Abdominal Pain

What is Abdominal Pain?

Abdominal Pain also referred to as stomach ache in daily life, is the pain which might be arising from any organ in the abdomen. It could be the stomach, liver, pancreas, spleen, intestines, kidneys, gall bladder, or the tissue called the peritoneum which envelopes all these organs. The type and the cause of this stomach ache could be of several types.

Is Abdominal Pain a Medical emergency?

Abdominal Pain becoming a medical emergency depends on the severity and the actual reason behind the condition. In specific situations, if the pain is left untreated, it can lead to life-threatening complications.

Types

Abdominal Pain could be of several types:

• Localized: When a particular organ in the abdomen is affected, the person will be able to precisely point out the location of the pain
• Cramping: Conditions which commonly cause this type of pain include:
  • Constipation
  • Diarrhea
  • A sensation of fullness of the tummy (Bloating)
  • Presence of gas in the intestines (Flatulence)
  • Menstrual irregularities
• Colicky: This is a squeezing type of pain. This happens when the intestines, the Ureters (tube-like parts collecting urine from the Kidneys) or the Bile Duct (tube-like part collecting bile from the Gall Bladder), contract and relax abnormally.

Both cramp-like and colicky pain tends to come and go, which means, they start suddenly and disappear without any treatment. They often start again after a certain period of time.

Causes

Causes of Abdominal Pain include:

• Constipation
• Infections of the intestines (Gastroenteritis)
• Ulcers in the stomach
• The Gall Bladder becoming sore (inflamed), which is called Cholecystitis
• Infections of the Liver called Hepatitis
• The Pancreas becoming sore (inflamed), a condition called Pancreatitis
• The small tube-like organ called Appendix becoming sore. This is when it is called Appendicitis.
• Irritable Bowel Syndrome (IBS)
• Inflammatory Bowel Diseases (IBD), which could be of two types- Crohn’s Disease and Ulcerative Colitis
• The layers of tissue called the Peritoneum surrounds the organs in the tummy. When this layer becomes inflamed, it is called Peritonitis, which needs immediate medical attention.
• When the intestines or the stomach ruptures, the condition is called a Perforation

Risk factors

Common risk factors include:

• Irregular meals
• A diet containing a high level of spices and salt
• Psychological factors
• Stress
• Cigarette smoking
• Alcohol
• Excess use of Aspirin or other pain killers
• Infections in the Kidneys and Gall Bladder
• Stones in the Kidneys and Gall Bladder
• Injections with needles infected by Hepatitis B virus

Symptoms & signs

Abdominal Pain quite often occurs along with other symptoms like:

• Constipation
• Diarrhea
• Fever
• Jaundice
• Vomiting
• Passing excess gas along with stool
• Indigestion
• The fullness of the tummy

Apart from these symptoms which the person experiences, a doctor might notice some peculiarities in examining the abdomen. These are referred to as signs. There are several signs a doctor might notice depending on the condition. The method of identifying these signs also varies with the condition.

Investigations

Currently, there are various modalities to diagnose the cause of Abdominal Pain. However, to precisely choose from these numerous tests, the doctor first examines the person and makes a note of how the condition started and progressed.

Lab tests:

1) Complete Blood Picture

2) Serum Amylase & lipase

3) Hepatitis Serology

4) Blood culture and Urine cultures, which help identify bacteria

Imaging modalities: 

1) X-Ray of the abdomen

2) Ultrasound scans

3) CT and MRI scans

4) Colonoscopy

5) Endoscopy

6) Barium Swallow

7) Barium Enema

Diagnosis

The diagnosis of the underlying cause of Abdominal Pain is established based on medical history, clinical evaluation, and results of the investigations done.

Treatment options

The treatment of Abdominal Pain depends on identifying and managing the underlying cause. Therapies range from lifestyle changes to simple medications to even surgeries.

Medical treatment

For a number of causes, simple medications which are available over-the-counter (OTC) are sufficient. For example, laxatives (stool softeners) to treat constipation, antacids to provide relief from stomach ulcers, are available without a doctor’s prescription. However, it is always advisable to discuss these health conditions with a doctor to avoid complications:

• In conditions like Gastroenteritis, antibiotics are prescribed by a doctor to control the bacteria causing inflammation of the intestines
• In the case of Hepatitis, antivirals are advised in addition to several measures
• In Cholecystitis (inflamed Gall Bladder), medications are given to control the soreness (anti-inflammatory medicines) and to suppress bacterial infection (antibiotics)
• Antispasmodics (relieve cramp-like pain) and antidiarrheals (to control loose stool), are prescribed in Irritable Bowel Syndrome (IBS)
• Medicines called Salicylates are available to reduce bowel soreness (inflammation of intestines) in conditions like Inflammatory Bowel Diseases (IBD)

Interventional treatment including surgery and indications for surgery/ Surgical treatment

Surgery is not routinely required in Abdominal Pain. It is required only when medical management is not sufficient to cure the condition:

• In Cholecystitis caused by Gall Stones, after initial treatment with medications for a few weeks, surgery may be advised to remove the Gall Bladder.
• Appendicitis is yet another condition wherein surgery plays a key role in treatment. However, recently developed protocols advise medical management for some types of Appendicitis.
• In advanced cases of IBD, parts of the colon which have been severely damaged might have to be removed through surgery.
• In severe ulcers of the Stomach, there is a chance of rupture of the stomach. Similarly, the intestines may sometimes rupture due to a variety of reasons. Such scenarios are surgical emergencies and require emergency Laparotomy. This is a surgery in which the tummy has to be opened and the ruptured organ has to be operated upon.

Radiation

Abdominal Pain can be caused by tumors of various organs in the tummy. There are several treatment methods to deal with these tumors. Chemotherapy, Radiotherapy (Radiation) and surgery are commonly employed techniques. Radiation therapy is now being delivered through highly advanced techniques like stereotactic radiotherapy, to enhance the efficacy greatly.

Role of diet/ Exercise/ Lifestyle changes

Lifestyle changes are advised in several cases of Abdominal Pain. For instance:

• In constipation and Irritable Bowel Syndrome (IBS), people are advised to increase the amount of fibre in their diet, have small meals more frequently, drink adequate water, and exercise regularly. These modifications are found to benefit a large number of patients and this minimizes the dependence on medications for relief of symptoms.
• In IBS, psychological factors play a crucial role. Hence, doctors advise people to reduce their stress levels by practising relaxation techniques of their choice.
• Though Pancreatitis can be caused by several factors, alcohol consumption is a common cause. Thus, doctors advise people to stay away from alcohol to prevent damage to their Pancreas. The same is the case with conditions like Alcoholic Hepatitis.

Preventive measures

Although all types of Abdominal Pain cannot be prevented, some precautions can definitely lower the risk in a number of cases. A healthy diet, multiple small meals in a day, drinking an adequate amount of water, regular physical activity, can contribute to the health of the abdominal organs.

Complications

Complications of Abdominal Pain are not common. They arise only when the condition is neglected or when the treatment is delayed. Possible complications include:

• Constipation for a prolonged period may lead to Piles (Haemorrhoids)
• Untreated stomach ulcers may lead to bleeding in the stomach, which might cause blood vomiting. An even more dire consequence is the rupture of the stomach due to these ulcers. This requires emergency surgery
• Long-standing Gall Bladder infections can lead to Gall Stones. These stones might further block the various pathways of the Liver leading to severe Abdominal Pain and Jaundice
• When an inflamed Pancreas is left neglected, it can destroy the organ completely and permanently. The pancreas, being a source of Insulin, can lead to Diabetes when damaged. Prolonged soreness can lead to a collection of pus around the organ
• Inflammatory Bowel Diseases can cause severe blood loss in stool. This can lead to Anaemia. Furthermore, prolonged soreness of the intestines can cause a rupture

Prognosis

The outcome in various forms of Abdominal Pain is good, provided, they are appropriately treated.

When to contact the doctor? / How to identify complications?

Medical attention has to be sought when a person experiences any of the following symptoms:

• Stomach ache that lasts longer than 1 day
• Constipation that doesn’t resolve
• Vomiting
• Loss of appetite
• Weight loss through the person doesn’t do anything to lose weight
• Passing blood in the stools
• High fever
• Jaundice
• A swollen tummy

Indications for hospitalization

Hospital admission will be usually required when Abdominal Pain leads to a medical emergency. Conditions like Appendicitis, rupture of the stomach or the intestines, sudden worsening of conditions like Pancreatitis, Gall Stones, Kidney Stones, etc require emergency hospitalization and treatment. A few conditions might require surgery but they can be planned and scheduled. Such conditions include Gall Bladder and Kidney stones which are not causing pain, a tumor which is not causing any discomfort, etc.

Suggested clinical specialists/ Departments to consult for this condition

Several specialities can deal with Abdominal Pain. General Physicians & General Surgeons are the medical experts commonly consulted for this condition. However, depending on the severity and the complexity of the condition, specialists like Medical Gastroenterologists, Surgical Gastroenterologists contribute to the patient’s care. When a person is brought to the emergency department due to unbearable Abdominal Pain, Emergency Physicians are the ones who first stabilize the person’s condition.