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1 Introduction

Abdominal pain is traditionally described by its chronicity (acute or chronic), its progression over time, its nature (sharp, dull, colicky), its distribution (by various methods, such as abdominal quadrant (left upper quadrant, left lower quadrant, right upper quadrant, right lower quadrant) or other methods that divide the abdomen into nine sections), and by characterization of the factors that make it worse, or alleviate it.

2 Approaches

Due to the many organ systems in the abdomen, abdominal pain is a concern of General practitioners/ family physicians, surgeons, internists, emergency medicine doctors, pediatricians, gastroenterologists, urologists and gynecologists. Occasionally, patients with rare causes can see a number of specialists before being diagnosed adequately (e.g. chronic functional abdominal pain).

3 Types of pain and mechanisms

1. The pain associated with inflammation of the parietal peritoneum is steady and aching, and worsened by changes in the tension of peritoneum caused by pressure or positional change, and is often accompanied by tension of the abdominal muscles contracting to relieve such tension.
2. The pain associated with obstruction of the hollow viscera is often intermittent or " colicky"
3. The pain associated with abdominal vascular disturbances ( thrombosis or embolismIn medicine, an embolism occurs when an object (the embolus plural emboli migrate from one part of the body (through the circulation) and cause(s) a blockage (occlusion) of a blood vessel in another part of the body. This can be contrasted with a " thromb) can be sudden or gradual in onset, and can be severe or mild. Pain associated with the rupture of an abdominal aortic aneurysm may radiate to the back, flank, or genitals.
4. Pain that is felt in the abdomen may be "referred" from elsewhere (e.g., a disease process in the chest, like a subdiaphragmatic abscess, may cause pain in the abdomen), and abdominal processes can cause radiated pain elsewhere (e.g. gall bladder pain—in cholecystitisCholecystitis is inflammation of the gallbladder. It may be acute or chronic. The most common cause of cholecystitis is infection, usually from colonization by gut organisms. Cholecystitis is often accompanied by presence of gallstones. The classical pati or cholelithiasis—is often referred to the shoulder).

4 Some causes of abdominal pain

• parietal peritoneal inflammation
  • due to infectionInfection" is also the title of an episode of the television series Babylon 5; see Infection (Babylon 5). An infection is the detrimental colonization of a host organism by a foreign species. The colonizing organism interferes with the normal functioning: perforated appendixThe word appendix refers to the following things: In publishing, an appendix is a short section at the end of a book, often used for supplementary information. The literary plural is usually appendices''. In human anatomy, appendix is an abbreviation of v in appendicitisAppendicitis is a condition characterised by inflammation of the appendix. While mild cases may resolve without treatment, many require laparotomy with removal of the inflamed appendix. Untreated, mortality is high, mainly due to peritonitis and shock whe, pelvic inflammatory disease
  • due to chemical irritation: perforated gastric or peptic ulcer; pancreatitis, Mittelschmerz, ruptured ectopic pregnancy
  • miscellaneous ( Familial Mediterranean fever)
• mechanical obstruction of hollow viscera such as the small intestine, the large intestine, the biliary tree (e.g. by gallstones), or the ureter (e.g. by urinary calculi)
• vascular disturbances: embolism, thrombosis, vascular rupture, torsional occlusion, sickle cell anemia
• abdominal wall injury: mesenteric traction, muscle trauma, muscular infection
• distention of visceral surfaces such as the hepatic or renal capsule
• referred pain from the thorax ( pneumonia, coronary occlusion), the spine (radiculitis secondary to arthritis), genitals ( testicular torsion)
• metabolic disturbance: lead poisoning, Black widow spider bite, uremia, diabetic ketoacidosis, porphyria, C1-esterase inhibitor deficiency, adrenal insufficiency
• neurogenic pain: Tabes dorsalis, Herpes zoster, Lyme disease (Lyme radiculitis)
• functional pain, irritable bowel syndrome