Abdominal Pain is stimulated mainly by the stretching of smooth muscle or organ capsules. Severe acute abdominal pain can be due to a large number of gastrointestinal conditions, and normally presents as an emergency. An apparent ‘acute abdomen’ can occasionally be due to referred pain from the chest, as in pneumonia or to metabolic causes, such as diabetic ketoacidosis or porphyria.
Upper Abdominal pain
Epigastric pain is very common and is often related to food intake. Although functional dyspepsia is the commonest diagnosis, the symptoms of peptic ulcer disease can be identical. Heartburn (a burning pain behind the sternum) is a common symptom of gastro-oesophageal reflux.
Right hypochondrial pain may originate from the gall bladder or biliary tract. Biliary pain can also be epigastric. Biliary pain is typically intermittent and severe, lasts a few hours and remits spontaneously to recur weeks or months later. Hepatic congestion (e.g. in hepatitis or cardiac failure) and sometimes peptic ulcer disease can present with pain in the right hypochondrium. Chronic, persistent or constant pain in the right (or left) hypochondrium in a well-looking patient is a frequent functional symptom;
Lower abdominal pain
Pain in the left iliac fossa may be colonic in origin (e.g. acute diverticulitis) but chronic pain is most commonly associated with functional bowel disorders. Lower abdominal pain in women occurs in a number of gynaecological disorders and the differentiation from GI disease may be difficult.
Pain in the right iliac fossa may be due to acute appendicitis or ileocaecal disease, but may also commonly be functional. Proctalgia fugax is a severe pain deep in the rectum that comes on suddenly but lasts only for a short time. It is not due to organic disease.
Common causes of abdominal pain include:
• Constipation
• Diarrhea
• Gastroenteritis (stomach flu)
• Acid reflux (when stomach contents leak backward into the esophagus, causing heartburn and other symptoms)
• Vomiting
• Stress
Causes of severe abdominal pain include:
• Organ rupture or near-rupture (such as a burst appendix, or appendicitis)
• Gallbladder stones (known as gallstones)
• Kidney stones
• Kidney infection
