Abdominal Pain

Abdominal Pain

Aortic Pain Aortic pain can be severe and may have a tearing component if there is associated expanding, leaking or dissecting aneurysm. Abdominal pains are usually most marked in the back and may originate in the chest and spread down the legs.

Anal Pain Anal pain is usually well localized around the anal area of the perineal region. It is most often caused by fissures or piles. Anal abdominal pain is aggravated by defaecation. The anal fissures are narrow splits in the perianal skin, usually in the midline posteriorly which extend towards the anal edge where a sentinel pile may be found. Fissures are generally very painful.

Appendix Pain Generally appendix abdominal pain has a persistent pain wtarting in the central abdomen and then will localize to the right lower quadrant at Mc Burneys point. The pain can called re-bound pain as it is often more painful when the area is released during palpation which brings more pain.

Biliary Tract Pain Biliary tract abdominal pain classically is felt in the right upper quadrant and may radiate to the midline of the body. Biliary tract pain may also radiate towad the right scapula. The pain is often a minor discomfort but in the case of gallstones passing down this tract biliary colic may result and extreme pain ensures. (biliary colic is not colic!)

Bladder Pain Bladder pain is a midline pain felt just above the pubic bone. It is often associated with frequency, dysuria and other symptoms of urinary tract infections. Bladder pain and bladder inflammation (cystitis) will not cause a fever or renal pail unlike renal tissue inflammation (pyelonephritis). Acute bladder pain is most commonly caused by retention of urine in the bladder.

Colic Pain or Colicky Pain Colic abdominal pain is a squeezing pain which can vary it’s intensity. Patients experiencing colic pain often indicate the squeezing nature by clenching their fists. Colic almost invariably denotes abnormality in hollow organs.

Gastric Pain and Duodenal Pain Gastric and duodenal pains are often poorly defined upper abdominal pains which can also be felt in the back in accordance with meals. It can be a gnawing pain which may be relieved by antacids. Duodenal pain may be localized by the patient who can point directly to the xiphisternal area. The pain is aggravated when the patients stomach is empty therefore will habitually awaken the patient at night (duodenal lesions). In general, duodenal pain will be relieved after eating a meal but if the pain is aggravated by foods it will be gastric. If the pain radiates to the back it generally suggests posterior penetration of gastric or duodenal ulcer. When a ulcer perforates the pain will become more generalized (unless ulcer is small)

Hepatic Pain or Liver Pain Hepatic abdominal pain is usually in the right upper quadrant giving rise to more mild pain or discomfort than severe pain. If the pain is severe, this may indicate heart failure or acute hepatitis. Damage to the liver tissue does not give rise to pain! It is the stretching of various other tissues (hepatic capsule) which causes the pain.

Large Intestine Pain Large intestine (colonic) abdominal pain tends to be most predominantly felt in the central abdomen if the ascending or transverse colon is affected. If the descending colon is affected the discomforting pain will be felt in the lower abdomen below the umbilicus.

Liver Pain Hepatic abdominal pain is usually in the right upper quadrant giving rise to more mild pain or discomfort than severe pain. If the pain is severe, this may indicate heart failure or acute hepatitis. Damage to the liver tissue does not give rise to pain! It is the stretching of various other tissues (hepatic capsule) which causes the pain.

Oesophageal Pain Esophagus abdominal pain is pain felt in the midline of the body and retrosternal. This occasionally simulates cardiac pain. Oesophageal pain may radiate down the back or into the arms in a similar fashion to angina. Esophagus pain is aggravated when hot or bulky foods are swallowed. This type of pain may be caused by heartburn if the sensation is burning or hot and is closer in the chest. This may also indicate problems with peristalsis or achalasia.

Ovarian Pain

Pancreatic Pain Pancreatic abdominal pain is felt in the upper quadrants and usually also in the back. This pain may be worse when the patient is lying down (pancrease indents with spine) and may be relieved by bending over forwards. Abdominal pain caused by acute pancreatitis is generally a severe and constant pain and may be caused by alcohol abuse or biliary tract disease.

Peritoneal pain Abdominal pain due to peritoneal irritation gives rise to peritoneal pain. Focal irritation produces localized abdominal pain but generalized peritonitis with generalized irritation produces generalized pain with rebound tenderness.

Prostatic Pain Prostate pain is predominantly perineal and possibly associated with other prostate symptoms. A loaded rectum of digital rectal examination may cause prostate discomfort.

Rectal Pain Abdominal Pain due to rectal disorders is usually well localized with abrupt onset and severe pain if it is due to proctalgia fugax (cramping of pelvic floor muscles)

Renal Colic - Ureteric Pain Ureteric pain is a sudden onset, unilateral, severe pain with periodic exacerbation felt in the lateral abdomen. The pain can radiate downwards towards the external genitalia making the pain extreme.

Renal Pain Renal pain is most often associated with stretching or irritation of the renal capsule. There is generally constant pain which radiates to the back with some tenderness which runs from the back to the 12th rib. Pain may also radiate downwards in ureteric fashion.

Small Intestine Pain Small intestinal abdominal pain is a colicky and periumbilical when due to inflammatory or infective causes. Small intestine colic tends to have more frequent variations in intensity than does large intestinal colic. When the blood supply is impaired there may be mesenteric angina with pain after eating lasting until blood deficiency of the gut ends. Terminal ileal pain tends to be localized to the right lower quadrant. Complete arterial blockage with intestinal infarction causes sudden onset central abdominal pain with circulatory collapse.

Splenic Pain Pain of the spleen is a left upper quadrant pain which may vary as the spleen moves with each breath. This tuype of abdominal pain can be caused by spleenic infarction which occurs in sickle cell disease.

Ureteric Pain – Renal Colic Ureteric pain is a sudden onset, unilateral, severe pain with periodic exacerbation felt in the lateral abdomen. The pain can radiate downwards towards the external genitalia making the pain extreme.

Uterine Pain - see genital pain