YOUR ABDOMINAL PAIN DIAGNOSIS - MOST CLUES ARE IN THE HISTORY

Assessing your abdominal pain diagnosis can be as difficult as working on any equipment with an intermittent fault. Ask an electrician or mechanic.

If it is possible for your doctors to examine you when you have the pain, they will be better placed to offer you a likely explanation. Usually however, your account of the symptoms will be the most important guide to diagnosis.

Duration

Have you short term ( acute pain ), long term ( chronic pain ), or medium term pain ( stretching back weeks or months? ) For example, appendicitis is a painful short term disease, whereas irritable bowel syndrome is a long term disorder. This is the first essential bit of information needed for abdominal pain diagnosis.

Timing

Pain may come and go, either regularly (eg. with menstrual cycle,) at times of stress, or at random intervals ( duodenal ulcer with periodicity.) Pain associated with menses can start before bleeding ( spasmodic dysmenorrhea ), or with it ( endometriosis .) Thinking about it, can you identify anything which has coincided with the times you had pain?

On a day to day basis, the abdomen pain may precede or follow eating, using your bowels or passing urine. It is very usefull to tell your doctor if there is a pretty constant connection with one of these, or with any other bodily function.

Pain as you swallow is likely to originate in your esophagus. Stomach pain ( eg. gastritis or gastric ulcer ) is often within one hour of eating. Duodenal ulcer pain is later than one hour, often soon before the next meal.

Does your pain come on as you twist, straighten up or cough? Musculoskeletal causes or peritoeal irritation or some painfully distended organ, may hurt in these circumstances.

Area

Think about your tummy as divided into four quarters or quadrants. Is the pain in the upper right ( gallstones ,) lower left (diverticulitis ) or other of these? Is the pain in the center rather than any quadrant (small bowel colic, as in gastroenteritis?) Urinary bladder pain is in the mid line of the lower abdomen.

The classical shift of pain in acute appendicitis is from central to right lower abdomen, as the disease progresses.
Kidney stone colic classically spreads around from the back, to the groin, but can be just in the lower abdomen, on one side only.

In abdominal pain diagnosis one has to consider extra-abdominal conditions as possible causes.

The source of your abdominal pain may be elsewhere. Lower abdominal pain can be testicle pain ( torsion of the testis, ) or ovary pain ( eg. ovarian cancer .) Abdominal and back pain may both be caused by the same spinal problem.

Abdominal conditions can cause referred pain elsewhere, as in right shoulder blade pain from your gall bladder and shoulder tip pain from bleeding in your peritoneal cavity (irritating the diaphragm.)

Associations

Do you have other symptoms such as stomach cramps, bloating, difficulty swallowing or burning discomfort? Has there been ANY change in your bowel habit or any other bodily function? Has your weight altered? Are you generally feeling well, or not?

Have you had dark urine after bouts of pain, suggesting bile from a gallstone obstructing your bile passages.
Acute hepatitis causes the same dark tea coloured urine. The pain under the right ribs is much milder here.

Infectious mononucleosis causes hepatitis, and can also cause enlargement of your spleen, with a rare complication of acute rupture (an obvious emergency with pain in the left upper abdomen.)

Urine initially clear but darkening on exposure to light for some time, is the classical finding in porphyria attacks.

Darker than usual urine may just be concentrated, due to dehydration from fever or reduced intake from nausea.

If you think of something and have a memory like mine, write it down immediately you think of it (and refresh your memory immediately before seeing the doctor.)

Aggravating and relieving factors

This is the "suck it and see" approach to abdominal pain diagnosis.

Relief by antacid or eating may suggest stomach acid is involved in causing your pain. Relief by taking drugs such as ranatidine or proton pump inhibitors (PPIs) suggests the same.

The severe upper abdominal pain of pancreatitis may be eased by leaning forward posture, apparently.



Quality - words other than just "pain"

Pains can be burning, cutting, electric shock - like, gripping, heavy etc.
This sometimes is very useful...

Colicky pain makes one want to double over, wriggle or walk rather than stay still. This comes from some hollow organ going into spasm, as may happen after over indulgence in grapes or stone fruit.

Early shingles, before the rash, causes "neuropathic" pain. This may be burning (searing,) lancinating (cutting,) or electric shock like in quality.

Heart attacks can cause a heavy, crushing pain behind one's breastbone, but also in our epigastrium.

AND SELF EXAMINATION IS ALSO USEFUL

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Is it your stomach, possibly gastritis pain?


Have you got diverticular disease?


Lower abdominal pain diagnosis - from your pelvic organs


Pregnancy abdomen pains


Abdominal pain can indicate celiac disease.


Notes on the obvious - gastroenteritis, travellers diarrhoea


Irritable bowel syndrome page here, here, here***


Notes on Crohn's disease


Possibly lactose intolerance ?


Wondering if you may have bowel cancer?


Some notes on intestinal parasites.


constipated?


Maybe PID?


Baby screaming, drawing legs up to tummy?


A bit about your bugs - intestinal flora


About abdominal bloating

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Our peritoneum is the lining of the cavity in which most of our abdominal organs are suspended