The mechanism of abdominal pain and methods for diagnosing it

Abdominal pain is acute or chronic pain in the abdominal area, occurring periodically (paroxysmal) or occurring constantly. The abdomen is bounded above by the costal arches and below by the pubic symphysis, so any discomfort in this region is regarded as abdominal pain syndrome.

Abdominal pain is not an independent disease, but only a sign of some pathology of the abdominal cavity.

Classification

• Visceral (come from a hollow or parenchymal organ). They occur most often and are associated with mechanical damage, excessive stretching, inflammation or circulatory disorders of internal organs. They occur in both organic and functional conditions. Accompanied by symptoms of dysfunction (for example, nausea, vomiting, stool retention, bloating, increased body temperature), vegetative manifestations (fear, palpitations, dizziness, sweating, pallor).
• Parietal or somatic. They arise due to irritation of the peritoneum. In some cases, the involvement of the peritoneal layers in the inflammatory process occurs following the internal organ. The pain syndrome intensifies, becomes more distinct (localized), and acute.
• Irradiating. Referred pain sensations occur in areas of skin sensitivity, which are innervated by the same part of the spinal cord as the affected organ.
• Psychogenic pain occurs when the central mechanisms of pain sensitivity control are disrupted. In this case, no organic pathologies are observed in the abdominal cavity. Most often, such pain is constant, long-lasting, not acute, does not lead to sleep disturbances, and is accompanied by depression. These symptoms are usually not accompanied by disruption of the digestive tract: constipation, diarrhea, tension in the abdominal muscles.

According to the duration and nature of the pain, they are divided into:

• Spicy. Observed in case of vascular or other pathologies in the abdominal cavity (perforation of a stomach ulcer, thrombosis of mesenteric vessels, rupture of the spleen, intussusception, bleeding, etc.).
• Paroxysmal (periodic). Appears at certain intervals, lasting from several seconds to several hours. Characteristic of intestinal colic, biliary dyskinesia.
• Permanent (chronic). The patient is disturbed almost constantly, often of moderate intensity, dull. Observed with inflammation of the pancreas, chronic hepatitis, prolonged constipation associated with intestinal overfilling and the development of partial intestinal obstruction.

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• Epigastric pain (in the solar plexus area under the xiphoid process).
• Right hypochondrium (liver disease, gall bladder).
• Left hypochondrium (inflammation of the pancreas).
• Periumbilical region (mesogastrium) – duodenal ulcer.
• Right or left iliac region (sigmoid, cecum, ovaries).

For reasons:

• Intra-abdominal: stretching, spasm, inflammation, perforation of a hollow organ, circulatory disorders, duct blockage, neoplasm in the abdominal cavity, etc.
• Extra-abdominal (cause not in the abdomen): myocardial infarction, pneumonia, pleurisy, osteochondrosis, anemia, hormonal or endocrine disorders. At their core, most of these pains are referred.

Causes of abdominal pain

The cause of any abdominal pain can be diseases of internal organs or functional disorders that do not have an organic pathology.

Non-pathological causes

• Violation of the diet: lack of fluid, excess of spicy, salty, carbohydrates, gas-forming foods, consumption of expired foods or food in large quantities.
• Taking medications that affect the mucous membrane and motility of the gastrointestinal tract (non-steroidal anti-inflammatory drugs, vitamins, analgesics, prokinetics).
• Menstruation. Periodic pain in women is associated with temporary endometrial ischemia and myometrial spasm during menstruation.
• Abdominal pain in children. Up to one year old, infants are bothered by colic (bloating of the intestines) due to the immaturity of the digestive system. At 1-3 years old, painful sensations in the abdomen can be of a psychological nature (this is how the child attracts the attention of adults) or arise due to errors in eating.
• Pain sometimes occurs in predisposed persons with a pronounced temperament, emotionally unbalanced, and susceptible to the influence of external factors. They appear after excitement, conflicts, shocks and experiences. They pass on their own.
• Pain during pregnancy can occur due to sprained ligaments, divergence of the symphysis pubis, articular surfaces, and skin tension.

Pathological causes

• Pain associated with inflammation of the organ (gastritis, pancreatitis, cholecystitis, esophagitis, colitis, endometritis and others).
• Pain caused by ischemia (acute thrombosis of mesenteric vessels, gastrointestinal bleeding, infarction of the kidney or spleen, ovarian apoplexy).
• Obstruction of a duct or hollow organ (stone in the ureter, common bile duct, intestinal obstruction, stenosis of the esophagus, pylorus).
• Pain due to a violation of the integrity of an organ or tissue (ulcerative, erosive defect, organ rupture as a result of injury, necrosis).
• Cancer pain is considered the most severe, and at the last stage it is chronic.

Dangerous symptoms that require you to see a doctor

• Increased abdominal pain with the appearance of dizziness, tachycardia, fainting, severe weakness, a sharp decrease in blood pressure, the appearance of blood in the vomit or stool. Similar signs can occur with bleeding from any part of the abdominal cavity.
• Pain with fever, chills, vomiting or diarrhea indicates an infection (viral, bacterial).
• Prolonged pain of any intensity against the background of noticeable weight loss, anemia. Such symptoms occur with malignant tumors.
• Acute unbearable pain in the abdomen, forced posture with abducted knees, retention of stool and gases speaks in favor of intussusception (volvulus). In this case, any delay is life-threatening.
• Tension of the abdominal wall muscles (positive Shchetkin's symptom) is a sign of local or widespread peritonitis.
• An increase in abdominal volume (as a rule, occurs over time and indicates the accumulation of free fluid - ascites).

The addition of the following symptoms may indicate a serious pathology that is dangerous to life and health.

Diagnosis of the causes of abdominal pain

1. General analysis of blood and urine, blood biochemistry with determination of enzymes, hormones, and levels of microelements.
2. An ultrasound examination of the abdominal and pelvic organs gives the doctor a lot of information about their condition, shape, size, pathological inclusions, and neoplasms.
3. Plain radiography of the abdominal cavity with or without contrast allows you to identify foreign bodies of hollow organs, space-occupying formations, impaired blood flow, intestinal obstruction, and the presence of fluid or gas in the abdominal cavity.
4. CT or MRI is performed if previous diagnostic methods have been ineffective, as well as to clarify the extent of the pathological process, its nature, and to identify tumor metastases.

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Treatment

Therapy of inflammatory diseases

It is aimed at eliminating inflammation in the organ, suppressing infection (if any), reducing pain and swelling, improving blood circulation and restoring the function of damaged tissues. For this use:

• Antibiotics, if necessary, taken orally or parenterally.
• Antispasmodics (No-shpa, Duspatalin, Buscopan).
• Painkillers for severe pain (Analgin, Sedalgin, Ketorol). It should not be used if the diagnosis is unclear or there is a suspicion of surgical pathology, so as not to blur the clinical picture of the disease.
• Enzymes, hepatoprotectors, choleretic, sorbents, prokinetics, uroseptics to improve organ function.
• Non-steroidal anti-inflammatory drugs (NSAIDs) – Movalis, Voltaren, Ibuprofen.
• Herbs, homeopathy.
• A diet aimed at reducing the load on the organ and relieving irritation (exclude hot, cold, spicy, sweet, fatty, carbonated drinks, caffeine).

Therapy of vascular pathologies of the gastrointestinal tract

• Surgical treatment (stopping bleeding, suturing vessels, suturing a mucosal defect, resection of a necrotic part of an organ or complete removal, and so on).
• Restoration of blood circulation (antiplatelet agents and anticoagulants for infarction of the kidney, spleen; hemostatic drugs for ulcerative bleeding).
• Replenishment of lost blood volume (saline solutions, plasma).
• Narcotic painkillers (Promedol, Omnopon).

Therapy of obstructive diseases and traumatic injuries

Basically, in this case, you have to resort to a surgical method to eliminate the problem: removal of the gallbladder in case of gallstone colic, removal of a stone from the ureter or kidney, balloon dilatation of the esophagus, release of intestinal loops during volvulus, suturing ruptures. After the operation, antibiotics, hemodez, saline solutions, painkillers and NSAIDs, and physical therapy are indicated.

Cancer therapy

The golden rule of oncology treatment is radical removal of the tumor in the abdominal cavity, if possible.

Afterwards, according to indications, radiation, chemotherapy, courses of immunomodulators, or simply observation are possible.

In advanced cases, palliative treatment is prescribed to improve the quality of life: adequate pain relief, restoration of organ function, elimination or reduction of unpleasant symptoms.

Source: https://ProKishechnik.info/zabolevaniya/abdominalnye-boli.html

Abdominal pain in the abdomen (abdominal pain syndrome): causes and treatment

The abdominal cavity contains a number of vital organs, so if you are suffering from abdominal pain, this is an alarming signal. The syndrome can affect not only the organs located in the abdomen, but also the systems adjacent to this area.

The article will discuss a symptom that is leading in most clinics specializing in lesions of the abdominal cavity. If you are experiencing acute abdominal pain, this is a reason to consult a doctor without the slightest delay.

Etiology

The following signs accompany pain attacks in the abdomen are identified:

• Smooth muscle spasm. Affects the excretory ducts and hollow organs (stomach, esophagus, gall bladder, intestines, pancreatic duct and urinary tract).
• Wall stretching. Inherent in hollow organs located in the abdomen. Accompanied by simultaneous tension of the ligamentous apparatus.
• Circulatory disorders. Ischemic and congestive dysfunction of the blood vessels of the abdomen. These include stenosis of the branches of the abdominal aorta, spasm, embolism of mesenteric vessels, thrombosis, microcirculation disorders and other pathologies.
• Structural organ damage (tumor growth, inflammation, ulceration, necrosis).
• Penetration, perforation and peritoneal pain.

Classification

The presence of abdominal pain requires in-depth diagnosis and subsequent treatment. The classification system for the mentioned syndrome is quite complex.

Pathogenetic classification

• Spasmodic pain. Colloquially known as colic. The cause is a spasm of smooth muscles. They arise from organic abdominal pathologies (renal, gastric, liver, pancreatic), functional ailments (irritable bowel syndrome) and poisoning. Spastic pains flare up unexpectedly and can stop just as suddenly. The syndrome can be alleviated with antispastic drugs and heat. Concomitant symptoms sometimes include flatulence, vomiting, cardiac arrhythmia, and problems with coronary circulation.
• Pain associated with stretching of hollow organs. There is no clear localization, the character is pulling and cutting.
• A syndrome caused by problems of local circulation. There are two types: angiospastic (attacks) and stenotic (proceed slowly, but can become increasingly severe).
• Peritoneal pain. They are characterized by suddenness, duration and gradual subsidence. The localization is clear, the doctor can identify it through palpation. Mechanical impact (movement, coughing, palpation) may increase the degree of pain.
• Reflected syndrome. Abdominal pain that flares up in the digestive organs can radiate to the stomach.

Mechanism of occurrence

• Visceral syndrome. It is greatly facilitated by pathological processes occurring in the internal organs. The starting point can be, say, an increase in pressure in the cavity of the organ, as well as tension, stretching and vascular disorders in the abdomen.
• Somatic pain. They occur if the abdominal wall and the peritoneum itself are involved in the pathological process. They are clearly localized and acute in nature. It gets worse when coughing and moving.
• Referred pain. With visceral syndrome (passage of a stone), the impulse can radiate to the abdomen. The syndrome may also be based on an anatomical cause (strangulation of the intestine). Sometimes the pain radiates to the back, shoulder or right shoulder blade.
• Psychogenic syndrome. If there are no somatic and visceral causes, the triggering factor may be psychogenic. Depression plays a key role here. Abdominal pain is associated with depression through complex biochemical processes. The main features: monotony, duration and diffuse qualities. At the same time, pain may be felt in the back, head and throughout the body.

Localization

Depending on the damage to a particular organ, different parts of the abdomen may hurt.

• Right hypochondrium. Signals about ailments in the gall bladder, liver, duodenum, biliary tract, pleura, right lung, head of the pancreas.
• Left hypochondrium. Problems in the stomach, spleen, pancreas, ureter, left kidney, pleura and left lung.
• Epigastrium. The disease is rooted in the bile ducts, liver, pancreas, lower esophagus, stomach, chest, celiac plexus.
• Right iliac region. The pathology crept into the ileum (terminal section), appendix, ureter, right kidney, right appendages of the uterus (in women).
• Left iliac region. The problem is in the colon, ureter, left kidney and left uterine appendages.
• Periumbilical part. The colon or small intestine (transverse), appendix, abdominal vessels or pancreas are affected.
• Groin and pubis. The violations affected the female genital organs, bladder, and rectum.

Etiological classification

This classification includes the main symptoms of abdominal pain.

Intra-abdominal causes

• inflammation of organs (cholecystitis, appendicitis, peptic ulcer, etc.);
• generalized peritonitis (primary and secondary);
• obstruction of a hollow organ (biliary, intestinal, urinary tract, aorta, uterine);
• ischemic disorders (organ torsion, intestinal infarction, etc.);
• others (retroperitoneal tumors, drug withdrawal, hysteria, hemolytic anemia).

Extra-abdominal causes

They mean radiating pain not in the abdomen - formed by pathologies of other organs. These include:

• pathologies of the thoracic cavity organs (myocardial ischemia, pneumonia, pneumothorax, diseases of the esophagus, pleurisy);
• neurogenic diseases (syphilis, spinal diseases, polyneuritis);
• exposure to toxins (poisons, insect bites);
• metabolic disorders (diabetes mellitus, for example).

"Non-surgical" reasons

It also happens that abdominal syndrome is of a non-surgical nature. The reasons lie in the area of ​​the following systems:

• cardiovascular;
• respiratory organs;
• digestive organs;
• urogenital;
• hematopoietic;
• diseases of the musculoskeletal system;
• infectious diseases;
• endocrine and metabolic disorders.

Development speed

Depending on the progression, the syndrome in question is divided into:

1. acute form;
2. chronic form.

Dangerous symptoms

What symptoms are the most dangerous for abdominal pain? Let us briefly list the signs hinting at emergency surgery:

• tachycardia;
• arterial hypotension;
• weakness;
• apathy;
• dizziness;
• fever;
• visible bleeding;
• repeated vomiting;
• absence of peristaltic noise and gas discharge;
• increase in abdominal volume;
• muscle tension in the abdominal wall;
• increased pain syndrome;
• fainting during bowel movements;
• Shchetkin-Blumberg symptom (positive).

Diagnostics

For abdominal pain, the following types of diagnostics are recommended:

1. Pregnancy test (biochemical) for women.
2. Analysis of urine. Will help identify pyelonephritis, genitourinary tract infection, urolithiasis.
3. Blood analysis. In case of inflammation (diverticulitis, appendicitis), leukocytosis is observed in the blood, but conventional analysis is not able to detect it.
4. Liver function tests. Along with lipase and amylase studies, they may indicate pathologies of the gallbladder, liver, and pancreas.
5. Ultrasound of the abdomen. It is done if there is a suspicion of an abdominal aortic aneurysm, lesions of the biliary tract, ascites or ectopic pregnancy.
6. CT. This type of research is aimed at the abdominal organs and, in the presence of pain, allows identifying abdominal aortic aneurysm, nephrolithiasis, diverticulitis, mesenteric ischemia, appendicitis, and intestinal obstruction.
7. Radiography. A survey examination of the abdominal area designed to diagnose two ailments - intestinal obstruction and perforation of a hollow organ.
8. ECG. Required to exclude myocardial ischemia.

Differential diagnosis

In case of abdominal syndrome, it is necessary to differentiate the following ailments:

• Perforated ulcer (both duodenum and stomach). This disease is characterized by sharp and sudden pain in the epigastric region. Primary localization is the upper abdomen. Gradually, unpleasant sensations cover the entire abdomen, affecting its sections in turn.

• Acute cholecystitis. Repeated acute pain is observed in the right hypochondrium, accompanied by repeated vomiting, fever, and occasionally jaundice.
• Acute pancreatitis. This disease is caused by eating large amounts of fatty foods. Acute pain flares up suddenly and has a girdling character. The patient vomits bile and literally screams in pain. The muscles are tense, the stomach is swollen, peristalsis is weakened.
• Colic (renal and hepatic). The patient experiences cramping, acute pain, and there are also clinical manifestations of urolithiasis and cholelithiasis.
• Acute appendicitis. This pathology is easily confused with a perforated ulcer. In the second case, the syndrome is localized in the right iliac region, the peritoneum is irritated, and its anterior wall becomes tense.
• Thromboembolism. This disease affects the mesenteric vessels. There is no clear localization. The patient is tossing about in bed, he is worried, intoxication is rapidly turning into collapse. The patient suffers from loose bloody stools. The abdomen is distended and there is no peristalsis. The pulse is increased. Sometimes it is possible to identify a heart defect.
• Abdominal aortic aneurysm (dissecting). Typically, this disease affects older people. Occurs against the background of atherosclerosis. The pain flares up unexpectedly in the epigastrium. The abdominal muscles are tense, but the abdomen itself is not bloated. Blood pressure drops, pulse quickens. A tumor-like formation is palpable in the abdominal cavity. Limbs are weakened.
• Pleurisy and pneumonia (lower lobe). At first, the sensations are similar to abdominal syndrome, but examination reveals pneumonia.

Treatment

To suppress the syndrome, the following medications are used:

• Relaxers. They affect smooth muscles, reducing their contractile activity. Normal transit is restored, and the spasm is eliminated. Platyfillin (30-55 rubles), atropine (about 50 rubles), metacin (prices range from 15 to 253 rubles) have a good systemic effect.
• Myotropic antispasmodics. Designed to relieve abdominal pain. The most effective drugs are no-spa (cost - within 100 rubles), papaverine (up to 50 rubles).
• Mebeverine hydrochloride. It has a pronounced spasalytic effect and does not have an atropine-like effect on the body. Cost - 300-450 rubles.
• Selective blocker. Relieves abdominal pain at any level of the gastrointestinal tract. A typical example is pinaverium bromide (200-300 rubles).
• Prokinetics. Increase motor activity.
• NSAIDs. Regulate the mechanisms of pain perception. True, COX-2 inhibitors do not always achieve the desired analgesic effect.

Let us remind you that purchasing these substances in pharmacies on your own, without medical advice, is strictly not recommended.

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Source: https://healthage.ru/poleznye-sovety/lechenie-boleznej/chto-takoe-abdominalnaya-bol/

Abdominal colic: diagnosis and treatment

Abdominal pain has remained a serious medical problem for several thousand years. Abdominal pain is quite widespread in the world.

World statistics

Almost 50 million people experience this symptom. High-intensity pain affects 12 million people in European countries. Pain always leads to a decrease in the quality of life, and huge amounts of money are spent on diagnosing the causes of pain and treating this cause. After the initial examination and examination, the cause of the patient’s pain may remain unclear.

Types of pain syndrome

There are acute and chronic pain syndromes. Acute pain is an attack lasting up to 48 hours. A tenth of all patient visits to emergency departments are associated with acute abdominal pain. Of these patients, only 13% require emergency surgery.

The terminology “colic”, “abdominal colic” is most often used to describe problems with the urinary tract, as well as problems with the functioning of the digestive system. These terms are mainly introduced based on the patient's subjective complaints and feelings.

In pediatric practice, acute pain lasts up to 1 week, while chronic pain lasts more than a seven-day period.

Classification

There are different classifications of pain due to its multifocality, volatility and prevalence.

According to the mechanism of formation, pain occurs:

• Visceral;
• Parietal;
• Irradiating;
• Psychogenic.

Only with visceral pain do symptoms of intestinal colic and other types of colic start. Visceral pain syndrome never has a clear localization and is manifested by diffuse sensations in the patient who cannot accurately determine the location of the pain. The patient feels this pain as a spasm or burning sensation. In this case, other visceral symptoms occur:

• Nausea and vomiting;
• Anxiety;
• Paleness of the skin.

Visceral pain syndrome is often localized along the nerve fibers and radiates to various parts of the body. Such pain can manifest itself in areas of increased sensitivity of the skin - in the Zakharyin-Ged zones.

What are the mechanisms of pain and colic?

Any pain appears due to irritation of certain pain receptors (nociceptors) due to inflammatory changes, due to stretching or muscle spasm.
Manifestations of colic may indicate normal functional disorders or more severe organic diseases.

From the site of irritation, the impulse is transmitted along special nerve fibers to parts of the nervous system, and these are the reticular formation and the limbic system. In these departments, data is processed and understood by humans.

Then the effector link of the reflex arc is turned on and the impulse from the brain goes back to the muscles, creating a defense reaction - a spasm. This type of pain occurs:

• Dysfunctional;
• Neuropathic;
•  Inflammatory.

In this case, the nature of pain largely depends on the activity of the central nervous system and biologically active substances - serotonin, dopamine, bradykinin.

Muscle spasms can cause pain, but pain can also cause muscle spasms. In the latter version, pain is a kind of response of the nervous system to irritation of nociceptors.

Abdominal colic and its genetic background

The influence of genetic causes on the development and formation of pain is currently being actively studied in modern medicine. Many pathological conditions have a hereditary basis. Such diseases include:

• Fibromyoalgia;
• Backache;
•  Migraine;
• Pain in the neck.

More than 300 genes that are responsible for the characteristics of pain and the characteristics of the reaction to the administration of analgesic drugs have already been identified by scientists. The enzyme catechol-O-methyltransferase is now being studied very closely.

It is involved in the development of acute and chronic pain syndrome. In addition, research is being carried out on the OPRM1 gene, which promotes the functioning of opioid receptors.

The gene is extremely polymorphic, which determines the variety of pain sensations and attitude to narcotic analgesics.

Both components described above can lead to the development of completely different pain. In addition, the CNA1B and SCN9A genes contribute additional factors to the formation of pain.

There is no way to genotype each patient in order to determine his genetic relationship to pain and to analgesics, so specialized scales are being developed to determine the intensity, nature, duration, prevalence of pain and pain in particular.

Variety of species

At the moment, nothing has changed in identifying the types of colic, despite the development of medicine. Still exist:

• Intestinal colic;
• Renal colic;
• Biliary colic.

Biliary or biliary colic

This type of colic occurs due to obstructive changes in the biliary tract. Obstruction or obstruction can be caused by stones located in the gallbladder or bile ducts.

The intensity of the pain syndrome in this condition varies, and the pain is always visceral in nature.

The criteria for biliary colic are:

• Cutting nature of the pain;
•  Feeling of fullness in the stomach;
• Tension in the epigastrium or right hypochondrium;
• The pain radiates to the right shoulder blade;
• Duration varies from 15 minutes to several hours.

Usually colic occurs not only during the day, but also at night. An attack of pain usually occurs once, but in half of the cases the pain can return again.

There are several causes of colic. This is dysfunction of the sphincter of Oddi, cholelithiasis.

Diagnosis of biliary

The first and indispensable diagnostic method is ultrasound of the abdominal organs. Secondary methods are magnetic resonance imaging and cholecystopancreatography, which are also more accurate.

Intestinal

Moderate to severe pain appears in the abdomen. Predisposing factors and causes may be:

• Spasm of intestinal smooth muscles;
• Increased peristalsis;
• The presence of an obstacle along the gastrointestinal tract;
• Excessive gas formation.

Symptoms of intestinal colic can in many ways resemble the symptoms of biliary colic and often manifest as nausea and vomiting, bloating and a feeling of fullness in the epigastrium and hypochondrium.

Mechanical factors include:

• Volvulus of the sigmoid colon;
• Obstruction of functional origin;
• Inflammatory pathological conditions of the intestine;
• Acute appendicitis;
• Dolichosigma;
• Volume formations in the gastrointestinal tract;
• Lead poisoning. With such poisoning, sharp, spasmodic pain appears in the abdomen. Along with the pain syndrome, mental and cognitive changes develop. Sleep is disturbed, dizziness occurs, the patient becomes nervous and irritable, and a metallic taste appears in the mouth. A blood test reveals anemia, damage to blood vessels, kidneys, and heart is detected. Treatment is carried out by introducing chelates into the victim’s body, which bind the heavy metal and remove it.

Renal

With colic associated with kidney disease, severe, unbearable pain occurs in the abdomen and lower back. The pain radiates to the groin area.

With this pain syndrome, hematuria and frequent urination occur. Physical activity, shaking, poor nutrition or a change in its nature can provoke an attack of colic

Nausea and vomiting often occur with colic.

How to diagnose renal colic

Renal colic is often a symptom of many diseases, so diagnosis when it appears should be especially careful. As usual, ultrasound is considered an accessible and informative research method.

In doubtful cases, computed tomography is used. In addition to instrumental research methods, clinical and laboratory tests and routine instrumental manipulations are prescribed.

 This is necessary to determine the causes of a non-renal nature.

Treatment of renal , biliary and intestinal colic

Each patient with colic should be observed by a doctor according to an individual program in accordance with the pathogenetic mechanisms of its occurrence. Only by eliminating the cause can pain be relieved correctly and effectively. But despite the logic of this statement, this option is not always possible.

• Pain relief is carried out according to the developed algorithm:
• Stage 1 – non-narcotic analgesics are used;
• Stage 2 – soft opioid drugs are prescribed;
• Stage 3 – opioids (morphine, promedol).

Antispasmodic drugs are also used. These drugs include Buscopan with the active ingredient hyoscine bromide, which has proven itself in the fight against various types of abdominal colic.

In addition to these drugs, the market is beginning to fill with opioid analgesics without the formation of drug and psychological dependence on them.

• Alexey Kusenko
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Source: https://pancreatit.info/abdominalnaya-kolika-diagnostika-i-lechenie/

Causes of abdominal pain

Abdominal pain is not always a sign of a pathological process in the abdominal cavity. The pain may be due to the stomach and esophagus, damage to the lungs or heart. Why does abdominal pain develop and in what cases should you immediately visit a doctor?

Causes and mechanisms of development

Abdominal pain syndrome is caused by 4 groups of factors:

• visceral;
• parietal;
• reflected;
• psychogenic.

Visceral

The cause of smooth muscle spasm can be:

• stone obstruction (urolithiasis or cholelithiasis);
• the appearance of an ulcer (duodenum, stomach);
• overstretching of the walls of the organ (gastritis, flatulence);
• a non-infectious inflammatory process that provokes the release of mediators in nerve receptors (erosions, ulcers of the digestive tract);
• spasms due to impaired neurohumoral regulation (spastic constipation, dyskinesia);
• development of ischemia during vascular spasm (a spasmodic vessel does not allow enough blood to pass through, and the organ does not receive enough oxygen).

Diseases of the following organs provoke spasmodic pain in the abdomen:

• gallbladder and bile ducts;
• digestive tract;
• pancreatic ducts;
• bladder and ureters;
• uterus, fallopian tubes (in women).

Pain is also caused by inflammation of the prostate parenchyma (in men), liver and kidneys, and ovaries (in women).

With visceral pain syndrome, a person cannot accurately convey where it hurts (points only to part of the abdomen). Vague soreness is often accompanied by increased sweating, nausea and vomiting, and pale skin.

Parietal

The receptors of the omentum and peritoneum are irritated. Pain increases when coughing, changing position or pressing on the abdominal wall. Life-threatening conditions provoke parietal abdominal pain:

• infectious-inflammatory process (perforation of internal organs, acute appendicitis, peritonitis);
• the influence of an aseptic irritant (polyserositis and other autoimmune processes, metastasis of the abdominal wall);
• chemical irritation of the peritoneum (at the early stage of perforation of the ulcer, until the contents of the organ have penetrated into the abdominal cavity, the irritating factor is the entry of duodenal or stomach secretions into the omentum and peritoneum).

With parietal abdominal syndrome, pain develops acutely and gradually increases, fever appears, and dyspeptic disorders are possible.

Reflected

The nerve impulse is transmitted from the diseased area to the upper abdomen. The causes of pain are:

• pleurisy;
• pneumonia;
• heart diseases;
• heart attack

Palpation of the abdomen does not increase pain.

In childhood, the tummy hurts due to respiratory infections. Preschoolers often have tonsillitis or ARVI with abdominal syndrome.

There is no need to think that the reflected pain manifestations are not accompanied by indigestion. A classic example is the abdominal form of myocardial infarction, when instead of chest pain, diarrhea, nausea and vomiting appear. The stomach hurts, and externally the symptoms resemble an intestinal infection or poisoning.

Psychogenic

They occur in the absence of diseases of the internal organs. The triggering mechanism is:

1. Stress factor. During times of worry and excitement, a reflex spasm of smooth muscles occurs. Additionally, there may be a delay in defecation or urination. Painkillers and antispasmodics are ineffective: the pain disappears spontaneously after eliminating the cause of the anxiety.
2. Hypochondria. A person suspects that he has a disease, looks for similar symptoms and, despite healthy internal organs, feels discomfort. In such a situation, a placebo helps when distilled water is administered under the guise of a medicine.

Psychogenic pain does not have a clear localization, is long-lasting and is not relieved by traditional painkillers.

Classification of abdominal pain

Pain syndrome is systematized according to the following characteristics:

• speed of development;
• the nature of painful manifestations;
• localization.

Rate of symptom formation

There are 2 forms:

1. Spicy. Symptoms appear suddenly (appendicitis, perforation of an ulcer), and the pain increases. The patient either rushes about, trying to find a comfortable position (pancreatitis, renal colic), or takes a forced position. Emergency medical attention required.
2. Chronic. Lasts for hours and sometimes days. Characteristic of dyskinesia, diverticula or exacerbation of chronic processes in the gastrointestinal tract.

Based on the nature of the abdominal syndrome, the doctor can determine the severity of the pathological process.

Nature of pain manifestations

The nature of the pain is divided as follows:

1. Cramping. The cause is a spasm of smooth muscles. Painful manifestations either increase or decrease, and can pass without the use of medications. Unpleasant sensations are accompanied by rushing around in search of a comfortable position, bloating and other intestinal disorders, and increased heart rate.
2. Aching. The intensity persists for a long time and decreases when taking a forced pose. The localization is blurred: the patient cannot clearly indicate the area where it hurts.
3. Growing. The pain gradually intensifies; taking a forced position brings minor relief. Weakness, increased sweating, hyperthermia and tachycardia appear. They occur both in acute disruption of the functioning of organs in the abdomen, and in other diseases (heart attack).
4. Vague. The patient points to the area of ​​the abdomen, but cannot indicate the exact location of the pain. They occur with irradiation from organs located outside the abdominal cavity, psychogenic manifestations or moderate visceral pain.

Emergency assistance is required by cramping and increasing pain.

Localization

Painful discomfort occurs in different parts of the abdomen:

1. Epigastric region and hypochondrium. This location is typical for diseases of the stomach, liver and pancreas, as well as for referred pain from the chest organs.
2. The area around the navel. Pathology of the small intestine, less commonly the pancreas, liver, or referred pain syndrome.
3. Lower sections. Pain in the intestines in the lower abdomen below the navel indicates diseases of the colon, bladder or prostate. For pain in the lower abdomen in women, the cause may not be the intestines, but pregnancy or an inflammatory disease of the genital organs.

Using the classification, an experienced doctor, even before receiving laboratory data, will be able to guess where the patient should be hospitalized. Surgery, urology, gastroenterology, and gynecology treat the organs of the upper chest.

Diagnostic measures

To clarify the diagnosis, a standard examination plan is used:

1. Survey. They ask about existing diseases, the nature of the pain and the suspected causes.
2. Visual inspection. Pay attention to the patient’s behavior: he rushes about or takes a forced position, how he reacts to palpation (whether the pain intensifies or not).
3. Ultrasound. The abdominal organs are examined.
4. General and biochemical tests. The composition of the blood allows us to determine the cause of the disorders.
5. Cardiogram. Detects abnormalities in the functioning of the heart.
6. Radiography. Provides information about changes in the structure of the lungs and heart.

Therapy is carried out after the cause of abdominal syndrome has been established.

Treatment options

There are 2 possible patient management tactics:

• conservative;
• operational.

Conservative therapy

Medicines are selected depending on the cause:

• analgesics and antispasmodics - to relieve pain;
• agents that improve the functioning of the gastrointestinal tract in functional disorders;
• medications that relieve nausea and vomiting (“Cerucal”);
• antibiotics to reduce inflammation.

Home remedies for pain relief can only be used in combination with traditional therapy. Self-medication with folk recipes is prohibited: complications may arise.

Surgery

For intestinal pain, surgical treatment is indicated in the following cases:

• appendicitis;
• peritonitis;
• perforation of the ulcer;
• blockage of the bile duct with a stone;
• tissue necrosis;
• intestinal obstruction.

After eliminating the cause surgically, conservative therapy is carried out using antibiotics and painkillers.

Forecast

The outcome depends on the nature of the disease:

• appendicitis, intestinal obstruction and other acute conditions in a healthy person do not recur, and complete recovery occurs;
• dyskinesias, diverticula, chronic pancreatitis and other diseases are not dangerous to health and, subject to medical recommendations (diet, lifestyle), rarely worsen;
• pathologies of the heart and lungs can be relatively safe (pneumonia), but can cause death (heart attack);
• peritonitis at the initial stage is successfully cured, and if the process is advanced it leads to death;
• It is impossible to eliminate metastases in the peritoneum; pain relief is used with non-narcotic and narcotic analgesics.

Not all abdominal pathologies can be successfully cured. Sometimes patients need to take medications for the rest of their lives to prevent exacerbations or relieve pain.

Preventive actions

There are no universal recommendations. To prevent abdominal pain, doctors suggest:

1. Eat well. This will help improve digestion and reduce the likelihood of constipation and intestinal obstruction.
2. Treat emerging somatic diseases.
3. Strengthen the abdominal muscles. This will prevent constipation and improve blood supply to the pelvic organs.

It is impossible to predict when abdominal syndrome will occur, but it should be remembered that abdominal pain is a dangerous sign. There is no need to take painkillers: this will only distort the pathology clinic and complicate diagnosis. If you experience pain in the abdominal cavity, you should immediately visit a medical facility.

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Source: https://ProSindrom.ru/gastroenterology/abdominalnyj-sindrom.html

What is abdominal pain and its causes

Attention! Self-medication can be dangerous to your health.

Abdominal pain is not an independent disease. The symptom manifests itself as pain in the abdominal area and indicates the development of pathologies of internal organs. This type of pain can be acute or chronic.

Pain may be present constantly or occur periodically. Very often in the second case, the pain syndrome is paroxysmal in nature. In any case, abdominal pain requires urgent diagnosis.

Classification of abdominal pain

Abdominal pain is:

• Spicy . In this case, they are called colic. Very often, such painful sensations manifest themselves in attacks of varying intensity. Pain may appear suddenly and disappear just as quickly. Their occurrence may be accompanied by nausea, vomiting, flatulence, and palpitations.
• Chronic . Painful sensations are present almost constantly. Patients often characterize this symptom as “burning in the stomach.”

Acute pain

Acute abdominal pain in medicine is included in the concept of “acute abdomen”. This is a very dangerous symptom that indicates serious damage to internal organs. Diseases such as appendicitis, cholecystitis and pancreatitis during exacerbation, perforated ulcers, etc. cause acute abdominal pain.

In addition, this sign may indicate the possibility of developing other pathological changes:

• obstruction of hollow organs, in particular, the development of intestinal obstruction;
• impaired organ perfusion due to thrombosis, stenosis and ruptures;
• stretching of the capsule of a certain organ, for example, due to acute alcoholic hepatitis or heart failure.

Chronic pain

Chronic pain indicates the presence of serious pathologies in the abdominal organs. This pain syndrome most often occurs against the background of irritable bowel syndrome.

• Chronic abdominal pain is of low intensity, but due to the fact that it is constantly present, a person is exhausted, irritability and depression occur.
• In addition, there are other types of abdominal pain:

1. Peritoneal pain. They are characterized by a sudden onset, last a long time and subside slowly. By palpation, you can accurately detect their location. Pain increases with coughing and sneezing.

2. Abdominal pain of a cutting and pulling nature. They occur against the background of stretching of the muscles of the internal organs. In such cases, it is very difficult to find the location of pain using palpation.

3. Stenotic and angiospastic pain. They occur against the background of impaired local circulation. In the first case, the intensity of the pain gradually increases, and in the second, the pain is paroxysmal in nature.

There are functional and pathological causes of abdominal pain. The danger to health in general arises in the second case. For abdominal pain that depends on functional causes, treatment consists of eliminating the provoking factors.

Functional reasons

The most common cause of abdominal pain is a violation of the principles of healthy eating.

The following factors can trigger abdominal pain:

• Lack of fluid in the body.
• Passion for spicy, salty, fatty foods.
• A large amount of carbohydrate and gas-forming foods in the diet.

In addition, functional reasons include uncontrolled use of drugs that have a negative effect on the state of the digestive system. Also, abdominal pain during menstruation, pregnancy, and colic in children in infancy do not require special treatment.

Pathological causes

Pathological causes are associated with diseases or injuries of specific organs. They are conditionally divided by reason of their occurrence.

Painful sensations can be caused by:

• Inflammatory processes of certain organs.
• Ischemia.
• Obstruction of a duct or any hollow organ.
• Violation of the integrity of an organ or internal tissues.
• Oncological neoplasms.

Diagnostics

Diagnosing the pathologies that caused abdominal pain is not always easy during an examination or based on patient complaints. To make an accurate diagnosis, laboratory and instrumental research methods are used.

Laboratory tests include:

1. a general blood test, which evaluates the general condition of the body;

2. a general urine test to detect pathologies in the functioning of the urinary system;

3. biochemical blood test to determine the amount of enzymes, hormones and trace elements in the blood (including liver tests).

Instrumental diagnostic methods:

• Ultrasound of the abdominal organs;
• plain radiography with a contrast agent, with the help of which neoplasms and foreign bodies of the abdominal cavity are detected;
• computed tomography or magnetic resonance imaging. These studies are highly informative diagnostic methods. They are prescribed when the diagnosis cannot be established by other methods;
• ECG (if myocardial ischemia is suspected).

Dangerous symptoms when urgent emergency care is needed

Abdominal pain can signal the development of dangerous conditions. You should immediately consult a doctor if the pain intensifies and is accompanied by tachycardia or dizziness. You need to call an ambulance when there is a sharp deterioration in your health and a decrease in blood pressure, and blood appears in the stool or vomit.

Sometimes abdominal pain is caused by viral and bacterial infections. Additional symptoms include fever, diarrhea, and chills. In such a situation, it is also necessary to call a doctor.

You should immediately contact an ambulance if an “acute abdomen” occurs. It is characterized by causing a person to seek a position in which pain is reduced.

Treatment

Treatment of abdominal pain is always associated with treatment of the underlying pathology. All therapeutic measures are prescribed on an individual basis based on the results of laboratory and instrumental studies.

For abdominal pain, the following groups of medications can be prescribed:

• Antispasmodics that can quickly relieve spasms of smooth muscles and relieve pain.
• Muscle relaxants that relax smooth muscles and thereby relieve pain.
• NSAIDs, analgesics.
• Antibiotics.
• Enzymes, sorbents, hepatoprotectors, choleretic agents, etc.

Source: https://bolit.net/o-boli/72-abdominalnaja-bol.html