Abdominal pain is among the most common reasons for admission to outpatient clinics and emergency departments. Although it most commonly occurs due to gastrointestinal problems, abdominal pain has a wide variety of causes.
First of all, the duration of occurrence (new/long-term?), severity, location, other accompanying complaints and Findings are very important for diagnosis. The person's age, gender, and previous illnesses are also important. For example, gastroenteritis due to food poisoning is the cause of abdominal pain in the presence of pain that has recently emerged and occurs after consuming a suspicious food and may be accompanied by nausea and/or diarrhea, whereas in an individual who has been accompanied by nausea and occasionally diarrhea for the last 6 months, this pain may be caused by a large intestine disease. It could also be a tumor. That's why, whether the abdominal pain has just started or is old, detailed history, questioning of other additional complaints and then detailed physical examination are important.
1. Pain occurring in the upper right part of the abdomen;
- If the cramp-like pain occurs, especially when fasting, it may be an ulcer in the duodenum.
- If it increases after a meal and sometimes sour water comes to the mouth, stomach ulcer and reflux may be considered.
- If there is fever together,gallbladder inflammationmay be the case. Fever response may be delayed in older ages. If there is fever and jaundice together, blockage of the bile ducts (cholangitis) may occur. This most often occurs as a result of blockage of the bile ducts with gallstones. Weight loss, poor general condition, lack of appetite for a while, or newly emerging diabetes may suggest pancreatic cancer. Bile duct cancer or liver diseases may also cause the same complaint. For example, the same complaints may occur in acute viral hepatitis. The cause of rapid damage to the liver may be the same in every case (ischemic hepatitis that occurs in cases that cause serious low blood pressure,toxic hepatitis as a result of drugs or chemicals,hepatitis during infections /strong>,tuberculosis,brucellosis,space occupying mass,liver abscess,hepatocellular carcinoma,hydatid cyst,obstruction of hepatic veins [Budd Chiari Syndrome],affecting the liver other cancers, etc.)
- In rapidly occurring pancreatic damage (acute pancreatitis), the clinical condition of the patient is very poor. There is often girdle-like pain in the midline and throughout the upper abdomen. Blood pressure drops very quickly and the person may quickly go into shock.
- Among all these reasons, tumors usually cause long-term pain, but this is not necessary.
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2. Pain occurring in the upper left part of the abdomen;
- Stomach ulcer, stomach tumor, colon tumor, spleen infarction,spleen abscess, obstruction in the vessels feeding the intestines (mesenterary artery embolism)
- Referred pain (cardiac origin:myocardial infarction)
- Pneumonia:Left flank pain and left upper abdominal pain may occur in lower left lung infection.
3. Lower abdominal quadrant pain
- Kidney diseases (stone, mass and other):Very severe cramp-like pain in the flanks or towards the groin, certain increases and decreases at intervals
- Bladder pathologies:Cystitis, which occurs in the form of burning during urination, and bladder cancer, which may not cause any complaints other than detecting blood in the urine (sometimes it may cause pain)
- Intra-abdominal mass:It may cause complaints depending on the organ and system from which it originates. Masses originating from the intestines can cause obstruction, bloating, constipation and diarrhea. Sometimes the patient may come to the emergency room due to complete or near-complete obstruction. It can cause fever, weight loss, loss of appetite, pain, nausea, etc., regardless of organ systems. He may not complain at all. Sometimes it can be noticed by chance. A mass due to stomach cancer may cause severe nausea and vomiting. Sometimes there may be palpable masses under the skin, they are painless, sometimes even surgery may be recommended. These are mostly painless and do not grow, they are benign tumoral fatty tissue increases called lipoma. If it does not cause serious aesthetic problems, it does not require treatment. Sometimes it's big If a tumor occurs, a biopsy should be performed and the treatment will be determined accordingly. Recurrent urinary tract infections, blood in the urine, weight loss and pain may suggest kidney tumors. If there is persistent or recurrent high fever, intra-abdominal inflammatory abscess may be considered. If we think about our country, tuberculosis should also come to mind.
- Urinary system diseases (stones, pyelonephritis):High fever, burning in urine, general condition disorder, only impaired consciousness in older ages, waist and flank pain in the presence of stones. pain.
- Gynecological diseases (ovarian, uterus):Breakthrough bleeding, menstrual cessation, vaginal discharge, bleeding, fever, weight loss, palpable mass may occur.
- Colon cancer:Recent diarrhea or constipation, abdominal pain (may not be present), palpable mass (may not be present), iron deficiency at any age in men, post-menopausal iron deficiency in women, weight loss. Colon cancer: >
- Other system cancers
- Inflammatory bowel diseases:Diarrhea, bloody diarrhea, small intestine type diarrhea (abundant stools 3-5 times a day containing abundant watery diarrhea), large intestine type diarrhea (very frequent, 10-15 times a day, bloody diarrhea in small amounts), weight loss, pain, anemia, vitamin D deficiency, vit B12 deficiency, low blood proteins, fever. It may occur with attacks. There are two types of diseases. The first is Crohn's disease, causing small intestine type diarrhea, and the second is ulcerative colitis, causing large intestine type diarrhea. Sometimes the patient goes to the toilet because it is available, but he cannot defecate (tenesm) even though he feels it. /li>
- Referred pain (cardiovascular disease):shortness of breath with exertion, chest pain with exertion, previous history of heart disease, post-meal chest/abdomen/back, left shoulder/jaw/neck pain.
- Appendicitis:Severe pain that occurs rapidly in the lower right part. Cramp-like pain. Pain initially around the navel, then radiating to the lower right side. Fire. Nausea, vomiting.
- Diverticitis:It usually occurs in older ages. The symptoms of the complaint are just like appendicitis, but there is pain in the lower left part. It occurs due to herniation and pocket formation (diverticulum) that occur within the intestinal muscle layers in older ages. It occurs as a result of inflammation of the layer lining the inside of these pockets. It may cause acute abdomen.
- Mittel Schmerz:It manifests itself with sudden abdominal pain, cramp-like pain, in the middle part of the menstrual cycle of women (7-10 days after the end of the menstrual period). and it goes away on its own within 1-2 days. It coincides with the moment when the eggs in the ovary open into the abdomen. There is no danger.
- Irritable bowel disease:Meticulous personality structure, easily angered, prone to depression or overexcitement (for example, those with migraine), changes in bowel habits such as diarrhea or constipation. people who show up. Under all kinds of stress, bowel habits change. It mostly occurs in women. Often there are similar complaints in the past story.
4. Pain in the middle part of the abdomen
- Acute pancreatitis:Severe abdominal pain, nausea, vomiting, general condition disorder, in the middle part of the abdomen towards both sides radiating pain in a girdle fashion. The patient's general condition may deteriorate in a short time and he may even be admitted to intensive care.
- Pancreatic tumor:Complaints usually appear in the late stages. If there is a tumor in the head of the pancreas, jaundice occurs at an earlier stage. Weight loss and decreased appetite are the most common complaints. Tumors in the tail of the pancreas cause complaints in the late stages. Generally, patients present with severe weight loss and pain.
- Obstruction in the vascular structures of the intestines (mesenteric ischemia):Severe abdominal pain, nausea, vomiting. Complaints that occur especially after meals. Diseases such as cardiovascular diseases, diabetes, etc. in the past history. There is often no serious tenderness on abdominal examination.
- Stomach or duodenal ulcer:The complaint character has been mentioned before.
- Stomach perforation: It mostly develops after chemical or alcohol consumption and on the basis of stomach ulcers. There is severe tenderness and pain in the abdomen. The abdomen is very hard when palpated. The person writhes, so to speak. Severe nausea and vomiting may occur. There may be bloody vomiting.
- Aortic dissection:The destruction of the inner layers of the aorta, the largest artery in the body. rupture and bleeding into the vessel wall. In this case, the tissue blood supply of the parts below this level is rapidly deteriorated. It is a life-threatening situation. Severe abdominal, back pain, bruising in the legs (sudden onset), poor general condition, drop in blood pressure, impaired consciousness, urinary interruption, etc.
5. Widespread pain
- Intra-abdominal bowel perforation (rupture):A situation in which severe pain and tenderness are detected as a result of the spread of intestinal contents into the abdominal cavity, which we call acute abdomen. situation arises. It is a reason for emergency surgery.
- Occlusion in the vascular structures of the intestines (mesenteric ischemia):Mentioned above.
- Acute gastroenteritis:Fever, nausea. diarrhea. It most often develops due to viral causes or food poisoning. It goes away on its own within days. The important thing is that the patient does not become dehydrated. In this respect, fluid, salt and nutritional products (when necessary) should be given intravenously when necessary.
- Irritable bowel disease:Mentioned above.
- Intestinal obstruction: Mentioned above.
- Ectopic pregnancy:Sometimes pregnancy occurs in the tubes or in the abdomen, not in the uterus. This is a condition that prevents the pregnancy from continuing. It can cause severe abdominal pain and acute abdomen. Pregnancy is terminated.
- Often localized in one place: Herpes Zoster:This is a virus infection. It causes rash, watering, itching and pain on the skin, often limited to one area (the area where the pain occurs). The rash appears as redness in that area, watery vesicles, and burst vesicles after itching. Sometimes there may not even be a rash. In this case, diagnosis becomes difficult.
- Lead poisoning:Lead is a metal that can poison people in case of contact. Damage to various tissues, abdominal pain, nausea and vomiting, kidney failure, changes in consciousness, liver damage, movement disorders, epileptic attack, etc.
- Porphyria:Hemoglobin, which carries oxygen in the cells that carry oxygen in the blood It occurs as a result of the accumulation of some molecules in the body due to a defect in the synthesis of the molecule called 'heme' in the structure of the protein called 'heme'. A genetic structure
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