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Abdominal Pain

Correctly interpreting the cause of acute abdominal pain can be quite challenging, and because some of the causes can be serious it is quite important for any patient with significant acute abdominal pain to be evaluated in urgent care or ER to rule out serious cause.

 

Simple non serious causes of chronic or recurrent nature:

Disease

Pain Quality

Location

Radiation

GERD/Esophagitis Burning Mid chest Left arm and back
Stomach Ulcer Gnawing Upper center  Back
Gall Bladder stones Colicky Right upper Back and right shoulder
Kidney stone  Colicky   R or L flank.   Anterior lower abdomen
Dyspepsia Bloating and dull Upper center None
Irritable Bowel    Cramping Lower abdomen None
Bladder infection  Discomfort  Center of lower abdomen None
Constipation Colicky Left lower abdomen None
Abdominal Pain

Causes of more serious acute abdominal pain

Most of the conditions listed below present with more severe acute pain and should be evaluated in ER if the suspicion is high.

They can be divided into 2 categories:

  • Focal infectious or inflammatory process (Appendicitis)leading to inflammation of the adjacent abdominal wall lining (peritonitis) this type of pain is usually achy and steady, aggravated by pressure or change in the abdominal wall tension and is accompanied by tonic reflex spasm in adjacent abdominal wall muscles
  • Mechanical blockage of a hollow organ (kidney stones, Gall stones or bowel obstruction) leading to colicky pain

Disease

Pain Type

Location

Radiation

Associated Symptoms

Acute AppendicitisCrampy steadyUmbilicus —> R lower abd Back Fever, Nausea and vomiting
Acute CholecystistisPressure CrampyR upper Abd Right Shoulder Fever, Nausea and vomiting
Acute PancreatitisSever SteadyUmbilicus and upper Abd Back Fever, Nausea and vomiting
Bowel PerforationSudden and Severe Upper Abd Entire Abdomen 
Bowel ObstructionCrampy Periumbilical Back Nausea and vomiting
Bowel InfarctionSevere Diffuse Periumbilical Entire Abdomen  Fever, nausea and vomiting 
Acute DiverticulitisCramping Aching Left lower Abd. To Lower Abdomen Fever, vomiting and diarrhea

I have abdominal pain, where shall I go ER or urgent care?

Most of abdominal pain cases seen in primary care are caused by minor causes such as stomach reflux , stomach ulcer , viral minor stomach flu or food poisoning and these are usually minor and can be addressed by your primary care doctor or in urgent care.

Please go to ER or get screened in urgent care if you have any of the following:

  • If you have severe persistent or worsening abdominal pain
  • If you have rectal bleeding (other than hemorrhoids)
  • If you have fever
  • If you have nausea and vomiting leading to dehydration
  • If you are unable to have a bowel movement or unable to pass gas
  • If you are pregnant or have vaginal bleed outside the period
  • If you are older than 55 year of age
  • If you have chronic medical illnesses such as heart disease, Hypertension or Diabetes
  • If you have swelling in groin, scrotum or signs of hernia
  • If you are alcoholic
  • If you have weak immune system (Cancer)
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