Symptoms of Abdominal Pain or Stomach Ache Include
1. Chronic Abdominal Pain:
- Sudden and Severe Pain– is caused by perforation, mesenteric ischemia, intestinal obstruction, biliary colic, black widow spider bite, and poisoning.
- Sluggish and Severe Pain– is caused pancreatitis (upper abdomen and upper back).
- Duration of pain is either brief or prolonged.
- Brief pain is observed when pain is caused by gas in bowel, food poisoning.
- Prolonged abdominal pain is caused by gallstone, pancreatitis and cancer of abdominal organs.
- Abdominal Cramps– cramps are waves of abdominal pain due to contractions of the intestinal muscles and distention of the intestine.
- Less than 24 hours: Gas, constipation.
- More than 24 hours: Associated with diarrhea and fever, e.g. stomach flu, infection, food poisoning, ulcer, obstruction, volvulus and intussusception.
- Stabbing Pain– Stabbing pain is caused by food poising, irritable bowel syndrome, peptic ulcer, appendicitis, diverticulitis, psoas abscess, intussception, menstruation and peritonitis.
- Twisting Pain– Twisting pain is caused by miscarriage, Crohn’s disease, ulcerative colitis, stomach flu, indigestion, food poisoning, infection in the uterus or fallopian tubes, pelvic inflammatory disease (PID), cystitis, stomach cancer, pancreatic cancer and mesenteric ischemia.
Piercing pain is caused by appendicitis, divericulitis, perforated ulcer, peritonitis, ectopic pregnancy, gallstones or other gallbladder infection, kidney stones, Crohn’s disease, ulcerative colitis, rupture ovarian cyst, disease of ovaries, pelvic inflammatory disease (PID), kidney or ureter stones, infection in the urinary tract, cystitis, stomach cancer and pancreatic cancer.
- Referred Pain: Pain is referred to various sites over body. Pain is called referred pain when observed at distant region.
- Shoulder: Rare but occasional from disease of liver, gall bladder, stomach, spleen, lungs, or pericardial sac.
- Groin: Intra-abdominal causes of pain rarely referred to groin. Kidney stone and testicular torsion can cause groin pain.
- Buttocks: Colon cancer, urethral stone and abdominal aneurysm.
2. Visceral Pain
- Upper Middle Abdominal Pain (Epigastric):
Epigastric pain is caused by gastritis, stomach ulcer, stomach cancer, pyloric stenosis, hiatal hernia, esophageal regurgitation and pancreatitis.
- Upper Right Abdominal Pain (Right Hypochondriac):
Right hypochondriac pain is seen in patients suffering with liver diseases like hepatomegaly, fatty liver, hepatitis, liver cancer, liver abscess and liver hemangioma. Right hypochondriac pain is also observed in patients suffering with cholangitis, cholecystitis, roundworms, gallstones and gallbladder cancer. Other causes of right hypochondriac pain are bowel obstruction, intestinal spasm, colon cancer.
- Upper Left Abdominal Pain (Left Hypochondriac):
Left hypochondriac pain is observed in patient suffering with splenomegaly, spleen infection, splenic abscess, pancreatitis, pancreatic cancer, Bowel obstruction, functional disorder, gas accumulation, spasm, inflammation and colon cancer.
- Middle Abdominal Pain (Umbilical Pain):
Umbilical pain is often seen in patients with history of appendicitis, intestinal spasm, obstruction, perforation and injury. Metabolic disorders like diabetic ketoacidosis and uremia may cause umbilical pain. Mesenteric thrombosis (blood clot in mesenteric vein) also causes severe umbilical pain.
- Lower Right Abdominal Pain (Right Iliac):
Right iliac pain is more common then left iliac pain. Pain is caused by bowel distension, constipation and perforation. Other causes are appendicitis, carcinoma of appendix and impacted stool in cecum. Less common causes of pain in right iliac area are cholecystitis, carcinoma of gall bladder, bladder cystitis, bladder stone, bladder cancer, cancer of uterus, vagina, ovaries, fallopian tube and ectopic pregnancy. Right iliac pain may be secondary to endometriosis, Mittelschmerz (pain associated with ovulation), salphingitis (inflammation of fallopian tube), tubo-ovarian abscess, Crohn’s disease, ulcerative colitis and inguinal hernia.
- Lower Left Abdominal Pain (Left Iliac):
Left iliac pain is caused by intestinal polyp, sigmoid volvulus, obstruction, gas accumulation, urinary bladder cystitis, bladder stone, and bladder cancer.
Diseases of genital organs such ectopic pregnancy, endometriosis, Mittelschmerz (pain associated with ovulation), salphingitis (inflammation of fallopian tube) and tubo-ovarian abscess also causes severe left iliac pain.
Hypogastic pain is above the pelvic bone and lower part of abdomen. Pain is caused by diseases of urinary bladder, uterus and sigmoid colon.[2,3]
- Upper Middle Abdominal Pain (Epigastric):
3. Symptoms associated with Abdominal Pain
- Abdominal Distension:
Abdominal distension is an enlargement of abdominal content or sensation of elevated abdominal pressure and volume. Causes of abdominal distension are as follows: Celiac disease, tropical sprue, gastroenteritis, giardiasis, worm infection, Whipple disease, ascites, diverticulitis, kidney stone, lactose intolerance, bowel obstruction, pregnancy, premenstrual syndrome and ovarian cancer.
Infection, ulcerative colitis, Crohn’s disease, gastroenteritis, appendicitis, gall bladder problems, intestinal ischemia, diverticulitis, food poisoning, ulcerative colitis and infection.
Diarrhea is caused by viral or bacterial infection of stomach or small bowel. Parasite infections like amebiasis, giardiasis and worm infection also causes severe diarrhea. Other causes of diarrhea are food allergy, food intolerance, celiac disease, lactose intolerance, fructose intolerance, pernicious anemia, cystic fibrosis, pancreatitis, short bowel syndrome and chemotherapy. Ulcerative colitis, Crohn’s disease and Irritable bowel syndrome are also few of the common causes of diarrhea.
Constipation is one of the common diseases associated with abdominal pain. Constipation is defined as an infrequent bowel movement and during the act of defecation; stool may or may not pass. Constipation may be secondary to insufficient fiber and fluid intake. Causes of constipation, which may need further investigations are colorectal carcinoma causing partial obstruction, hypercalcemia, hypothyroidism, diabetes mellitus and cystic fibrosis.
Hematemesis is a vomiting or spitting of blood. It is observed in disease such as gastric ulcer, esophagitis, esophageal varices, esophageal ulcer, esophageal cancer and stomach cancer.
- Rectal Frank or Occult Bleeding:
Rectal bleeding is lower gastrointestinal bleeding cause by gastrointestinal diseases such as colon cancer, colitis, ulcer, ischemia and hemorrhoids.
- Skin Rash:
Associated with severe pain secondary to post herpetic neuralgia or shingles.
- Inability to Urinate:
Urinary retention or inability to pass urine is sometimes associated with abdominal pain. Urinary retention is obstructive or neurogenic in origin. Causes of inability to urinate in male are enlarged prostate, carcinoma prostate, bladder stone and urethral stone. Causes of retention in male and females are tumor, infection, stricture of urethra, blood clot and stones. Patients suffering with neurogenic bladder, spinal cord stenosis, spinal cord tumor, diabetes mellitus and herniated disk also may suffer with inability to urinate.
- Vaginal Bleeding:
Vaginal bleeding is considered normal in menstruation unless bleeding is profuse and considered abnormal in quantity. Regular monthly vaginal bleeding is called menstruation and irregular vaginal bleeding is called metrorrhagia. Term metro-menorrhagia is use to indicate normal regular menstrual bleeding associated with irregular vaginal bleeding. Vaginal bleeding may originate from uterus, cervix or vagina. Vaginal bleeding is seen in ovaries, fallopian tube, vagina, uterus cervix, ectopic pregnancy and miscarriage.
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