Chronic abdominal pain

Introduction Chronic abdominal pain is a relatively slow onset, relatively long course of disease, or abdominal pain secondary to acute abdominal pain, and its location is relatively accurate. Often induced by mental stimulation, there is no evidence of organic lesions in each examination. Psychological factors are the important pathogenesis of abdominal pain. Abdominal pain is characterized by sudden onset, severe pain, and unfixed parts, accompanied by anxiety, fear, insomnia or hysteria. Chronic abdominal pain is divided into four types according to its afferent nerve and clinical manifestations, namely, somatic pain, visceral pain, involvement pain, and mental pain.

Cause

Chronic abdominal pain is a common symptom. The cause is quite complicated and often causes diagnostic difficulties. Chronic abdominal pain involves chronic inflammation, tumor and adhesion in the stomach, intestine, liver, gallbladder, pancreas, kidney, urinary tract, genital organs and abdominal cavity and pelvis. Such lesions, especially the nature of chronic abdominal pain, the degree of pain, the law of pain, changes and chronic abdominal pain accompanied by vomiting, diarrhea, and mass are important manifestations of changes in the condition and aggravation, and should not be taken lightly.

(1) Abdominal organ diseases:

1 chronic inflammation: reflux esophagitis, chronic gastritis, chronic cholecystitis, chronic pancreatitis, tuberculous peritonitis, inflammatory bowel disease.

2 stomach, duodenal ulcer and gastrinoma.

3 torsion or obstruction of intra-abdominal organs: chronic gastrointestinal torsion, intestinal adhesions, omental adhesion syndrome.

4 organ capsule tension increased: liver congestion, hepatitis, liver abscess, liver cancer, splenomegaly and so on.

5 gastrointestinal dysfunction: gastroparesis, functional dyspepsia, hepatic flexion and splenic syndrome.

1. General thinking about the diagnosis of abdominal pain:

(1) Abdominal pain can generally be divided into umbilical abdominal pain (pain around the umbilicus), small abdominal pain (pain in the middle of the umbilical cord), and less abdominal pain (below the umbilicus and pain on both sides of the lower abdomen).

(2) spleen, pancreas: intestinal lesions, as well as liver, gallbladder, stomach, lipid membrane, uterine palace, bladder and other intra-abdominal organ lesions, can produce abdominal pain. The location of abdominal pain should be carefully identified to identify the location of the disease by considering the organ to which it belongs.

(3) Generally, the earliest position of abdominal pain or the most obvious site of tenderness is mostly where the lesion is located.

2. Identify the disease according to the traits and accompanying symptoms of abdominal pain, such as:

(1) Sudden severe pain is more common in Shilin, Qi and abdominal pain, stomach pain (stomach perforation), sputum, intestinal knot and so on.

(2) Those with abdominal pain and fever are mostly dysentery, diarrhea, visceral rickets, intestinal fistula, pancreatic fistula, hot shower, and cholera. Wet temperature and the like.

(3) abdominal pain and see pale, cold sweat, blood pressure and other symptoms, mostly organ perforation, visceral bleeding, ectopic pregnancy rupture, pancreatic fistula and other critical lesions.

(4) Prominent abdominal pain and vomiting are common in diarrhea, cholera, cholera and other diseases.

(5) Shi Lian's abdominal pain often connects with the genitals and the inner thighs.

(6) abdominal pain with hematuria, mostly renal diseases, such as stone shower, hot shower, renal pelvis, kidney cancer.

(7) Patients with abdominal pain and blood in the stool should consider diseases such as bowel cancer, intestinal knot, small bowel fistula and dysentery.

(8) Abdominal pain in dysmenorrhea and ectopic pregnancy is closely related to menstruation. Women's new postpartum laparotomy is a painful and unbearable person, suffering from postpartum abdominal pain.

(9) Intestinal depression, abdominal pain caused by sputum, and more related to the stimulation of emotional factors and other factors, often repeated attacks.

(10) Intestinal knots and intestinal fistulas at the same time as abdominal pain, it can be seen that the abdomen has intestinal or intestinal peristaltic waves, or touches the mass.

(11) Those who have abdominal pain and touch the fixed mass should generally consider intestinal knot, intestinal fistula, Fuliang, cancer, fat, and sarcophagus.

(12) Frequent abdominal pain, accompanied by abdominal distension, poor food, chronic diarrhea, can be seen in chronic sputum, spleen, pancreas, gallbladder and other diseases.

(13) If the abdominal wall is as a plate, it may be a lipid membrane (peritonitis), stomach pain (stomach perforation), intestinal fistula and other diseases.

(14) abdominal pain with night sweats, hot flashes, etc., or a history of rickets, mostly intestinal fistula, lipid raft (mesomembrane, peritoneal tuberculosis) and other diseases.

(15) Women with severe abdominal pain during menstruation are dysmenorrhea.

(16) Acute abdominal pain, accompanied by fever, rash, and madness, is a blood-storing disease.

an examination

Related inspection

Abdominal plain film abdominal CT abdominal ablation

In general, chronic abdominal pain, the doctor will check the body in detail to determine the characteristics of abdominal pain, such as the location of pain, the nature of pain, other symptoms associated with pain, etc., according to these characteristics can initially determine the cause of abdominal pain. If you can't determine the cause according to the characteristics of the pain and the results of the doctor's examination, you need to further pass the laboratory test to help diagnose, such as blood routine examination, urine routine examination, laboratory stool, gastric juice analysis, gastroscopy, colonoscopy, B-ultrasound. Scan the abdomen, X-ray, etc. Computer scans and MRI are also required when necessary.

Laboratory inspection:

1. Blood, urine, feces routine, ketone body and serum amylase are the most commonly used laboratory tests.

2. For clinical diagnosis of peritonitis, internal hemorrhage, abdominal abscess and certain abdominal masses, routine puncture, bacterial culture or pathological examination of the puncture.

Other auxiliary inspections:

1. X-ray examination: When the diagnosis is difficult, suspected and chest and abdomen have lesions, it is feasible to see the chest and abdomen, the purpose is to observe whether there is lesion in the chest, whether there is free gas under the armpit, changes in diaphragmatic movement, presence or absence of intestinal gas and liquid level Wait, if there are any abnormalities, you should make a regular film. When suspected sigmoid torsion or low intussusception, barium enema examination is feasible; patients with suspected intestinal obstruction, internal hemorrhoids or perforation should not be examined for barium meal.

2. B-ultrasound: mainly used to check biliary and urinary calculi, bile duct dilatation, pancreas and hepatosplenomegaly. It also has a good diagnostic value for a small amount of effusion, intra-abdominal cysts and inflammatory masses in the abdominal cavity.

3. Endoscopy: Endoscopy has become an important means of finding the cause of abdominal pain. Retrograde cholangiopancreatography, cystoscopy, and laparoscopy can also be performed if the patient's condition permits.

4. CT, magnetic resonance and radionuclide scanning examination: for intra-abdominal and retroperitoneal lesions, such as liver, spleen, pancreatic lesions and some intra-abdominal masses and abdominal abscesses, effusion, gas accumulation, etc. Diagnostic value should be selected according to the condition.

5. Electrocardiogram examination: For older patients, ECG should be performed to understand myocardial blood supply and exclude myocardial infarction and angina pectoris.

Differential diagnosis

Terror diagnosis of chronic abdominal pain:

1, acute abdominal pain: acute abdominal pain (abdominal pain) refers to the patient's sudden abdominal pain, often caused by intra-abdominal or extra-abdominal organ diseases, the former is called visceral abdominal pain, often paroxysmal with nausea, A series of related symptoms such as vomiting and sweating, abdominal pain is transmitted by the splanchnic nerve; while the latter abdominal pain is transmitted by the somatic nerves, so it is called somatic abdominal pain, which is often persistent, and is often accompanied by nausea and vomiting.

2. Abdominal pain after violent action: Abdominal pain after violent action is one of the symptoms of liver rupture. Liver rupture is a common disease in abdominal trauma, and right liver rupture is more than left liver.

3, exercise abdominal pain: some people who do not exercise regularly, exercise less than 15 minutes will feel abdominal pain, and even some people will have abdominal pain in the rush to go quickly, rest for a while naturally improved. What is going on here? In fact, most people have this kind of abdominal pain in the early stage of exercise. Sports medicine is called "abdominal pain during exercise".

In general, chronic abdominal pain, the doctor will check the body in detail to determine the characteristics of abdominal pain, such as the location of pain, the nature of pain, other symptoms associated with pain, etc., according to these characteristics can initially determine the cause of abdominal pain. If you can't determine the cause according to the characteristics of the pain and the results of the doctor's examination, you need to further pass the laboratory test to help diagnose, such as blood routine examination, urine routine examination, laboratory stool, gastric juice analysis, gastroscopy, colonoscopy, B-ultrasound. Scan the abdomen, X-ray, etc. Computer scans and MRI are also required when necessary.

The material in this site is intended to be of general informational use and is not intended to constitute medical advice, probable diagnosis, or recommended treatments.