Abdominal Pain

Acute Abdominal Pain refers to pain going on 1-2 weeks, oftentimes just a few days.  In contrast, Chronic Abdominal Pain, which continues on & off for weeks to years, is caused by completely different conditions. 

Areas of the Abdomen

xxxxxxxxxxxxAcute Upper Abdominal Pain xxxxxxxxx Acute Lower Abdominal Pain
xxxxxxxxxxxxAcute Flank Pain xxxxxxxxxxxxxxxxxxx Acute Generalized Abdominal Pain
xxxxxxxxxxxxChronic Abdominal Pain

The term โ€œAcute Abdominal Painโ€ can also mean very serious and needing surgery, like appendicitis, but thatโ€™s not how weโ€™re using the word here. Also, various conditions may cause some pain, but primarily cause other more prominent symptoms like vomiting or diarrhea that lead a patient to seek care.  Those arenโ€™t addressed here; weโ€™re now dealing with the patient whose main concern is new-onset belly pain.

Having identified the primary area of pain, we think of the diseases localized there (realizing that there may be some overlap).  See our diagrams and discussion of The Gastro-Intestinal System.

Acute Abdominal Pain — Causes

Right Upper Quadrant (RUQ)
 
Hepatitis (Acute)
Gallbladder Disease
Pneumonia
Stomach Ulcer ?
Muscle Strain
Herpes Zoster (Shingles)
x
x
xxxxxx
Right Flank
 
Kidney Infection
Kidney Stone
Kidney Infarction
Muscle Strain
Herpes Zoster (shingles)
Aortic Aneurysm (ruptured)
 

Right Lower Quadrant (RLQ)
 
Appendicitis
Kidney Stone ?
Hernia
Muscle Strain
Tubal Infection (PID)
Ectopic Pregnancy
Miscarriage
Mittelschmerz/Dysmenorrhea
xxx(menstrual pains)
Ovarian Disease
Testicular Disease
Herpes Zoster (Shingles)

x
x
x
? = sometimes here t
x
? = sometimes here toox
xxxxxxxEpigastric

Stomach Diseases:
โ€ข Ulcer / Gastritis / Dyspepsia
xxxEsophageal Reflux (GERD)
โ€ข Gastric Cancer
Pancreatitis
Heart Attack
Hepatitis
?
Gallbladder Disease ?
Muscle Strain
Early Appendicitis
NOT โ€œGastroenteritisโ€
  
Periumbilical (or Generalized)
 
Ulcer ? /  Gastritis ? /
xxxxDyspepsia ?
Bowel Obstruction
Peritonitis
Bowel Ischemia
Aortic Aneurysm (ruptured)
Abdominal Wall Hernia
Muscle Strain
Early Appendicitis
Diabetic Ketoacidosis
NOT โ€œGastroenteritisโ€
 
xxxxxxxSuprapubic
 
Bladder Infection (UTI)
Uterine Infection xxx(endometritis)
Muscle Strain
Mittelschmerz/Dysmenorrhea xxx(menstrual pains)
x
x


? = sometimes here too
Left Upper Quadrant (LUQ)
 
Pancreatitis
Stomach Ulcer / Gastritis ?
Dyspepsia ?
Heart Attack ?
Muscle Strain
Herpes Zoster (Shingles)
x
x
xxxxxxx
Left Flank
 
Same as Right Flank
x
x
x
x
x
x


Left Lower Quadrant (LLQ)
 
Constipation
Diverticulitis
All conditions that cause RLQ xxxxpain

x

x
? = sometimes here toox
x
x
x
x
x
x
x
x
x? = sometimes here
? = sometimes here too

Before we even start to think about the cause of abdominal pain, we form a rapid idea as to whether a patient will need surgery.  We say โ€œyesโ€ when the person struggles to walk, doubled over, holding their belly.

If the disease is just as serious, but a little less advanced, the belly still tenses up every time we touch it, even if we tap on it or gently rock it.  On the other hand, the child who leaps off the exam table, landing with a happy thud, doesnโ€™t need surgery!

Abdominal pain plus fever is also concerning.  Not just โ€œfeeling hot,โ€ but a measured temperature over 100.6ยฐ F (38.0ยฐ C).  Maybe itโ€™s an infection we can treat (like the bladder or kidney), but if we canโ€™t make a sure diagnosis then & there, theyโ€™ll need a variety of same-day tests best obtained in an E.R.

Weโ€™re also overly cautious when an immunocompromised person (with weak immune system) has a new, never-before abdominal pain.  They can have serious conditions with hardly any symptoms.  Such people include:

โ€ข Elderly
โ€ข Debilitated
โ€ข Malnourished
โ€ข Alcoholics
โ€ข Kidney Failure
โ€ข Liver Failure
โ€ข Cancer
โ€ข Immunosuppressive Meds
โ€ข AIDS
โ€ข Various Chronic Diseases xxxx(Lupus, severe diabetes, xxxxxxxetc.)xxx

And we beware the Severely Mentally Ill (with psychosis), who tolerate high degrees of pain.  So if they come to us with a new type of abdominal pain, something bad may be going on.

Onward now, to Diagnosis:  Choose the location of pain which most interests you:

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