Synonyms in a broader sense
Abdominal pain, abdominal cramps, stomach pain, stomach cramps English: stomachache
Definition of abdominal pain
Abdominal pain is a painful discomfort that either originates in the area of the abdomen and is perceived as such there or is caused elsewhere in the body and transmitted to the abdominal region. Since abdominal pain is a symptom in itself, the following section will discuss the different forms of abdominal pain and other accompanying symptoms in addition to abdominal pain. Every patient experiences the intensity and type of abdominal pain differently.
However, this depends mainly on the fact that abdominal pain can have a variety of different causes, which can cause complaints of varying intensity and at different points in the abdomen. Often, however, the pain is not felt on the organ itself, i.e. the place where something is not working properly, but on the skin that lies over this section. Often the abdominal pain cannot be attributed to a direct location and is felt to be rather dull and diffuse over the abdomen.
Which disease causes which type of abdominal pain is explained in more detail in the Causes section. Abdominal pain can occur in the entire abdominal cavity. In technical terminology and for easier orientation for medical staff, the skin above the abdomen is divided into four parts or quadrants, the centre being the navel itself.
The upper left quadrant, for example, is located to the left of an imaginary centre line above the navel, the lower right quadrant is located to the right of an imaginary centre line below the navel. If the abdominal pain is located around the navel, this pain is called paraumbilical abdominal pain. Furthermore, there is often talk of upper abdominal pain (above the navel) and lower abdominal pain (below the navel).
Depending on the type of abdominal pain, patients often try to relieve the abdominal pain by changing position. Often, as a treating physician, you can already tell from the patient’s posture what type of abdominal pain it is, as patients with certain types of abdominal pain tend to lie still, while others are walking briskly through the doctor’s office and cannot remain lying still. Other patients report abdominal pain in a sitting position.
Other accompanying symptoms of abdominal pain
Abdominal pain is often accompanied by other symptoms that are often related to the underlying disease and determine the severity of the abdominal pain. Particularly in the case of severe abdominal pain, falling blood pressure can occur as a result. If the abdominal pain has been present for a long time, a loss of weight may be present at the same time, which can be an alarm signal for a serious illness of the gastrointestinal tract.
Likewise, a very hardened abdominal wall is an alarm signal for a more serious illness in the abdominal area. If a so-called acute abdomen (acute abdomen) occurs, characterised by sudden onset of severe abdominal pain which quickly becomes even worse, a doctor should be consulted immediately, as this is often a life-threatening deterioration of the general condition. An acute abdomen can be recognised by the following symptoms, among others, which always require immediate treatment by a doctor:
- Pale skin and a
- Possible impotence
- Nausea (Nausea)
- Flatulence (meteorism)
- Diarrhoea (diarrhoea)
- Vomiting (emesis) or
- Constipation (constipation)
- Bloated and very hard belly
- Heaviest pains
- Strong vomiting with blood admixtures or even stool admixtures
- Yellow discoloration of the skin (jaundice, icterus)
- Absence of bowel movements/lack of urination for several days
- Blood in urine
- High fever
- Weld outbreaks
Abdominal pain can have many different causes, as there are different organ systems in the abdominal area, all of which can be damaged in different ways, and the patient will experience different forms of abdominal pain.
However, abdominal pain often has a functional cause in the gastrointestinal tract. If the abdominal pain always occurs after the consumption of certain foods, there may be intolerance to these foods. This is particularly common in
- Upset stomach (the most common and at the same time the most harmless cause of stomach pain)
- Due to psychological stress, abdominal pain can occur, e.g. due to stress (abdominal pain caused by stress),which then, however, has no organic cause and can be classified as harmless.
(However, abdominal pain often has a functional cause in the gastrointestinal tract. If the abdominal pain always occurs after eating certain foods, there may be intolerance to these foods. This is particularly frequent in the case of lactose intolerance and also in the case of fructose intolerance (in the case of lactose intolerance, complaints such as diarrhoea and flatulence always occur after the consumption of products with milk or to which milk sugar (lactose) is added).
coeliac disease (gluten intolerance). Gluten intolerance describes a clinical picture in which the affected persons cannot digest the vegetable glue gluten contained in cereals and develop antibodies against it, which can lead to the most varied symptoms inside and outside the gastrointestinal tract. Both gluten intolerance and lactose intolerance are easy to diagnose and can be controlled by avoiding the respective food.
- Lactose intolerance and also in
- Fructose intolerance (In the case of lactose intolerance, complaints such as diarrhoea and flatulence always occur after the consumption of products containing milk or to which lactose (milk sugar) is added). – Celiac disease (gluten intolerance). Gluten intolerance describes a clinical picture in which the affected persons cannot digest the vegetable glue gluten contained in cereals and develop antibodies against it, which can lead to the most varied symptoms inside and outside the gastrointestinal tract.
Both gluten intolerance and lactose intolerance are easy to diagnose and can be controlled by avoiding the respective food. – Lactose intolerance and also in
- Fructose intolerance (In the case of lactose intolerance, complaints such as diarrhoea and flatulence always occur after the consumption of products containing milk or to which lactose (milk sugar) is added). – coeliac disease (gluten intolerance).
Gluten intolerance describes a clinical picture in which the affected persons cannot digest the vegetable glue gluten contained in cereals and develop antibodies against it, which can lead to the most varied symptoms inside and outside the gastrointestinal tract. Both gluten intolerance and lactose intolerance are easy to diagnose and can be controlled by avoiding the respective food. – Reflux disease: One of the most common causes of abdominal pain, especially in the upper part of the abdomen, is reflux disease, as well as stomach and small intestine ulcers.
In reflux disease, gastric acid enters the esophagus and attempts to treat classic symptoms such as heartburn and pain in this area under the breastbone. These occur particularly during fasting periods or when you lie down, as the stomach acid can then flow back into the oesophagus more easily. – Hole in the stomach lining: In peptic ulcers, the cause of the pain is a hole in the top layer of the stomach, most commonly caused by the bacterium Helicobacter pylori and the prolonged use of certain painkillers, such as Aspirin® or Ibuprofen®.
In the case of gastric or small intestinal ulcers, the pain is more localised in the upper abdomen and can become more severe during and after meals. – Gastritis: In addition to these complaints in the stomach, a general inflammation of the stomach lining can also be the cause of stomach pain in the upper abdomen. For example, if you have eaten or drunk too much and now suffer from pain in the upper abdomen, an inflammation of the mucous membrane of the stomach (gastritis) could be the cause of the pain.
- Gallstones If the abdominal pain is colicky, i.e. in waves and not regularly, the obstruction of various ducts is usually the cause, as in this case the wall muscles periodically try to remove the obstacle. This colicky pain, especially if it occurs in the right upper abdomen or flanks, can be caused by gallstones or kidney stones. – With biliary colic, i.e. an obstruction of the bile duct by gallstones, the pain is usually strongest in the left upper abdomen and can even radiate into the shoulder.
Due to the obstruction of the bile duct (choledocholithiasis) and the simultaneous backflow of bile into the liver, parts of the bile can enter the blood, causing the white part of the eyeball (sclera) and the skin to turn yellow (jaundice, icterus). – Inflammation of the gall bladder: If there is a simultaneous inflammation of the gallbladder (cholecystitis), the pain is no longer colicky but constant, and fever may also be a symptom. – In the case of renal colic, the ureter is blocked by a kidney stone so that urine is congested on one side in the kidney, causing characteristic pain in the flank.
- An intestinal obstruction (ileus) can also cause severe abdominal pain throughout the abdomen. Intestinal obstruction is a mechanical obstruction where there is an obstacle in the intestine, such as a tumour or a foreign body, which blocks the intestine. The intestinal muscles try to push the intestinal contents past the obstacle, causing the colicky pain.
Adhesions from previous surgery can also be a possible cause of intestinal obstruction (obstruction of the colon). A paralytic intestinal obstruction, in which intestinal movement is no longer possible due to a lack of nerves or blood supply, can also be the cause of pain in the entire abdominal area. – Intestinal vascular obstruction: Especially patients with
- Heart attacks (myocardial infarction)
- Strokes (Apoplexy)
- Vascular calcifications (arteriosclerosis) or
- Blood coagulation disorders in the history of the disease can be susceptible to vascular occlusion of various vessels in the abdomen (for example, the intestinal vessels, mesenteric infarction).
The resulting pain may subside after some time as the undersupplied area of the intestine gradually dies off. However, this easing of pain is a fallacy, as the dying tissue can simultaneously cause the peritoneum to become inflamed (peritonitis) and this can lead to renewed severe pain, which can even cause life-threatening blood poisoning (sepsis). Chronic inflammatory bowel disease: If the abdominal pain persists for a long time together with frequent diarrhoea, which can also be mixed with blood, a chronic inflammatory bowel disease can be the cause.
The following topic might also be of interest to you: Stomach pains at night
- The classic irritable bowel (no exact cause known)
- Autoimmune diseases such as Crohn’s disease and ulcerative colitis, in which the patient’s own immune system has directed itself against the intestinal mucosa and destroys it. This leads to diarrhoea, which can also be mixed with blood, depending on how advanced the disease is. As a rule, bloody diarrhoea is more common in ulcerative colitis than in Crohn’s disease.
Blood in the stool or blood in vomit are always indications of bleeding in the gastrointestinal tract and should always be taken seriously, as a tumour may also be a possible cause. – Pancreatitis: Severe pain in the upper abdomen, which can radiate like a belt to the back, is a typical sign of acute inflammation of the pancreas (pancreatitis). In older people, the most severe, unprecedented pain in the lower abdomen can also be a sign of a bulging of the aorta (abdominal aortic aneurysm, AAA), which must be treated IMMEDIATELY, since a burst bulging of the aorta leads to death within a very short time (internal bleeding).
- Urinary tract infection: Especially in women, a urinary tract infection can also be the cause of abdominal pain in the lower abdomen. These are then often accompanied by pain when urinating. In addition, menstrual problems, endometriosis and pregnancy can generally lead to abdominal pain in the lower abdomen.
Therefore, a pregnancy test for women of childbearing age with abdominal pain is one of the first laboratory diagnostic tests carried out in hospital. Due to further development of the technique and trained doctors, colonoscopy rarely leads to complications. It is then a simple irritation of the intestine due to mechanical stress or air entering the intestine.
Mild and short-term abdominal pain after a colonoscopy is therefore normal and requires no medical intervention. Abdominal pain is a common reason why patients consult their doctor. For him it is important to distinguish dangerous forms of abdominal pain from harmless forms.
An essential part of the diagnosis is the patient interview (anamnesis), in which the beginning of the pain, the type, the pain region and accompanying symptoms should be asked. The doctor will also ask whether the symptoms are accompanied by diarrhoea and whether the symptoms initially improve after going to the toilet (chronic inflammatory bowel disease) and whether the patient wakes up from the abdominal pain at night or whether he/she does not feel the pain at night (psychogenic abdominal pain). It would be important to inquire about accompanying symptoms such as diabetes mellitus, high blood pressure or heart disease, such as atrial fibrillation.
When estimating the time, it should be asked whether the symptoms occurred suddenly and how long ago this occurred or whether the pain was rather gradual. In any case, after the patient survey, a physical examination is due. First of all, the intestinal sounds should be listened to with a stethoscope while the patient is lying down.
Afterwards, the doctor should palpate the abdomen in order to detect defensive tension and resistance in the abdominal region. In order to find the cause of the abdominal pain, the anamnesis (medical history) is one of the most important diagnostic possibilities. The character of the pain must be precisely determined.
A sudden strongest pain, which then becomes weaker and then slowly increases again, can be an indication of an organ rupture and thus a sign of a life-threatening disease, which should be operated on as soon as possible. Pain that flares up and down again and again indicates the character of a colicky pain and is therefore a sign of a biliary colic or ureteral stone. In this case, the stone must be removed using minimally invasive procedures.
Once the stone has been removed, the pain stops immediately. A dull, persistent pain can be an indication of inflammation in the intestine or liver capsule tension. In this case, the clinical examination can further limit the diagnosis.
For further diagnosis, the inflammatory parameters in the blood can be determined, which provide an indication of chronic or acute inflammation. For imaging, ultrasound (sonography) can be used first, which is non-invasive and can provide a good picture of the situation in the abdomen. Here, free fluid or air can be seen as a sign of an organ rupture.
However, a swollen intestinal wall, a significantly enlarged gall bladder or congested liver veins are also indications of an inflammation or mass and can be visualised by ultrasound. All further examinations depend on which clinical picture is ultimately responsible for the abdominal pain. If it is a food intolerance, which is usually accompanied by diarrhoea, a laboratory examination of the stool could be carried out to identify the corresponding pathogens.
In the case of colicky pain, an ultrasound of the abdomen should be made as soon as possible, showing the gall bladder, the bile ducts and the urinary organs. If it is an inflammation of the abdominal organs, various tests can be used. If the gall bladder is inflamed, one can try to trigger the so-called Murphy’s sign in the patient.
To do this, the patient lying down must exhale, then the abdomen is pressed in deeply from the outside diagonally on the right above the navel and the patient is asked to inhale. In case of pain the Murphy’s sign is positive (inflammation of the gall bladder). There are many different tests for appendicitis.
First of all, the patient will express severe pain after palpating the so-called Mc Burney point and the lancet point (both are points on the right side of the abdomen). After pressing deeply on the left side and suddenly letting go, the patient will report pain on the right side (so-called pain of letting go). If you hold the left leg of the lying patient on the couch and ask the patient to lift the right leg, the patient will also complain of strong pain (psoas test).
The patient will also generally report severe pain when asked to squat the right leg. If appendicitis is suspected, a laboratory blood test should be performed. A severe and acute inflammation of the appendix will be noticeable in the blood count by an increase in the leukocyte count and an increase in CRP.
Abdominal pain with a gynaecological or urological cause should always be visualized by ultrasound. Patients with vascular occlusion are usually conspicuous by a corresponding history (atrial fibrillation) and a characteristic pain pattern (first severe pain, then pain-free, then again severe pain). In order to be able to depict a vascular occlusion, the artery supplying the intestine, a contrast medium examination with subsequent computer tomography would have to be carried out.
All abdominal pain caused by intestinal obstructions should be examined by x-ray on a standing patient. So-called standing intestinal loops and mirrors would be just as typical for an intestinal obstruction as either high-pitched intestinal sounds (mechanical intestinal obstruction) or total silence in the intestine (paralytic intestinal obstruction). Diverticulitis can be detected by ultrasound and colonoscopy.
Gastritis or peptic ulcers or ulcers of the duodenum can be shown by means of a gastroscopy. Malignant changes and tumours can also be shown in this way. Peritonitis could be suspected on the one hand on the basis of the blood count (leucocytes and CRP elevation) and on the other hand on the basis of an ultrasound image, which would probably show free fluid. The diagnosis of psychogenic abdominal pain is a difficult challenge. In most cases it is a diagnosis of exclusion when no organic cause can be found.