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 “Acute Abdominal Pain” can also mean very serious and needing surgery, like appendicitis, but that’s not how we’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 aren’t addressed here; we’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 xxxxxxRight 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: • Ulcer / Gastritis / Dyspepsia xxxEsophageal Reflux (GERD) • Gastric Cancer Pancreatitis Heart Attack Hepatitis ? Gallbladder Disease ? Muscle Strain Early Appendicitis NOT “Gastroenteritis”    Periumbilical (or Generalized)   Ulcer ? /  Gastritis ? / xxxxDyspepsia ? Bowel Obstruction Peritonitis Bowel Ischemia Aortic Aneurysm (ruptured) Abdominal Wall Hernia Muscle Strain Early Appendicitis Diabetic Ketoacidosis NOT “Gastroenteritis”   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 xxxxxxxLeft 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

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 “yes” 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, doesn’t need surgery!

Abdominal pain plus fever is also concerning.  Not just “feeling hot,” but a measured temperature over 100.6° F (38.0° C).  Maybe it’s an infection we can treat (like the bladder or kidney), but if we can’t make a sure diagnosis then & there, they’ll need a variety of same-day tests best obtained in an E.R.

We’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:

• Elderly • Debilitated • Malnourished • Alcoholics

• Kidney Failure • Liver Failure • Cancer • Immunosuppressive Meds

• AIDS • 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:

• Acute Upper Abdominal Pain:xxxxxxxxxSummary ApproachxxxxxxxFull Discussion
• Acute Lower Abdominal Pain:xxxxxxxxxSummary ApproachxxxxxxxFull Discussion
• Acute Flank Pain:xxxxxxxxxxxxxxxxxxxSummary ApproachxxxxxxxFull Discussion
• Acute Generalized Abdominal Pain:xxxxSummary ApproachxxxxxxxFull Discussion
• Chronic Abdominal PainxxxxxxxxxxxxxxSummary ApproachxxxxxxxFull Discussion