April 30, 2017

Abdominal Pain (Causes, Remedies, Treatment)

What exams and tests help diagnose the cause of abdominal pain?

Physical examination

Examining the patient will provide the doctor with additional clues to the cause of the pain. The doctor will determine:

  1. The presence of sounds coming from the intestines that occur when there is obstruction of the intestines,
  2. The presence of signs of inflammation (by special maneuvers during the examination),
  3. The location of any tenderness
  4. The presence of a mass within the abdomen that suggests a tumor, enlarged organ, or abscess (a collection of infected pus)
  5. The presence of blood in the stool that may signify an intestinal problem such as an ulcer, colon cancer, colitis, or ischemia.

For example:

  • Finding tenderness and signs of inflammation in the left lower abdomen often means that diverticulitis is present, while finding a tender (inflamed) mass in the same area may mean that the inflammation has progressed and that an abscess has formed.
  • Finding tenderness and signs of inflammation in the right lower abdomen often means that appendicitis is present, while finding a tender mass in the same area may mean that the inflammation has progressed and that an abscess has formed.
  • Inflammation in the right lower abdomen, with or without a mass, also may be found in Crohn's disease. (Crohn's disease most commonly affects the last part of the small intestine, usually located in the right lower abdomen.)
  • A mass without signs of inflammation may mean that a cancer is present.

While the health history and physical examination are vitally important in determining the cause of abdominal pain, other medical tests often are necessary to determine the cause.

Laboratory tests

Laboratory tests such as the complete blood count (CBC), liver enzymes, pancreatic enzymes (amylase and lipase), pregnancy test and urinalysis are frequently ordered.

  • An elevated white count suggests inflammation or infection (as with appendicitis, pancreatitis, diverticulitis, or colitis).
  • A low red blood cell count may indicate a bleed in the intestines.
  • Amylase and lipase (enzymes produced by the pancreas) commonly are elevated in pancreatitis.
  • Liver enzymes may be elevated with gallstone attacks or acute hepatitis.
  • Blood in the urine suggests kidney stones.
  • When there is diarrhea, white blood cells in the stool suggest intestinal inflammation or infection.
  • A positive pregnancy test may indicate an ectopic pregnancy (a pregnancy in the fallopian tube instead of the uterus).

Plain X-rays of the abdomen

Plain X-rays of the abdomen also are referred to as a KUB (because they include the kidney, ureter, and bladder). The KUB may show enlarged loops of intestines filled with copious amounts of fluid and air when there is intestinal obstruction. Patients with a perforated ulcer may have air escape from the stomach into the abdominal cavity. The escaped air often can be seen on a KUB on the underside of the diaphragm. Sometimes a KUB may reveal a calcified kidney stone that has passed into the ureter and resulted in referred abdominal pain or calcifications in the pancreas that suggests chronic pancreatitis.

Radiographic studies

  • Ultrasound is useful in diagnosing gallstones, cholecystitis appendicitis, or ruptured ovarian cysts as the cause of the pain.
  • Computerized tomography (CT) of the abdomen is useful in diagnosing pancreatitis, pancreatic cancer, appendicitis, and diverticulitis, as well as in diagnosing abscesses in the abdomen. Special CT scans of the abdominal blood vessels can detect diseases of the arteries that block the flow of blood to the abdominal organs.
  • Magnetic resonance imaging (MRI) is useful in diagnosing many of the same conditions as CT tomography.
  • Barium X-rays of the stomach and the intestines (upper gastrointestinal series or UGI with a small bowel follow-through) can be helpful in diagnosing ulcers, inflammation, and blockage in the intestines.
  • Computerized tomography (CT) of the small intestine can be helpful in diagnosing diseases in the small bowel such as Crohn's disease.
  • Capsule enteroscopy, uses a small camera the size of a pill swallowed by the patient, which can take pictures of the entire small bowel and transmit the pictures onto a portable receiver. The small bowel images can be downloaded from the receiver onto a computer to be inspected by a doctor later. Capsule enteroscopy can be helpful in diagnosing Crohn's disease, small bowel tumors, and bleeding lesions not seen on x-rays or CT scans.

Endoscopic procedures

Surgery. Sometimes, diagnosis requires examination of the abdominal cavity either by laparoscopy or surgery.

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Reviewed on 2/27/2017