What Is Acute abdominal Pain (Sudden Severe Abdominal Pain)

Pain in the abdomen, commonly called a stomach ache, which is frequently encountered in children and younger adults, is not generally a cause of concern. However, a sudden, severe Acute Abdominal pain is often an indication of a serious problem which requires immediate medical attention. Occasionally, severe abdominal pain appearing suddenly may be the only symptom of a condition requiring urgent surgery.

People with immune deficiency diseases, or those who take immunosuppressant drugs are particularly prone to abdominal pains, so are very old people. Children and younger adults usually feel more severe stomach pains for the same disorders which may cause a lesser sensation of pain in the older adults.  Infants and young babies also get abdominal pain and they may express it by crying and crankiness, as they cannot express it in words.

Types of Acute Abdominal Pain

Abdominal pains are differentiated based on the location of their origin.

Visceral pain originates in the organs inside the abdomen, viscera being the collective name for all the organs and structures inside the abdominal cavity. The visceral nerves respond to the stimuli of stretching but not to tearing or cutting. Stretching of the stomach or intestine with gas accumulation is registered as pain which is dull and vague and difficult to pinpoint to a particular area. Disorders of liver, stomach, pancreas and the first part of the small intestine often precipitate a pain in the upper abdominal area. Pain around the navel or the mid section of the abdomen may result from problems affecting portions of the small intestine. Pain due to inflammation of the appendix is usually felt on the right side of the navel. Infections or other disorders affecting genital and urinary structures and the lowest part of the digestive system may result in lower abdominal pain.

Somatic pain is often a sharp pain which is easy to locate. It originates in the lining of the abdomen called peritoneum. It may be caused by an infection or inflammation of the peritoneal membranes or by irritation caused to them by blood or chemical irritants in the abdominal cavity.

Referred pain refers to pain which is felt in places elsewhere, than the actual location of the disorder causing the pain. For example, pain due to kidney stones is often felt in the groin and pain due to an inflamed diaphragm is usually felt as shoulder pain.

Peritonitis

Peritonitis is a serious, potentially fatal inflammation of the cavity between the layers of peritoneum. It may be caused by the infection of any of the visceral organs such as pancreas or appendix.  When body fluids such as blood or stomach contents spill into the abdominal cavity as in the rupture of the fallopian tube during Ectopic pregnancy or perforation of intestine, they may leak into the peritoneal cavity. These substances may cause irritation and result in peritonitis. An injury to the abdominal area also may cause peritonitis.

Inflammation of the peritoneal cavity causes the peritoneal fluid to leak into the abdominal cavity after a few hours, and it may result in dehydration, and may eventually lead to shock. It may also release many toxic substances formed by the inflammation, which may affect other organs adversely. It may result in liver and kidney failure or severe inflammation of the lungs. It may have a fatal outcome, if not treated urgently.

Causes of Abdominal Pain

Abdominal pain can result from various causes; some of them are gastric ulcers, infections and inflammations of various organs, ruptures, perforations and obstructions in the intestines, blockage in the abdominal blood vessels and muscle spasms.

Potentially fatal conditions which require immediate surgical interventions are:-

  • Abdominal aortic aneurysm that has ruptured
  • Perforations resulting from ulcers in the intestine or stomach
  • Mesenteric ischemia caused by a blockage in the blood supply to the intestines
  • Ectopic pregnancy which has ruptured, spilling the contents into the abdominal cavity

Other Serious conditions which require urgent medical attention are:-

Abdominal pain may also result from several other disorders unrelated to the abdomen such as pneumonia or heart attack. Diabetic ketoacidosis, testicular torsion, porphyria, certain venoms (scorpion and spider bites) and poisons, sickle cell anemia, methanol poisoning etc., are some other less frequent reasons. In infants and newborns, abdominal pain may have entirely different causes unique to them.

Evaluation

Since stomach pain is a common complaint and often the cause may not be serious and may resolve on its own, the patient may self-evaluate the symptoms to assess the need for urgent medical attention.

 Warning signsPeople who have the following symptoms should seek immediate medical intervention.

  • Excruciating pain in the abdomen
  • Presence of symptoms associated with shock such as low blood pressure, fast heart rate, confusion and sweating.
  •  Steadily worsening pain; slightest touch or movement increasing it, which may be a symptom of peritonitis.
  • Enlargement of the abdomen

Those who have abdominal pain, but not the above mentioned warning signs, also may have to consult a doctor as soon as they can.

Diagnosis

Physical examination of the patient may include thorough examination of the abdominal area by touching, tapping and pressing various points in the abdomen. Doctor may ask about the nature of the pain, whether it is intermittent or constant or whether it worsens with touch or movement. Severity or sharpness of the pain may be assessed by the patient’s reactions as well as by the general appearance such as anxiousness, sweating and paleness. Previous medical history of similar pain or surgical procedures undergone, drugs being used including illicit stimulants and alcohol and even details about the food eaten recently are gathered and analyzed for possible causes.

When doctors examine the abdomen, they look for particular sensations and reactions from the patients. Stiffness can be felt by the fingers and tenderness may be detected from the patient’s expression. Guarding is a reflex reaction, of contracting the abdominal muscles by the patient, when an area is touched by the doctor. Rigidity would mean the muscles remaining in a contracted state even in the absence of any external stimuli. Flinching when the doctor suddenly withdraws his hand is termed as rebound. Peritonitis is diagnosed from the above mentioned reactions.

Anus and rectum may be examined for signs of bleeding, tenderness, bulging or masses. Women and girls of reproductive age are asked about the possibility of pregnancy and any existing disorders of the genital system. Pelvic examination may be done to detect vaginal bleeding.

Accompanying symptoms such as nausea and vomiting; blood in sputum, stool or urine; abnormalities in bowel movements such as constipation or diarrhea; weight loss or fatigue may help the doctor in deciding on the further investigations required.

Testing

Testing may be necessary to detect the exact cause of the condition. But, when characteristic symptoms point to certain conditions which requires immediate surgery, doctors may proceed with preparations of surgery without waiting for the test results.

  • Pregnancy is always ruled out in girls and women before further tests or procedures are done.
  • X-rays, ultrasound scans and other imaging tests are done to detect the cause.
  • Urine analysis may be done to rule out urinary tract infections.
  • Blood tests also may be done to look for other possible reasons for the stomach pain.

A  CT scan of the abdomen may give a clear picture of the visceral organs which may have any disorder that can result in abdominal pain but it may not be able to identify all the possible causes

Treatment

When the cause of the abdominal pain is detected, it can be treated with medication, or surgery if necessary. The pain may be relieved by taking appropriate pain relievers. But aspirin is never given as it may worsen abdominal bleeding, if present.

Earlier, doctors were reluctant to prescribe pain killers before the diagnosis was made as there was a chance of them masking the symptoms, but now, with improved diagnostic tests, subjective assessment has become unnecessary.

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Yasser Elnahas

MD, PHD, Professor Of CardioVascular Surgery
Dr. Yasser Elnahas, Is an associate Professor of Cardiovascular Surgery. Dr. Elnahas was trained as a fellow At Texas Heart Institute And Mayo Clinic Foundation.Dr. Elnahas is dedicated to educating the general public about different disease conditions and simplifying the medical knowledge in an easy to understand terminology.

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