Abdominal Pain, also known as a stomach ache, is a symptom associated with both non-serious and serious medical issues. Common causes of pain in the abdomen include gastroenteritis and irritable bowel syndrome.[2] About 15% of people have a more serious underlying condition such as appendicitis, leaking or ruptured abdominal aortic aneurysm, diverticulitis, or ectopic pregnancy.[2] In a third of cases the exact cause is unclear.[2] Given that a variety of diseases can cause some form of Abdominal Pain, a systematic approach to examination of a person and the formulation of a differential diagnosis remains important. The most frequent reasons for Abdominal Pain are gastroenteritis (13%), irritable bowel syndrome (8%), urinary tract problems (5%), inflammation of the stomach (5%) and constipation (5%). In about 30% of cases, the cause is not determined. About 10% of cases have a more serious cause including gallbladder (gallstones or biliary dyskinesia) or pancreas problems (4%), diverticulitis (3%), appendicitis (2%) and cancer (1%).[2] More common in those who are older, mesenteric ischemia and abdominal aortic aneurysms are other serious causes.[3] Acute abdomen can be defined as severe, persistent Abdominal Pain of sudden onset that is likely to require surgical intervention to treat its cause. The pain may frequently be associated with nausea and vomiting, abdominal distention, fever and signs of shock. One of the most common conditions associated with acute Abdominal Pain is acute appendicitis. A more extensive list includes the following: The location of Abdominal Pain can provide information about what may be causing the pain. The abdomen can be divided into four regions called quadrants. Locations and associated conditions include:[4][5] Esophagus Lower respiratory tract Stomach Proximal duodenum Liver Biliary tract Gallbladder Pancreas Cecum Appendix Ascending colon Proximal transverse colon Descending colon Sigmoid colon Rectum Fever Superior anal canal Abdominal Pain can be referred to as visceral pain or peritoneal pain. The contents of the abdomen can be divided into the foregut, midgut, and hindgut.[6] The foregut contains the pharynx, lower respiratory tract, portions of the esophagus, stomach, portions of the duodenum (proximal), liver, biliary tract (including the gallbladder and bile ducts), and the pancreas.[6] The midgut contains portions of the duodenum (distal), cecum, appendix, ascending colon, and first half of the transverse colon.[6] The hindgut contains the distal half of the transverse colon, descending colon, sigmoid colon, rectum, and superior anal canal.[6] Each subsection of the gut has an associated visceral afferent nerve that transmits sensory information from the viscera to the spinal cord, traveling with the autonomic sympathetic nerves.[8] The visceral sensory information from the gut traveling to the spinal cord, termed the visceral afferent, is non-specific and overlaps with the somatic afferent nerves, which are very specific.[9] Therefore, visceral afferent information traveling to the spinal cord can present in the distribution of the somatic afferent nerve; this is why appendicitis initially presents with T10 periumbilical pain when it first begins and becomes T12 pain as the abdominal wall peritoneum (which is rich with somatic afferent nerves) is involved.[9] In order to better understand the underlying cause of Abdominal Pain, one can perform a thorough history and physical examination. The process of gathering a history may include:[10] After gathering a thorough history, one should perform a physical exam in order to identify important physical signs that might clarify the diagnosis, including a cardiovascular exam, lung exam, thorough abdominal exam, and for females, a genitourinary exam.[10] Additional investigations that can aid diagnosis include:[11] If diagnosis remains unclear after history, examination, and basic investigations as above, then more advanced investigations may reveal a diagnosis. Such tests include:[11] The management of Abdominal Pain depends on many factors, including the etiology of the pain. In the emergency department, a person presenting with Abdominal Pain may initially require IV fluids due to decreased intake secondary to Abdominal Pain and possible emesis or vomiting.[12] Treatment for Abdominal Pain includes analgesia, such as non-opioid (ketorolac) and opioid medications (morphine, fentanyl).[12] Choice of analgesia is dependent on the cause of the pain, as ketorolac can worsen some intra-abdominal processes.[12] Patients presenting to the emergency department with Abdominal Pain may receive a "GI cocktail" that includes an antacid (examples include omeprazole, ranitidine, magnesium hydroxide, and calcium chloride) and lidocaine.[12] After addressing pain, there may be a role for antimicrobial treatment in some cases of Abdominal Pain.[12] Butylscopolamine (Buscopan) is used to treat cramping Abdominal Pain with some success.[13] Surgical management for causes of Abdominal Pain includes but is not limited to cholecystectomy, appendectomy, and exploratory laparotomy. Below is a brief overview of Abdominal Pain emergencies. Periumbilical pain, migrates to RLQ Abdominal CT IV fluids as needed General surgery consultation, possible appendectomy Antibiotics Pain control Imaging (RUQ ultrasound) Labs (leukocytosis, transamintis, hyperbilirubinemia) IV fluids as needed General surgery consultation, possible cholecystectomy Antibiotics Pain, nausea control Labs (elevated lipase) Imaging (abdominal CT, ultrasound) IV fluids as needed Pain, nausea control Possibly consultation of general surgery or interventional radiology Imaging (abdominal X-ray, abdominal CT) IV fluids as needed Nasogastric tube placement General surgery consultation Pain control Labs (complete blood count, coagulation profile, transaminases, stool guaiac) Blood transfusion as needed Medications: proton pump inhibitor, octreotide Stable patient: observation Unstable patient: consultation (general surgery, gastroenterology, interventional radiology) Labs (complete blood count, coagulation profile, transaminases, stool guaiac) Blood transfusion as needed Medications: proton pump inhibitor Stable patient: observation Unstable patient: consultation (general surgery, gastroenterology, interventional radiology) Imaging (abdominal X-ray or CT showing free air) Labs (complete blood count) General surgery consultation Antibiotics Cecal volvulus: Abdominal Pain (acute onset), nausea, vomiting Imaging (abdominal X-ray or CT) Cecal: General surgery consultation (right hemicolectomy) If ruptured ectopic pregnancy, patient may present with peritoneal irritation and hypovolemic shock Labs: complete blood count, urine pregnancy test followed with quantitative blood beta-hCG Imaging: transvaginal ultrasound If patient is stable: continue diagnostic workup, establish OBGYN follow-up Imaging: Ultrasound, CT angiography, MRA/magnetic resonance angiography If patient is stable: admit for observation Imaging: Chest X-Ray (showing widened mediastinum), CT angiography, MRA, transthoracic echocardiogram/TTE, transesophageal echocardiogram/TEE Blood transfusion as needed (obtain type and cross) Medications: reduce blood pressure (sodium nitroprusside plus beta blocker or calcium channel blocker) Surgery consultation Imaging: FAST examination, CT of abdomen and pelvis Diagnostic peritoneal aspiration and lavage If patient is unstable: general or trauma surgery consultation with subsequent exploratory laparotomy Imaging: FAST examination, CT of abdomen and pelvis Diagnostic peritoneal aspiration and lavage If patient is unstable: general or trauma surgery consultation with subsequent exploratory laparotomy and possible splenectomy If patient is stable: medical management, consultation of interventional radiology for possible arterial embolization Abdominal Pain is the reason about 3% of adults see their family physician.[2] Rates of emergency department visits in the United States for Abdominal Pain increased 18% from 2006 through 2011. This was the largest increase out of 20 common conditions seen in the ED. The rate of ED use for nausea and vomiting also increased 18%.[15]

Source:Wikipedia.org