Abdominal Pain (cont.)
William C. Shiel Jr., MD, FACP, FACR
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
In this Article
- Abdominal pain facts
- What is abdominal pain?
- What causes abdominal pain?
- How is the cause of abdominal pain diagnosed?
- Characteristics, symptoms, and signs of the abdominal pain
- Associated signs and symptoms of abdominal pain
- Physical examination
- Exams and tests
- Special problem in irritable bowel syndrome (IBS) of diagnosing the cause of abdominal pain
- Why can diagnosis of the cause of abdominal pain be difficult?
- How can I help my doctor to determine the cause of my abdominal pain?
- Pictures of Abdominal Pain - Slideshow
- Pictures of What's Causing Your Pelvic Pain - Slideshow
- Pictures of Appendicitis & Appendectomy - Slideshow
- Find a local Doctor in your town
Special problem in irritable bowel syndrome (IBS) of diagnosing the cause of abdominal pain
As previously discussed, the pain of irritable bowel syndrome is due either to abnormal intestinal muscle contractions or visceral hypersensitivity. Generally, abnormal muscle contractions and visceral hypersensitivity are much more difficult to diagnose than other diseases causing abdominal pain, particularly since there are no typical abnormalities on physical examination or the usual diagnostic tests. The diagnosis is based on the history (typical symptoms) and the absence of other causes of abdominal pain.
Why can diagnosis of the cause of abdominal pain be difficult?
Modern advances in technology have greatly improved the accuracy, speed, and ease of establishing the cause of abdominal pain, but significant challenges remain. There are many reasons why diagnosing the cause of abdominal pain can be difficult. They are:
- Symptoms may be atypical. For example, the pain of appendicitis sometimes is located in the right upper abdomen, and the pain of diverticulitis is on the right side. Elderly patients and patients taking corticosteroids may have little or no pain and tenderness when there is inflammation, for example, with cholecystitis or diverticulitis. This occurs because corticosteroids reduce the inflammation.
- Tests are not always abnormal.
- Ultrasound examinations can miss gallstones, particularly small ones.
- CT scans may fail to show pancreatic cancer, particularly small ones.
- The KUB can miss the signs of intestinal obstruction or stomach perforation.
- Ultrasounds and CT scans may fail to demonstrate appendicitis or even abscesses, particularly if the abscesses are small.
- The CBC and other blood tests may be normal despite severe infection or inflammation, particularly in patients receiving corticosteroids.
- Diseases can mimic one another.
- IBS symptoms can mimic bowel obstruction, cancer, ulcer, gallbladder attacks, or even appendicitis.
- Crohn's disease can mimic appendicitis.
- Infection of the right kidney can mimic acute cholecystitis.
- A ruptured right ovarian cyst can mimic appendicitis; while a ruptured left ovarian cyst can mimic diverticulitis.
- Kidney stones can mimic appendicitis or diverticulitis.
- The characteristics of the pain may change. Examples discussed previously include the extension of the inflammation of pancreatitis to involve the entire abdomen and the progression of biliary colic to cholecystitis.
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