Lower abdominal pain

Introduction Lower abdomen pain: In daily life, women always encounter a lot of unspeakable discomfort, and lower abdominal pain is a more common one. Lower abdominal bulge is mainly related to pelvic congestion, and many of them can be classified as medically known as pelvic congestion syndrome. Women with lower abdominal pain are one of the main symptoms of most obstetric and gynecological diseases. Once a woman has a lower abdominal pain, she should carefully identify the location of the pain and the duration of the time, so that the doctor can treat the disease.

Cause

Acute lower abdominal pain:

There are many types of acute lower abdominal pain, and the performance is diverse, but there is a common feature, that is, the change is large and the progress is fast. If the delay time will bring serious consequences to the patient, it must be paid attention to.

Acute inflammation causes lower abdominal pain: acute endometritis, acute tubal oophoritis, pelvic peritonitis. Among them, acute fallopian tube ovarian inflammation is the most common, and abscess is formed in severe cases. Acute pelvic infections often occur after delivery and after abortion.

Non-inflammatory lower abdominal pain: common ectopic pregnancy, ovarian tumor pedicle torsion and rupture. Lower abdominal pain caused by ectopic pregnancy is usually dangerous. If the tubal pregnancy is ruptured, the amount of bleeding is high, the speed is fast, and the blood quickly spreads to the abdominal cavity causing total abdominal pain, resulting in anemia and shock. When the ovarian tumor is twisted, it can cause persistent cramps. In addition, the contents of the ovarian cysts will also stimulate the peritoneum to produce pain.

Other causes of acute lower abdominal pain: acute abdomen pain can occur when abortion occurs in abortion and uterine perforation. In addition, there are acute intestinal obstruction, abdominal organ stones, tortoise hydronephrosis, intestinal torsion, etc., dysmenorrhea, pelvic abdominal trauma can cause acute lower abdominal pain.

The differential diagnosis of acute lower abdominal pain is not very easy. Moreover, improper behavior before going to the hospital for emergency treatment may aggravate the condition, and may mask the original symptoms of the patient and bring illusion to the doctor.

Chronic lower abdomen pain:

Chronic lower abdominal pain is more common, common in chronic inflammation of the reproductive organs, endometriosis, adenomyosis, pelvic congestion and psychological pelvic pain.

Chronic genital inflammation: chronic cervicitis, chronic pelvic inflammatory disease, dysmenorrhea and other pelvic congestion: also known as pelvic varices, caused by chronic pelvic congestion.

Tumor pain: When the gynecological malignant tumor progresses to the advanced stage, the pelvic nerve is infiltrated or compressed by the cancer, which may cause pain.

Psychological lower abdomen pain: Psychological pelvic pain is generally characterized by repeated episodes of lower abdominal pain, but no organic lesions have been confirmed by examination. Psychological pelvic pain is more of a physical reaction. Some people may have experienced trauma due to sexual behavior, but they are afraid of sex, have painful intercourse, and develop pelvic pain over time. The study found that patients are prone to convert some repressed emotions into physical symptoms to alleviate psychological disorders. The external manifestation is psychological pelvic pain.

an examination

Related inspection

Laparoscopic

Diagnosis of acute lower abdomen pain:

Patients with acute lower abdominal pain should be carefully and carefully asked about the history, including history of menopause, history of vaginal bleeding, location of abdominal pain, nature, radiation pain and anemia. Combined with internal diagnosis and B-ultrasound, pregnancy test, posterior malleolar puncture, lower abdominal X-ray film and other auxiliary diagnosis. Laparoscopic or laparotomy should be performed if necessary.

Examination of acute lower abdominal pain includes:

(1) General examination: including blood pressure, pulse, breathing, body temperature, face, cardiopulmonary examination.

(2) Abdominal examination: The patient takes the supine position and performs observation, touch, sputum, and auscultation. At the time of diagnosis, attention should be paid to the shape of the abdomen. Obesity is more common in obstetrics and gynecology. If it is ascites, the abdomen is shaped like a frog belly, and the abdominal bulging is mainly on both sides. If it is caused by an ovarian tumor, the abdominal bulging is centered. Lord; if it is a pregnant uterus, the outline of the uterus is obvious, the bottom of the uterus is spherical; the bottom of the double-horned uterus is saddle-shaped, and the single-horned uterus is bent to one side. Palpation should be checked for abdominal muscle tension, with or without tenderness and rebound tenderness, and with or without a lump. When pelvic inflammation, especially pelvic peritonitis, check abdominal muscle tension, there is obvious tenderness and rebound tenderness; intra-abdominal tension is not significant during internal bleeding, abdominal tenderness is often where the lesion is located, such as inflammation, ectopic pregnancy (also known as Ectopic pregnancy) rupture, ovarian tumor pedicle torsion, tumor rupture or perforation; pregnancy uterine rupture, the fetus can be clearly touched under the abdominal wall, the uterus is often on one side of the fetus. In addition, routine examination of liver, spleen, etc. is required. At the time of percussion, the difference between the bowel sound and the presence or absence of mobile dullness should be distinguished, especially when identifying large ovarian tumors and ascites. The former is often squeezed by the tumor in the lumbar ribs. The intestines float in the ascites and often present a drumming area in the middle of the abdomen. Auscultation is used to listen to fetal heart sounds, bowel sounds, etc.

(3) Anal examination, double diagnosis, triple examination: Check whether the vaginal fistula is full and tender, whether the cervix has pain and movement pain, whether there is swelling or tenderness in the pelvis, and whether the attachment has thickening and tenderness.

Auxiliary examination of abdominal pain caused by intra-abdominal hemorrhage can be diagnosed by abdominal puncture, posterior malleolar puncture or B-mode ultrasound. If the blood is not coagulated, the bleeding caused by ectopic pregnancy (also known as ectopic pregnancy) should be considered; if the suspected tumor is worn out, the smear should be used to find the malignant neoplasms; if it is a purulent liquid, the abscess should be considered. Or suppurative pelvic inflammatory disease or peritoneal step. Suspected tumor pedicle torsion caused by bleeding, through the B-mode ultrasound diagnostic apparatus can help diagnose. For abdominal pain caused by inflammation, it can be diagnosed by peripheral blood leukocyte examination. In addition, laparoscopic examination, pregnancy test, X-ray examination and diagnostic curettage are often used.

Diagnosis of chronic lower abdomen pain:

Chronic lower abdominal pain is caused by chronic cervicitis, chronic appendicitis, chronic pelvic connective tissue inflammation, pelvic septicemia, posterior uterus, uterine prolapse, uterine hypertrophy.

Patients with long-term low back pain, lower abdominal pain, sexual life, menstrual period, increased bowel movements, or dysuria, frequent urination, leucorrhea, should consider chronic cervicitis, through vaginal examination, cervical mucus smear or biopsy Can be diagnosed.

If the pain in the lower abdomen is often constant at 7 days before menstruation and gradually increases until the end of the menstruation, endometriosis should be considered.

If the patient complains of pelvic sensation, low back pain and traction in the groin, uterine prolapse should be considered. Gynecological examination can be confirmed by seeing the cervix or cervix of the lower part of the vagina protruding from the vaginal opening.

After maternal, especially for patients with more than three births, if there is a lower abdominal pain, lumbosacral pain in the menstrual period, usually more vaginal discharge, excessive menstrual flow, should consider uterine hypertrophy. Gynecological examination except for the general swelling of the uterus to the size of the uterus of about 2 months of pregnancy, there is no other positive findings.

If the patient has long-term abdominal distension, pain and lumbosacral pain, and is tired after exertion, sexual intercourse, defecation or before and after menstruation, plus sometimes low fever, fatigue, vaginal discharge, menstrual disorders, etc., should consider chronic pelvic inflammatory disease . Gynecological examination can be found on one side or both sides of the uterus with flaky thickening, tenderness, uterine humeral ligament thickening, hardening, tenderness.

Pelvic sputum mainly manifests as lumbosacral pain or lower abdomen pain, long standing, tired, increased after menstruation or near menstrual period, often accompanied by menstrual flow and increased vaginal discharge. The vulva and vagina can be purple-blue, sometimes with varicose veins: the neck is soft and slightly purple, and so on.

Differential diagnosis

Lower abdominal cramps:

It is often caused by the strong peristaltic contraction of the muscles of the abdominal tube-like organs without the will of the person. Under normal circumstances, the pipe-like organs in the human body are constantly squirming. For example, the stomach is constantly moving and contracting to digest food, pushing the chyme into the small intestine, the small intestine is constantly squirming, absorbing nutrients and moisture, and allowing intestinal contents to the large intestine. Pushing, the large intestine is also constantly squirming while absorbing moisture and excreting waste; the gallbladder and bile duct are also creeping and contracting, storing and secreting bile according to the needs of the human body... The normal peristaltic contraction does not cause abdominal pain, but If you want to overcome the obstruction in the pipeline, it is necessary to strengthen the contraction, and the strong and severe contraction will cause abdominal cramps. Organs capable of producing abdominal cramps include the stomach and intestine (including the appendix), the cystic duct, the hepatic duct, the common bile duct, the pancreatic duct, the ureter, the uterus or the fallopian tube, and the kidney.

Lower abdominal pain:

It refers to the feeling of pain and swelling. It is a characteristic of qi stagnation. Lower abdominal pain is common in menstrual menstruation and various digestive diseases.

Lower abdominal rebound pain:

It is a sign of inflammation of the peritoneal wall layer, which is more common in intra-abdominal organ lesions involving adjacent peritoneum and primary peritonitis.

Lower abdominal tenderness:

Abdominal tenderness The pain that occurs when the abdomen is pressed from shallow to deep.

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