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Abdominal pain

Abdominal pain, also known as stomach pain, is a common symptom associated with both temporary, non-serious disorders and more serious conditions.

Common causes of pain in the abdomen include gastroenteritis and irritable bowel syndrome. In a third of cases the exact cause is unclear. About 10% of people have a more serious underlying condition such asappendicitis, leaking or ruptured abdominal aortic aneurysm, diverticulitis, or ectopic pregnancy.[1] Determining the cause can be difficult, because many diseases can cause this symptom.

Differential diagnosis

The most frequent causes of 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 (stones or biliary dyskinesia) or pancreas problems (4%), diverticulitis (3%), appendicitis (2%) and cancer (1%).[1]More common in those who are older, mesenteric ischemia and abdominal aortic aneurysms are other serious causes.[2]

A more extensive list includes the following:

Acute abdominal pain

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 ofshock. One of the most common conditions associated with acute abdominal pain is acute appendicitis.

Selected causes of acute abdomen

By location

Location[3]

Diagnostic approach

When a health care practitioner assesses a patient to determine the etiology and subsequent treatment for abdominal pain the history of the presenting complaint and physical examination should derive a diagnosis in over 90% of cases.

Investigations that aid diagnosis include

If diagnosis remains unclear after history, examination and basic investigations as above then more advanced investigations may reveal a diagnosis. These as such would include

Management

Butylscopolamine (Buscopan) is used to treat cramping abdominal pain with some success.[4]

Epidemiology

Abdominal pain is the reason about 3% of adults see their family physician.[1] 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%.[5]

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