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




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



 Typhoid fever

 Neutropenic enterocolitis or “typhlitis”

Pain Referred from Extraabdominal Source


 Acute myocardial infarction

 Myocarditis, endocarditis, pericarditis

 Congestive heart failure

 Pneumonia (especially lower lobes)

 Pulmonary embolus




 Esophageal disease, including spasm, rupture, or inflammation


 Torsion of the testis

Metabolic Causes





Acute adrenal insufficiency

Familial Mediterranean fever


C1-esterase-inhibitor deficiency (angioneurotic edema)

Neurologic/Psychiatric Causes

Herpes zoster

Tabes dorsalis


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


Uncertain Mechanisms 

Narcotic withdrawal

Heat stroke


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