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OverviewTreatment

Abdominal pain

Definition:
This symptom is pain in the abdominal area, stomach region, or belly (often referred to as stomach pain) or in the abdominal area.

Alternative Names:
Stomach pain; Pain - abdomen; Belly ache; Abdominal cramps; Acute abdomen

Considerations:
Abdominal pain is a nonspecific symptom that may be associated with a multitude of conditions. Some do not occur within the abdomen itself, but cause abdominal discomfort. An example would be the abdominal pain associated with strep throat. Some originate within the abdomen, but are not related to the gastrointestinal tract, such as a dissecting aortic aneurysm. Other pain is related directly to the gastrointestinal tract.

The severity of the pain does not always reflect the severity of the condition causing the pain. Severe abdominal pain can be associated with mild conditions, such as gas or the cramping of viral gastroenteritis, while relatively mild pain (or no pain) may be present with severe and life-threatening conditions, such as cancer of the colon or early appendicitis.

Abdominal pain can be caused by toxins, infection, biliary tract disease, liver disease, renal disease, bladder infections, menstruation, ovulation, female and male genitourinary disease, vascular problems, malignancy, ulcers, perforation, pancreatic disease, hernias, trauma, and metabolic diseases. The list is so extensive that it would be impossible to name all the possible diseases in each of the above groups.

Because abdominal pain is nonspecific, the health care provider will require much more information regarding the time of onset, duration of pain (minutes, hours, days, or even months), location of pain, nature of pain (dull, sharp, steady, crampy, off and on), severity of pain, and relationship to normal functions (such as menstruation and ovulation).

The location of pain and its time pattern may be helpful in suggesting its cause. During physical examination, the health care provider will try to determine if the pain is localized to a single area (point tenderness) or diffuse, and if the pain is related to inflammation of the peritoneum or of the abdomen. If the health care provider finds evidence of peritoneal inflammation, the abdominal pain may be classified as an "acute abdomen", which often requires prompt surgical intervention.

In addition, the health care provider will try to relate the abdominal tenderness to other general symptoms, such as fever, fatigue, general ill feeling (malaise), nausea, vomiting, or changes in stool. Then, the provider will ask about increasingly specific symptoms as the diagnostic considerations are narrowed.

In infants, prolonged unexplained crying (often called "colic") may be caused by abdominal pain that often ends with the passage of gas or stool. Colic is often worse in the evening. Cuddling and rocking the child may bring some relief.

Severe abdominal pain that occurs during menstruation may indicate a problem in a reproductive organ. This includes conditions, such as endometriosis, uterine fibroids, ovarian cysts, ovarian cancer (rare), or pelvic inflammatory disease (PID).

Common Causes:
The following is a list of the most common causes of abdominal pain. It is important to note that among this list there are relatively few serious diseases.

Common causes in children:

Less common, but serious causes:

Abdominal pain that may indicate a potential emergency:

  • Severe abdominal pain with nausea and fever may indicate appendicitis, cholecystitis (infected gall bladder), or complications of diverticulitis.
  • Abdominal pain, nausea, and bloating or constipation may indicate a bowel obstruction.
  • Abdominal pain that is accompanies by a stiff, "board like" abdomen may indicate peritonitis due to an infection spreading in the abdominal cavity or to a hole in the stomach or intestine.
  • Abdominal pain is accompanied by bloody stools, vomiting blood, or gastrointestinal bleeding from any cause can be dangerous.
  • Persistent upper abdominal pain and vomiting may indicate pancreatitis (inflammation of the pancreas).
  • Abdominal pain followed by nausea/ vomiting and fever may indicate appendicitis.
  • Intermittent abdominal pain manifested in an infant by drawing knees to chest, with crying, could be intussusception (telescoping intestines).
  • Dissecting abdominal aortic aneurysm.


Review Date: 1/31/2002
Reviewed By: Andrew J. Muir, MD MHS, Division of Gastroenterology, Department of Medicine, Duke University Medical Center, Durham, NC. Review provided by VeriMed Healthcare Network.

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