Abdominal Pain

Abdominal pain is discomfort felt anywhere between the chest and groin that can occur because of tissue injury, which could be due to mechanical, inflammatory, and ischemic mechanisms.

Mechanical mechanisms of tissue injury include processes that can cut, tear, or crush abdominal contents, like penetrating injuries seen with knife wounds or blunt injuries that occur during a car crash. Next, inflammatory mechanisms involve swelling, stretching, and distention. This can occur due to infectious processes like appendicitis, diverticulitis, or gastroenteritis. Lastly, ischemic mechanisms can be caused by any condition that obstructs blood flow to abdominal contents, like with mesenteric artery occlusion, which is when a blood clot blocks the artery that supplies oxygenated blood to the intestines.

Abdominal pain can be acute, meaning it develops quickly and resolves over hours to days; or chronic, meaning it can come and go over months or even years. Pain can also be visceral, parietal, or referred.

Visceral pain is typically dull, crampy, or burning in nature and difficult to localize. It can be felt with conditions like appendicitis. Parietal pain tends to be sharp and easy to localize, like with the right upper quadrant pain felt in acute cholecystitis. Referred pain can be dull or sharp, difficult or easy to localize, but is typically noted outside the abdominal region, like when biliary tract disease causes pain in the right shoulder.

Other clinical manifestations that accompany acute abdominal pain may include fever, an elevated white blood cell count, nausea, and vomiting, as well as changes in bowel patterns, like constipation, diarrhea, or the presence of blood or mucus in stool.

Okay, diagnosis of abdominal pain begins with a complete history and physical assessment. Laboratory testing depends on the suspected cause, but can include a CBC, to look for indications of infection, inflammation, and anemia; a comprehensive metabolic panel to check for electrolyte abnormalities; as well as tests for kidney and liver function. Also, a pregnancy test should be checked in patients of childbearing age for potential pregnancy-related causes of acute abdominal pain. Diagnostic imaging can also be performed, like abdominal X-ray, ultrasound, or CT scan.

Now, treatment will depend on the underlying cause. If infection is suspected, antibiotics can be administered. In cases where abdominal pain is due to life-threatening problems, like with appendicitis, the patient may require emergency surgery. Treatment may also include symptomatic management with IV fluid and electrolyte replacement, antiemetics, antacids, or stool softeners.

When caring for your patient with abdominal pain you'll assist in identifying the underlying cause and provide supportive care.