Topic Resources
Abdominal pain is common and often minor. Severe abdominal pain
that comes on quickly, however, almost always indicates a significant
problem. The pain may be the only sign of the need for surgery and must
be attended to swiftly. Abdominal pain is of particular concern in
people who are very young or very old and those who have human
immunodeficiency virus (HIV) infection or are taking drugs that suppress
the immune system. Older adults may have less abdominal pain than
younger adults with a similar disorder, and, even if the condition is
serious, the pain may develop more gradually. Abdominal pain also
affects children, including newborns and infants—who cannot communicate
the reason for their distress.
Types of Abdominal Pain
There are different types of abdominal pain depending on the structures involved.
Visceral pain comes from the organs within the abdominal cavity (which are called the viscera). The viscera's nerves do not respond to cutting, tearing, or inflammation. Instead, the nerves respond to the organ being stretched (as when the intestine is expanded by gas) or surrounding muscles contract. Visceral pain is typically vague, dull, and nauseating. It is hard to pinpoint. Upper abdominal pain results from disorders in organs such as the stomach, duodenum, liver, and pancreas. Midabdominal pain (near the navel) results from disorders of structures such as the small intestine, upper part of the colon, and appendix. Lower abdominal pain results from disorders of the lower part of the colon and organs in the genitourinary tract.
Somatic pain comes from the membrane (peritoneum) that lines the abdominal cavity (peritoneal cavity). Unlike nerves in the visceral organs, nerves in the peritoneum respond to cutting and irritation (such as from blood, infection, chemicals, or inflammation). Somatic pain is sharp and fairly easy to pinpoint.
Referred pain is pain perceived distant from its source (see Figure: What Is Referred Pain?). Examples of referred pain are groin pain caused by kidney stones and shoulder pain caused by blood or infection irritating the diaphragm.
What Is Referred Pain?
Pain felt in one area of the body does not always represent where
the problem is because the pain may be referred there from another
area. For example, pain produced by a heart attack may feel as if it is
coming from the arm because sensory information from the heart and the
arm converge on the same nerve pathways in the spinal cord.
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Peritonitis
Peritonitis is inflammation of the peritoneal cavity. It is very
painful and almost always signals a very serious or life-threatening
disorder. It can result from any abdominal problem in which the organs
are inflamed or infected. Common examples include appendicitis, diverticulitis, and pancreatitis.
Also, blood and body fluids (such as intestinal contents or urine) are
very irritating when they leak into the peritoneal cavity and can cause
peritonitis. Disorders that cause blood and body fluids to leak include
spontaneous organ rupture (such as a perforated intestine or ruptured ectopic pregnancy) and severe abdominal injury. People who have fluid in the peritoneal cavity (the fluid is called ascites) are at risk of developing an infection. Such an infection is called spontaneous bacterial peritonitis.
Once peritonitis has been present for a number of hours, the inflammation causes fluid to leak into the abdominal cavity. The person may then develop dehydration and go into shock. Inflammatory substances released into the bloodstream may affect various organs, causing severe lung inflammation, kidney failure, liver failure, and other problems. Without treatment, people may die.
Causes
Pain can arise from any of many causes, including infection,
inflammation, ulcers, perforation or rupture of organs, muscle
contractions that are uncoordinated or blocked by an obstruction, and
blockage of blood flow to organs.
Immediately life-threatening disorders, which require rapid diagnosis and surgery, include
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Ruptured abdominal aortic aneurysm
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Perforated stomach or intestine
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Blockage of blood flow to the intestine (mesenteric ischemia)
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Ruptured ectopic pregnancy
Serious disorders that are nearly as urgent include
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Sudden (acute) inflammation of the pancreas (pancreatitis)
Sometimes, disorders outside the abdomen cause abdominal pain.
Examples include heart attack, pneumonia, and twisting of a testis
(testicular torsion). Less common problems outside the abdomen that
cause abdominal pain include diabetic ketoacidosis, porphyria, sickle
cell disease, and certain bites and poisons (such as a black widow
spider bite, heavy metal or methanol poisoning, and some scorpion
stings).
Abdominal pain in newborns, infants, and young children has numerous causes not encountered in adults (see Table: Abdominal Pain in Newborns, Infants, and Young Children).
Evaluation
The following information can help people decide when a doctor's
evaluation is needed and help them know what to expect during the
evaluation.
Warning signs
In people with acute abdominal pain, certain symptoms and characteristics are cause for concern. They include
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Severe pain
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Signs of shock (for example, a rapid heart rate, low blood pressure, sweating, and confusion)
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Signs of peritonitis (for example, constant pain that doubles the person over and/or pain that worsens with gentle touching or with bumping the bed)
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Swelling of the abdomen
When to see a doctor
People who have warning signs should go to the hospital right
away. People who have no warning signs should see a doctor within a day.
What the doctor does
Doctors ask questions about the person's symptoms and medical
history and do a physical examination. What doctors find during the
history and physical examination helps them decide what, if any, tests
need to be done. Doctors follow the same process whether they are
evaluating mild or severe pain, although a surgeon may be involved early
on in the evaluation of severe abdominal pain.
When taking the medical history (see Table: History in People With Acute Abdominal Pain), doctors ask questions about the pain's location (see Figure: Causes of Abdominal Pain by Location)
and characteristics, whether the person has had similar symptoms in the
past, and what other symptoms the person has along with the abdominal
pain. Symptoms such as heartburn, nausea, vomiting, diarrhea,
constipation, jaundice, blood in the stool or urine, coughing up blood,
and weight loss help guide the doctor's evaluation. Doctors ask
questions about drugs taken, including prescription and illicit drugs as
well as alcohol.
Doctors ask questions about known medical conditions and previous
abdominal surgeries. Women are asked whether they are or could be
pregnant.
When conducting a physical examination, doctors first note the
person's general appearance. A comfortable-appearing person rarely has a
serious problem, unlike one who is anxious, pale, sweating, or in
obvious pain. The focus of the examination is the abdomen, and doctors
inspect, tap, and touch (a process called palpation) the abdominal area.
They usually examine the rectum and pelvis (for women) to locate
tenderness, masses, and blood.
Doctors touch the whole abdomen gently to detect areas of
particular tenderness, as well as the presence of guarding, rigidity,
rebound, and any masses. Guarding is when a person involuntarily
contracts the abdominal muscles when the doctor touches the abdomen.
Rigidity is when the abdominal muscles stay firmly contracted even when
the doctor is not touching them. Rebound is when a person flinches in
pain as the doctor's hand is briskly withdrawn. Guarding, rigidity, and
rebound are signs of peritonitis.
Causes of Abdominal Pain by Location
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Testing
Sometimes, people have findings so significant that doctors
realize right away that they need surgery. Doctors try not to delay
surgery on such people by doing tests. However, more often, doctors must
do tests to help choose among several different causes suggested by the
person's symptoms and physical examination results. Doctors select
tests based on what they suspect.
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Urine pregnancy test for all girls and women of childbearing age
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Imaging tests based on suspected diagnosis
An abdominal computed tomography (CT) scan helps identify many, but not all, causes of abdominal pain. Urine tests (for example, urinalysis)
are frequently done to look for signs of a urinary tract infection or a
kidney stone. Blood tests are often done but rarely identify a specific
cause (although blood tests can be used to diagnose pancreatitis). An ultrasound is helpful if doctors suspect a gynecologic disorder.
Treatment
The specific cause of the pain is treated. Until recently,
doctors thought that it was not wise to give pain relievers to people
with severe abdominal pain until a diagnosis was made because the pain
reliever might mask important symptoms. However, pain relievers are now
often given while tests are in progress.
Key Points
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Doctors look first for any life-threatening causes for the pain.
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Doctors rule out pregnancy in girls and women of childbearing age.
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Blood tests rarely identify a specific cause of acute abdominal pain.
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