Abdominal Pain: Symptoms, Complaints, Signs

The following symptoms and complaints may occur along with Abdominal pain (abdominal pain):

Leading symptoms

  • Stinging/burning/tearing
  • Colic-like discomfort
  • Radiation to other regions of the body
  • Occurrence after exertion, after a meal, etc.
  • Obstruction of breathing; dyspnea (shortness of breath).

Associated symptoms

  • Nausea (nausea)
  • Vomiting
  • Diarrhea (diarrhea)
  • Constipation (constipation)
  • Meteorism (flatulence)

Pain regions/pain locations as an indication of the diseased organ

Subsequent sorting is by descending reliability.

Localization Diseases
Left flank Dermatologic causes: esp. subcutaneous abscesses, granulomas, or herpes zoster (shingles)
Right under the costal arch Liver and biliary system: esp. cholecystitis gallbladder inflammation), cholangitis (bile duct inflammation), choledocholithiasis (gallstone disease: in common bile duct)
Right flank Urinary tract: v. a. nephrolithiasis (kidney stones)/urolithiasis urinary stones)
Middle lower abdomen Intestine (bowels): v. a. enteritis (inflammation of the intestine), gastroenteritis (gastroenteritis), constipation (constipation)
Left under the costal arch Musculoskeletal cause: v. a. contusion (contusion), myalgia (muscle pain), postoperative pain
Epigastric(“relating to the upper abdomen (epigastrium)”). Esophagus (food pipe), stomach, duodenum (duodenum): v. a. gastroenteritis, reflux esophagitis (reflux (lat. refluere = to flow back) of acidic gastric juice and other gastric contents into the esophagus with subsequent esophagitis), Barrett’s syndrome (changes in the mucosa of the esophagus due to replacement of squamous epithelium by cylindrical epithelium; change is considered a facultative (possible) precancerous condition )
Left flank Urinary tract: v. a. nephrolithiasis/urolithiasis)

Note: The authors caution that one should not be too sure of the associations. Posttest probability (versus pretest probability) of disease of a particular organ or organ system increases by 15-25% in the presence of corresponding pain.In the absence of pain at the corresponding site, the probability of disease of associated organs decreases by about 15%.

Warning signs (red flags)

Anamnestic information

  • Fever/chills of unclear cause.
  • Syncope (momentary loss of consciousness), collapse.
  • Persistent vomiting after onset of pain
  • Radiating pain – especially in the areas of the left shoulder, left arm and left hand, also possible are sore throat and jaw pain → think of: Myocardial infarction (heart attack).
  • Blood loss (hematemesis, melaena (tarry stools)).
  • Gastroenteritis (gastroenteritis) → think of: acute appendicitis (appendicitis).
  • Chronic (> 2 weeks), especially nocturnal diarrhea.
  • Anal blood discharge
  • Dysuria (pain during urination)
  • Weight loss
  • Pregnancy (see below)

Clinical findings

  • Peritonism (condition in which the peritoneum (abdominal membrane) is irritated without fully developed peritonitis (inflammation of the peritoneum)).
  • Circulatory instability
  • Sweating
  • Sleepiness
  • Very severe pain inconsistent with discrete clinical findings → think: e.g., ischemia/mesenteric infarction/acute obstruction of an intestinal vessel, obstruction/volvulus (intestinal twisting)
  • Epigastric (upper abdomen) pain + weight loss + normal endoscopic findings → think of: Pancreatic carcinoma (pancreatic cancer) (about 50% of cases).
  • Icterus (jaundice) with fever → think of: Cholangitis (bile duct inflammation).
  • Supraclavicular lymph node enlargement (Virchow’s gland) → think of: Gastric carcinoma (stomach cancer)
  • Anemia (anemia)
  • Pregnancy:
    • Unilateral lower abdominal pain in early pregnancy (early pregnancy) with light spotting (blackish discharge) should always be considered an extrauterine pregnancy (pregnancy in which implantation occurs outside the uterus) until proven otherwise.
    • Thinking about the possibility of premature labor!
    • Caveat. Appendicitis/induced appendicitis is difficult to diagnose in the 3rd trimester/third trimester of pregnancy).
    • In case of severe, persistent pain and a moderately pressure-dolent (pressure-painful) and hard uterus (uterus) with usually only minor vaginal bleeding, think of premature placental abruption (emergency! Immediate hospitalization).

Warning signs (red flags) in children and adolescents

Anamnestic information

  • Family history: inflammatory bowel disease (IBD), gastroduodenal ulcer, or celiac disease.
  • Severe diarrhea (diarrhea) and/or nocturnal diarrhea.
  • Visible blood in the stool
  • Menstrual irregularities
  • Pubertas tarda – delayed or even completely absent development of puberty; delayed puberty is when puberty is not present in the otherwise healthy girl or boy beyond the age of 13.5 (for girls) or 14 years (for boys).

Clinical findings

  • Pain away from the navel
  • Radiation of the pain
  • Fever
  • Unwanted weight loss or growth disturbance.
  • Decrease in performance
  • Palpable resistances
  • Anal changes such as mariscoes (flaccid skin folds (mariscoes) around the external anus), fissures; fistulas (→ think: Crohn’s disease).
  • Arthritis (inflammation of the joints)