Chapter 39: Abdominal Pain

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.
TABLE 39-1: Some Important 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
 

There's more to see -- the rest of this topic is available only to subscribers.