All you want to know about abdominal pain:

  when, how and why?  

notes by Dr. Claudio Italiano, gastroenterologist            see also index gastroenterology

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 The first rules:

   Never take care of abdominal pain or diarrhea using  medications advertised on TV, such as  opioid derived drugs.

  Also you should keep fasting the patients with abdominal pain. It's spoken about a sudden pain, throbbing, which is blocking the feces, a pain that makes us bend in two, and leads us to the hospital! Compare now the page on the surgical abdominal pain.

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. Seat: the seat of pain is usually the most important diagnostic aid, but not always corresponds to that of the morbid process. The patient may say he feels pain in this or in that forum, but the pain can also radiate, after having interviewed the patient, you can visit and assess the objectivity. The palpation is initiated in an not painful area, then  you can proceed to explore other areas, including the site of pain.

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It is often helpful to categorize abdominal pain into more specific types such as:

•             Upper abdominal pain ,which is also subdivided into epigastric pain and left and right abdominal pain

•             Lower abdominal pain

The areas of pain may be located into>

Right upper abdomen

 left upper abdomen  and right upper abdomen

 lower right abdomen

 lower left abdomen

A pain of upper right abdomen refers to the diagnosis of diseases of liver and biliary system (calculations), in which case it radiates back, under the right scapula. The pain is due to distension of the  coatings of liver,  which is innervated. The increasing of the volume is explained by diseases of liver such as hepatitis, cholangitis, abscesses, or increasing of liver volume due to cardiac failure. It's  known, however, that there are other diseases that cause pain, ie processes dependent on the region of the duodenum and gastric pre-pyloric (ulcer, gastritis, diverticulitis), and the pancreas (acute pancreatitis, chronic pancreatitis, inflammatory processes, tumors and pseudocysts). Near the liver even the bowel can give a syndrome pain in the irritable bowel syndrome, such as a spastic pain.

 The epigastric pain includes a typical disease of stomach; i.e. the  acute gastritis generally due to short-lived infection of the gastrointestinal tract by viruses, bacteria end protozoa, which is characterized by vomiting, nausea, darrhoea and fever. The ulcer causes a pain more limited, exacerbated by food. The hernia of esophageal hiatus (reflux)  causes  an epigastric  hearthburn,  similar to an hearth attack. But it’s also possible to treat an acute episode of angina or a myocardial infarction such as a reflux!  Particulary attention is required for a chest pain correlated to a pulmonary embolism!

 Never underestimate a chest pain!

  The pain due to Blood Vessel mesogastric, especially after a big meal, depends on an  atherosclerotic  mesogastric vessels  of the smokers, and  dyslipidemic patients.  And give rise to the so-called "claudication intermittens abdomen syndrome. If the pain is sudden and violent you can think the cause to be  ta portal vein thrombosis, accompanied by fever, splenomegaly, or mesenteric embolism. Even an aneurysm of the aorta adbominal can give intense pain (the aneurysm is a dilation of the vascular wall due to a congenital or degenerative vessel disease.

Abdominal pain upper left

 A  pain in the left upper abdomen  appears  into the stomach and large intestine pathologies, but may be interested  the kidney and the left pleura  (a left hypocondriac  syndrome).  Also you can investigate pancreas, which may be affected by acute or chronic pancreatitis in the alcoholism, or by a pancreatic cancer. The pancreatic calculi can give symptoms similar to biliary calculi. Consistently is located on the left splenic pain, accordingly eg. an enlarged spleen, leukemia, Gaucher's disease. Are sudden pains that hamper breathing, indicating splenic infarction, or endocarditis, or atrial fibrillation!

 Lower right abdominal pain

 The pain dell'addome the lower right corner indicates appendicitis, colic from kidney stones or, in women, salpingitis, namely the genital tract inflammation, or a tubal pregnancy, an ovarian cyst. Still a pain here can indicate terminal ileitis(Crohn's disease)or an abdominal hernias, or a pain in typhoid fever and dysentery, or cystitis.

Lower left abdominal pain

 Pains in this region may result from kidney disorders, of the urinary tract, the male appendages and feminile,or caused by ulcerative colitis involving the rectum-sigma, or simply depend on the irritable colon syndrome. Do not forget that a colic pain (it's a pain that comes and goes) characterizes the smooth muscles of a cable organ but can also depend simply by gaseous distension. We can not exclude, however, that the cause lies in carcinoma of the colon or in a diverticulitis. Therefore, since we know that most cancers of the colon affects this region, even a simple colic may be investigated by instrumental examination such as colonoscopy, a barium radiological examination etc..  

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