
    Abdominal pain is a common chief complaint presenting to emergency departments, comprising over 5% of all ED visits. Determining the cause of abdominal pain can be challenging due to the complex anatomy of the abdomen and its many organs. Abdominal pain can be classified as visceral, parietal, referred, or psychogenic based on its characteristics and location. An accurate assessment requires consideration of multiple factors including duration, location, severity, relieving/precipitating factors, and associated symptoms to determine if the cause is likely surgical versus nonsurgical and to guide appropriate investigations.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 20

    Abdominal Pain

    • Abdominal pain is the most common chief complaint for


    patients presenting to the ED comprising >5% of all ED visits

    • The abdomen has many organs and complex structures.

    • Determining the cause of an abdominal complaint is


    challenging even for experienced health professionals.
    • Left upper
    • Right upper
    quadrant (LUQ)
    quadrant (RUQ)
    contains the
    contains the
    stomach, spleen,
    liver, gallbladder
    pancreas and
    and part of the
    part of the large
    large intestine.
    intestine.

    • Right lower
    • Left lower
    quadrant (RLQ)
    quadrant (LLQ)
    contains the
    contains the
    appendix, small
    small and large
    intestine,
    intestine,
    fallopian tube
    fallopian tube
    and ovary.
    and ovary.
    There are four types of abdominal pain:

    • Visceral. Gut organs are insensitive to stimuli such as burning and cutting
    but are sensitive to distension, contraction, twisting and stretching. Pain
    from unpaired structures is usually but not always felt in the midline.

    • Parietal. The parietal peritoneum is innervated by somatic nerves, and its


    involvement by inflammation, infection or neoplasia causes sharp, well-
    localised and lateralised pain.

    • Referred pain. (For example, gallbladder pain is referred to the back or


    shoulder tip.)

    • Psychogenic. Cultural, emotional and psychosocial factors influence


    everyone’s experience of pain. In some patients, no organic cause can be
    found despite investigation, and psychogenic causes (depression or
    somatisation disorder) may be responsible
     Viseral pain referred to areas
    corresponding to the embryonic
    origin of the affected structure.
    1. Foregut structures (stomach,
    duodenum, liver, and pancreas)
    cause upper abdominal pain.
    2. Midgut structures (small bowel,
    proximal colon, and appendix)
    cause periumbilical pain.
    3. Hindgut structures (distal colon
    and GU tract) cause lower
    abdominal pain
    IMPORTANT FACTORS IN THE ASSESSMENT OF
    ABDOMINAL PAIN

    • Duration
    • Site and radiation
    • Severity
    • Precipitating and relieving factors (food, drugs, alcohol,
    posture, movement, defaecation
    • Nature (colicky, constant, sharp or dull, wakes patient at night)
    • Pattern (intermittent or continuous
    • Associated features (vomiting, dyspepsia, altered bowel habit)
    Acute abdominal pain

    • Generally present for less than a couple weeks , Usually


    days to hours old

    • Don’t forget about the chronic pain that has acutely


    worsened

    • More immediate attention is required

    • Surgical v. nonsurgical
    • This accounts for approximately 50% of all urgent admissions to general
    surgical units.

    • The acute abdomen is a consequence of one or more pathological


    processes

     Inflammation. Pain develops gradually, usually over several hours. It is


    initially rather diffuse until theparietal peritoneum is involved, when it
    becomes localised. Movement exacerbates the pain; abdominal rigidity
    and guarding occur.

     Perforation. When a viscus perforates, pain starts abruptly; it is severe


    and leads to generalised peritonitis.

     Obstruction. Pain is colicky, with spasms which cause the patient to writhe
    around and double up. Colicky pain which does not disappear between
    spasms suggests complicating inflammation
    Chronic abdominal pain

    • Generally present for months to years


    • Generally not immediately life threatening
    • Outpatient work-up is prudent
    CHRONIC OR RECURRENT ABDOMINAL PAIN

    • A detailed history, with particular attention to the features of


    the pain and any associated symptoms, is essential.

    • Note should be made of the patient's general demeanour,


    mood and emotional state, signs of weight loss, fever,
    jaundice or anaemia.

    • If a thorough abdominal and rectal examination is normal, a


    careful search should be made for evidence of disease
    affecting other structures, particularly the vertebral column,
    spinal cord, lungs and cardiovascular system.
    'EXTRAINTESTINAL' CAUSES OF CHRONIC OR RECURRENT ABDOMINAL
    PAIN

    Retroperitoneal Metabolic/endocrine
     Aortic aneurysm  Diabetes mellitus
     Malignancy  Addison's disease
     Lymphadenopathy  Acute intermittent porphyria
     Abscess  Hypercalcaemia

    Psychogenic Drugs/toxins
     Depression  Corticosteroids
     Anxiety  Azathioprine
     Hypochondriasis  Lead
     Somatisation  Alcohol

    Locomotor Neurological
     Vertebral compression  Spinal cord lesions
     Abdominal muscle strain  Tabes dorsalis
     Radiculopathy
    Haematological
     Sickle-cell disease
     Haemolytic disorders
    • The initial choice of investigations will obviously depend on the
    clinical features elicited during the history and examination
    • Epigastric pain, dyspepsia and relationship to food suggest
    gastroduodenal or biliary disease. Endoscopy and ultrasound
    are indicated.
    • Altered bowel habit, rectal bleeding or features of obstruction
    suggest colonic disease. Barium enema and sigmoidoscopy, or
    colonoscopy are indicated.
    • Pain provoked by food in a patient with widespread
    atherosclerosis may indicate mesenteric ischaemia.
    Mesenteric angiography may be necessary.
    • young patients with pain relieved by defecation, bloating and
    alternating bowel habit are likely to have( irritable bowel
    syndrome (Simple investigations (blood tests and
    sigmoidoscopy) may be sufficient.
    • Upper abdominal pain radiating to the back, a history of
    alcohol misuse, weight loss and diarrhoea suggest chronic
    pancreatitis or pancreatic cancer. Ultrasound, CT and
    pancreatic function tests are required.

    • Recurrent attacks of pain in the loins or radiating to the flanks


    with urinary symptoms should prompt investigation for renal
    or ureteric stones by ultrasound and intravenous urography.

    • A past history of psychiatric disturbance, repeated negative


    investigations or vague symptoms which do not fit any
    particular disease or organ pattern may point to a
    psychological origin for the patient's pain
    .Management of acute abdominal pain: an algorithm
    THANK YOU

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