“ABDOMINAL PAIN” might be the warning sign of these 9 diseases!
Digestive system is uniquely constructed to perform its specialized functions including ingestion, mechanical and chemical digestion, absorption and excretion (or defecation). Our digestive system begins at the mouth, pharynx and esophagus, stomach, small intestine, large intestine (also known as the colon) and rectum. The digestive track ends at the anus. Other important internal organs located in abdominal cavity include liver, gallbladder, bile duct and pancreas. If any particular part of these organs is damaged or impaired, warning signs and symptoms will be manifested accordingly. The most common symptom that indicates the presence of abdominal abnormalities is “abdominal pain” which can be described in different types such as cramp, ache, dull pain, intermittent pain and sharp pain. There are some serious conditions that cause abdominal pain which should not be ignored. They may further require medical attention and even emergency medical care in some critical cases.
Abdominal pain is the primary symptom of these 9 diseases:
1. Gallstones or cholelithiasis
Gallbladder is a small, pear-shaped organ on the right side of the abdomen, locates beneath liver. The gallbladder holds a digestive fluid called “bile” which is a yellowish-brown fluid used to break up and digest fatty foods in the small intestine. Gallstones are one of the most common digestive diseases which small stones are formed in the gallbladder. These stones are typically caused by the precipitation of either calcium salts or cholesterol in bile. Particular risk factors include overweight, a regular consumption of high-fat diets, hypercholesterolemia (high level of blood cholesterol), taking medications that contain estrogen such as oral contraceptives or hormone replacement therapy, being diabetic or being diagnosed with thalassemia.
Mild to moderate symptoms of gallstones start from abdominal discomfort to flatulence and pain after consuming high-fat diets. Due to the similarity of signs and symptoms, patients with gallstones frequently misunderstand that they might have “peptic ulcer” thus only antacid or anti-ulcer medications are taken. If gallstones lodge in a bile duct and cause a blockage, it eventually results in severe life-threatening complications such as bile duct inflammation and infection, pancreatitis or cholecystitis (an inflammation of gallbladder). Aggravated symptoms include severe and sudden pain in the upper right abdomen especially when breathing in and out, back pain between shoulder blades, high fever, nausea, vomiting and jaundice with yellow tinge to the skin and white eyes. If biliary tract infection is indicated, an immediate surgery must be urgently performed. If cholecystitis remains untreated, it might lead to life-threatening sepsis. In addition, it might potentially trigger “gallbladder cancer and bile duct cancer (cholangiocarcinoma)”.
The most effective way to reduce risk of “gallstones” is to remain healthy including weight reduction if obese, avoiding the consumption of fatty diets with high calories, taking high-fiber foods such as vegetables and fruits. More importantly, having a regular health checkup every year helps to early screen gallstones before its symptom raises. If any suspected signs and symptoms of gallstones are manifested, a full physical examination and upper abdominal ultrasound scan are immediately recommended.
Hernias occur when an organ especially small intestine protrudes through a weakened spot or tear in the abdominal wall. Hernias are commonly caused by a combination of muscle weakness and increased abdominal pressure.
Hernias cause a bulge or lump in the affected area such as groin (inguinal hernia), umbilicus (umbilical hernia) or surgical incision which is not properly closed (incisional hernia). Hernias can be particularly felt during standing up, bending down or coughing. The most common symptoms are pain or discomfort (usually at lower abdomen), weakness or heaviness in the abdomen, burning or aching sensation at the bulge.
Risk factors that might induce hernias are
- Overweight or obesity: Being overweight increases the strain and pressure on abdominal muscles and makes them weaker and more prone to developing hernias.
- Advanced age: Abdominal muscle strength decreases with advance of age, thus the elderly people are susceptible to develop hernias.
- Some conditions that strain the abdominal wall such as lifting heavy weights, exercise, strain during bowel movement from constipation, strain during urination from BPH (benign prostatic hyperplasia) and persistent cough from smoking.
If the protruding intestine is not pushed back in place, the contents of hernia might be trapped in the abdominal wall, then becoming strangulated which cuts off blood supply to surrounding tissue that is trapped. If it is left untreated, a strangulated hernia can lead to life-threatening conditions such as necrotizing enterocolitis (severe inflammation of intestine) and sepsis. If there is any sign or symptom related to hernias, do not wait until it might be too late. Medical attention must be sought as soon as possible.
Appendicitis is an inflammation of the appendix which is a finger-shaped pouch that projects from colon on the lower right side of the abdomen. The appendix doesn't seem to have a specific function. Major cause of appendicitis is a blockage in the lining of the appendix, resulting in infections. Subsequently, pathogenic bacteria multiply rapidly and cause the appendix to become inflamed, swollen and filled with pus. If it is not treated promptly, appendicitis can cause serious complications such as a pocket of infection (abscess) and a ruptured appendix which spreads infection throughout abdomen (peritonitis). Since symptoms of appendicitis are frequently similar to other ailments such as peptic ulcer and gastritis, history taking and physical examination play a major role to make differential diagnosis. Signs and symptoms of appendicitis may include nausea and vomiting, loss of appetite, sudden pain that begins around umbilicus and often radiates to lower right abdomen, pain that worsens while walking or making jarring movements with low-grade fever as the illness progresses. The site of pain may vary depending on the position of appendix. If appendicitis is left untreated, appendix ruptures might lead to fatal conditions. Surgical removal of appendix (appendectomy) must be immediately performed. If appendicitis is suspected particularly with abdominal pain that shifts to lower right abdomen, immediate medical care is highly advised.
4. Peptic ulcer disease (PUD)
Peptic ulcers are open sores that develop on the inner lining of stomach and the upper portion of small intestine. Based on the affected area, there are 2 types of peptic ulcers; gastric ulcer and duodenal ulcer. An ulcer in the stomach is called a gastric ulcer, while that in the first part of the intestines is a duodenal ulcer. Peptic ulcer disease has been commonly found in both male and female with all age groups including children. However, gastric ulcers tend to occur in the elderly, after age 60 while duodenal ulcers usually appear in younger age. Potential risk factors to develop peptic ulcers are long-term use of anti-coagulant drugs, aspirin, pain killers called nonsteroidal anti-inflammatory drugs (NSAIDs), irregular meal timing, consumption of spicy foods, caffeine intake, untreated stress and bacterial infection in the stomach mainly caused by Helicobacter pylori.
The most common symptom of a gastric ulcer is pain in the center of stomach, below the ribs. Other related symptoms are bloating, flatulence, heartburn, nausea and vomiting. Abdominal pain usually happens either before or after meals for gastric ulcers and it will be substantially relieved after eating. Unlike gastric ulcer, duodenal ulcer has been frequently found in working age. The most common symptom is “epigastric pain” which is characterized by a burning sensation especially before meals. After eating, pain will be alleviated.
Aside from taking medical history and physical examination, diagnostic test “endoscopy” is used as a confirmative diagnosis of peptic ulcers. During endoscopy, a hollow tube equipped with a lens (endoscope) is passed down throat into esophagus, stomach and small intestine in order to thoroughly examine ulcers. Risk to develop peptic ulcers might be reduced if life style is accordingly modified such as having a regular meal timing, avoiding spicy food consumption, taking easy-to-digest diets, avoiding drinking caffeine containing beverages e.g. tea and coffee, alcohol restriction, smoke cessation and appropriate stress managements.
5. Gastroesophageal reflux disease (GERD)
Gastroesophageal reflux disease or GERD is a digestive disorder that affects the lower esophageal sphincter which is the ring of muscle between the esophagus and stomach. If this sphincter weakens or relaxes irregularly, stomach acid can flow back up into the esophagus. The backwash of acid constantly irritates the lining of esophagus, consequently often causing inflammation. Common signs and symptoms of GERD include a burning sensation in the chest (heartburn), belching, epigastric pain at the upper abdomen which often shifts to the middle of the chest, chronic cough, frequent hiccup or sore throat. Conditions that can increase risk of GERD are obesity or overweight, smoking, frequent consumption of tea, coffee, chocolates or chewing gums which might trigger reflux. During the course of peptic ulcer treatment, all prescribed medicines must be taken regularly and completely. Life style modification and home remedies include:
- Avoid all risk factors such as chocolate, peppermint, chewing gums, fatty meal e.g. steak or fried food, caffeine drinks and alcohol.
- Elevate the head of your bed or sleep on your left if heartburn is often experienced.
- To allow sufficient stomach empty time after eating, it requires at least three hours before going to bed. Lying down immediately after a meal must be avoided.
If the symptoms are still persistent after the completion of oral medication course, other conditions such as hernia at diaphragm (hiatal hernia) might be suspected. Further investigational approaches such as endoscopy and 24-hour esophageal and gastric pH monitoring might be additionally recommended. Further treatments could possibly be oral medications with adjusted regimens or surgical procedures.
Pancreatitis is the inflammation of the pancreas which causes sudden and severe abdominal pain. The pancreas is a long, flat gland that locates behind the stomach in the upper abdomen. Its main function is to produce digestive enzymes that help digestion and some hormones that regulate body sugar level. Conditions that can lead to pancreatitis include gallstones, alcoholism and infections. Acute pancreatitis signs and symptoms are sudden upper abdominal pain that might radiate to the back, nausea and vomiting with abdominal tenderness when touching the abdomen. Severity of abdominal pain could be substantially reduced when slouching, mostly in patients who have been long-term alcoholism. Tests and procedures used to accurately diagnose pancreatitis include blood tests, abdominal ultrasound, endoscopic ultrasound and CT scan (computerized tomography). MRI (magnetic resonance imaging) might be further needed in some cases.
Hepatitis is an inflammation of the liver. Major cause of hepatitis is viral infections including hepatitis virus A, B and C. Other risk factors include alcohol drinking, side effects of certain drugs, auto-immune diseases and ingestion of toxic substances. The condition can be self-limiting or cab progress to fibrosis (scarring), cirrhosis or unfortunately, liver cancer. Most commonly found symptoms are pain or discomfort in the upper right quadrant of the stomach and high fever presented with jaundice (a yellowish pigmentation of the skin and whites of the eyes). Diagnosis of hepatitis is made on the basis of patient's signs and symptoms, medical history, blood tests to determine liver enzymes level and functions combined with radiological imaging tests such as abdominal ultrasound, CT scan (computerized tomography) and MRI (magnetic resonance imaging).
Diverticulitis is inflammation or infection of small pouches called “diverticula” that develop along the walls of the intestines. The inflammation of diverticulitis can eventually result in a bowel obstruction which frequently causes chronic constipation. Typical presented symptoms are abdominal pain and cramping on either left or right side of the abdomen. If the obstruction persists, acute diverticulitis might develop complications which may include an abscess, a blockage in colon or small intestine, an abnormal passageway (fistula) and severe bleeding characterized by blood in stool. Treatment depends on the severity of signs and symptoms. In case of uncomplicated diverticulitis, medications will be mostly prescribed while surgical procedures might be considered in patients with complicated conditions.
9. Gynecologic Disorder
A gynecological disorder is a condition that affects the female reproduction system which consists organs in the abdominal and pelvic areas including the womb (uterus), ovaries, fallopian tubes, vagina and vulva. The most common unique manifestation of gynecological disorder is “abdominal pain in the lower abdomen” that might be in the middle, left side or right side depending on the affected organs. This particular type of abdominal pain is usually a warning symptom to potentially indicate certain abnormalities in the reproductive system, mainly uterus and fallopian tubes. Abnormal menstruation patterns such as menstrual flow that is much heavier or lighter than usual, periods that last longer than seven days or periods that occur infrequently are also typical signals of gynecologic diseases. If these abnormalities have been presented, gynecologic examinations and ultrasound are highly advised.
Abdominal pain caused from these 9 conditions entirely affects daily activities and quality of life. If these warning signs and symptoms are showed up, immediate medical attention must be sought. Since certain abdominal diseases are presented with similar symptoms, mostly abdominal pain, accurate and timely diagnosis enables the doctors to differentiate diseases, resulting in effective treatment plans and reduced disease severity. To early detect the abnormalities, regular annual checkups with blood test might not be sufficient. Abdominal ultrasound, as a baseline noninvasive imaging test, is additionally advised in order to screen and identify it there are any abnormal findings at the begining stage.
Reference: Dr. Komdej Thanavachirasin, Laparoscopic and Endoscopic Surgeon, Bangkok Hospital
For more information:
Surgery Center, Bangkok Hospital
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