Harrison's Manual of Medicine
Chapter 39: Abdominal Pain
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Numerous causes, ranging from acute, life-threatening emergencies to chronic functional disease and disorders of several organ systems, can generate abdominal pain. Evaluation of acute pain requires rapid assessment of likely causes and early initiation of appropriate therapy. A more detailed and time-consuming approach to diagnosis may be followed in less acute situations. Table 39-1 lists the common causes of abdominal pain.
| Pain Originating in the Abdomen | |
Parietal peritoneal inflammation Bacterial contamination Perforated appendix or other perforated viscus Pelvic inflammatory disease Chemical irritation Perforated ulcer Pancreatitis Mittelschmerz Blood Mechanical obstruction of hollow viscera Obstruction of the small or large intestine Obstruction of the biliary tree Obstruction of the ureter | Vascular disturbances Embolism or thrombosis Vascular rupture Pressure or torsional occlusion Sickle cell anemia Abdominal wall Distortion or traction of mesentery Trauma or infection of muscles Distension of visceral surfaces, e.g., by hemorrhage Hepatic or renal capsules Inflammation Appendicitis Typhoid fever Neutropenic enterocolitis or “typhlitis” |
| Pain Referred from Extraabdominal Source | |
Cardiothoracic Acute myocardial infarction Myocarditis, endocarditis, pericarditis Congestive heart failure Pneumonia (especially lower lobes) Pulmonary embolus | Pleurodynia Pneumothorax Empyema Esophageal disease, including spasm, rupture, or inflammation Genitalia Torsion of the testis |
| Metabolic Causes | |
Diabetes Uremia Hyperlipidemia Hyperparathyroidism | Acute adrenal insufficiency Familial Mediterranean fever Porphyria C1-esterase-inhibitor deficiency (angioneurotic edema) |
| Neurologic/Psychiatric Causes | |
Herpes zoster Tabes dorsalis Causalgia Radiculitis from infection or arthritis | Spinal cord or nerve root compression Functional disorders Psychiatric disorders |
| Toxic Causes | |
Lead poisoning Insect or animal envenomation Black widow spider bites Snakebites | |
| Uncertain Mechanisms | |
Narcotic withdrawal Heat stroke | |
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Numerous causes, ranging from acute, life-threatening emergencies to chronic functional disease and disorders of several organ systems, can generate abdominal pain. Evaluation of acute pain requires rapid assessment of likely causes and early initiation of appropriate therapy. A more detailed and time-consuming approach to diagnosis may be followed in less acute situations. Table 39-1 lists the common causes of abdominal pain.
| Pain Originating in the Abdomen | |
Parietal peritoneal inflammation Bacterial contamination Perforated appendix or other perforated viscus Pelvic inflammatory disease Chemical irritation Perforated ulcer Pancreatitis Mittelschmerz Blood Mechanical obstruction of hollow viscera Obstruction of the small or large intestine Obstruction of the biliary tree Obstruction of the ureter | Vascular disturbances Embolism or thrombosis Vascular rupture Pressure or torsional occlusion Sickle cell anemia Abdominal wall Distortion or traction of mesentery Trauma or infection of muscles Distension of visceral surfaces, e.g., by hemorrhage Hepatic or renal capsules Inflammation Appendicitis Typhoid fever Neutropenic enterocolitis or “typhlitis” |
| Pain Referred from Extraabdominal Source | |
Cardiothoracic Acute myocardial infarction Myocarditis, endocarditis, pericarditis Congestive heart failure Pneumonia (especially lower lobes) Pulmonary embolus | Pleurodynia Pneumothorax Empyema Esophageal disease, including spasm, rupture, or inflammation Genitalia Torsion of the testis |
| Metabolic Causes | |
Diabetes Uremia Hyperlipidemia Hyperparathyroidism | Acute adrenal insufficiency Familial Mediterranean fever Porphyria C1-esterase-inhibitor deficiency (angioneurotic edema) |
| Neurologic/Psychiatric Causes | |
Herpes zoster Tabes dorsalis Causalgia Radiculitis from infection or arthritis | Spinal cord or nerve root compression Functional disorders Psychiatric disorders |
| Toxic Causes | |
Lead poisoning Insect or animal envenomation Black widow spider bites Snakebites | |
| Uncertain Mechanisms | |
Narcotic withdrawal Heat stroke | |
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