What Are the Common Causes of Extreme Abdominal Pain?

Upper abdominal pain is a foreign body formed by ingestion of certain plant components or ingestion of hair or certain minerals such as calcium carbonate, barium, and bismuth in the stomach due to various causes of internal and external organ lesions. . Abdominal pain is manifested in more than half of patients with upper abdominal pain, fullness, nausea, and vomiting.

Epigastric pain

Epigastric pain

1. History (1) Gender and age: Common causes of abdominal pain in children are ascariasis, mesenteric lymphadenitis, and intussusception. Ulcers, gastroenteritis, and pancreatitis are more common in young adults. Middle-aged and elderly people have cholecystitis and gallstones. In addition, the possibility of gastrointestinal tract, liver cancer, and myocardial infarction should be paid attention to. Renal colic is more common in men, and twisted ovarian cysts and ruptured corpus luteum are common causes of acute abdomen in women. Ectopic pregnancy should be considered in women of childbearing age.
(2) Onset: The onset of onset is more common in ulcer disease, chronic cholecystitis, and mesenteric lymphadenitis. Rapid onset is more common in gastrointestinal perforation, bile duct stones, ureteral stones. Mesenteric artery embolism, torsion of ovarian cysts, ruptured nodule of liver cancer, ruptured ectopic pregnancy, etc. Those who have had a full meal or excessive fat meal before the onset of disease should consider the possibility of cholecystitis and pancreatitis.
(3) Previous medical history: those with biliary colic and renal colic have had similar episodes in the past. People with a history of abdominal surgery may have intestinal adhesions. Those with a history of atrial fibrillation should consider mesenteric vascular embolism and so on.
2. Clinical manifestations (1) Characteristics of abdominal pain itself: The location of abdominal pain often indicates the location of the lesion, which is an important factor in differential diagnosis. However, many visceral pains are often vaguely localized. Therefore, the site of tenderness is more important than the area where the patient feels pain. The diagnosis of the painful radiation site also has certain hints. For example, biliary diseases often have shooting pains on the right shoulder and back, and the pain of pancreatitis often radiates to the left waist. Renal colic is often radiated to the perineum.
The degree of abdominal pain reflects the severity of the disease in a certain sense. In general, pains such as gastrointestinal perforation, rupture of liver and spleen, acute pancreatitis, biliary colic, and renal colic are often severe, while ulcers and mesenteric lymphadenitis are relatively mild. However, the feeling of pain varies from person to person, especially in the elderly, and sometimes feels dull, such as acute appendicitis, and does not even feel abdominal pain until the perforation. The nature of pain is roughly related to the degree. Severe pain is often described by patients as scalpel-like pain and colic, while mild pain may be described as soreness and soreness. Pain in patients with biliary ascariasis is often described as drill-like pain and is more characteristic. Abdominal pain rhythm has a strong suggestive role in diagnosis, and the lesions of solid organs are mostly persistent pain, while the lesions of hollow organs are mostly paroxysmal. The persistent pain with paroxysmal aggravation is more common in the presence of inflammation and obstruction, such as cholecystitis with biliary obstruction, late intestinal obstruction and peritonitis.
(2) Accompanying symptoms: The accompanying symptoms of abdominal pain are very important in the differential diagnosis. Indications of fever are inflammatory lesions. Food poisoning or gastroenteritis are often associated with vomiting and diarrhea. Intestinal infections are associated only with diarrhea. Gastrointestinal obstruction and pancreatitis may be associated with vomiting. Accompanying jaundice indicates biliary disease. Conjunctival blood may be intussusception, mesenteric thrombosis. Accompanying hematuria may be ureteral stones. Intestinal obstruction may be associated with abdominal distension, and visceral rupture and bleeding, gastrointestinal perforation with peritonitis, and so on are associated with shock. If upper abdominal pain is accompanied by fever, cough, etc., the possibility of pneumonia should be considered, if upper abdominal pain is accompanied by cardiac rhythm disturbance, and myocardial infarction should be considered if blood pressure drops.
(3) Body pressure: physical signs of the abdomen are the focus of examination. The first thing to do is to find out whether it is total abdominal tenderness or local tenderness. Total abdominal tenderness indicates diffuse lesions, such as Mai's point tenderness as a sign of appendicitis. Check the tenderness of fashion should pay attention to muscle tension and rebound pain. Muscle tension is often indicative of inflammation, while rebound pain indicates that the lesion (usually inflammation-including chemical inflammation) involves the peritoneum. From time to time, pay attention to check for abdominal masses. If you touch an abdominal mass with tenderness and blurred borders, it is more suggestive of inflammation. There is no obvious tenderness, and the border is clearer, indicating the possibility of tumor. Tumorous masses are hard in texture. Intussusception, intestinal tortuosity, and closed intestinal obstruction can also affect the diseased bowel, ascariasis in the small intestine in children, feces in the colon of the elderly may also be used as abdominal mass.
Stomach type and intestinal type seen on the abdominal wall are typical signs of pyloric obstruction and intestinal obstruction. Hearing intestinal beep sounds indicates bowel obstruction, and disappearance of bowel sounds indicates intestinal paralysis. Lesions in the lower abdomen and pelvic cavity often require digital rectal examination, tenderness in the right pit or palpitation and mass, suggesting appendicitis or pelvic inflammation. Rectal uterine pits are full, and cervical pain may suggest rupture of the ectopic pregnancy.
Because the lesions of the external abdominal organs can also cause abdominal pain, heart and lung examinations are essential. Body temperature, pulse, respiration, and blood pressure reflect the patient's life status, of course, it is necessary to check. The groin area is the place where hernias occur, and it cannot be ignored in the examination. The enlargement of the supraclavicular lymph nodes may indicate tumorous diseases in the abdominal cavity, which should be taken seriously during physical examination.

1. Acute gastroenteritis: Abdominal pain above the abdomen and the umbilicus, often with persistent acute pain with paroxysmal aggravation. Often accompanied by nausea, vomiting, diarrhea, and fever. On physical examination, tenderness was found in the upper abdomen or around the umbilicus, with no muscle tension, no rebound pain, and bowel sounds slightly hyperactive. It is not difficult to diagnose the unclean diet before combining the onset.
2. Stomach and duodenal ulcers: It is common in young and middle-aged people. Abdominal pain is dominated by middle and upper abdomen. Most of them are persistent pains. They occur on an empty stomach. Eating or taking antacids can relieve them. Physical examination may have tenderness in the mid and upper abdomen, but no muscle tension or rebound pain. Frequent seizures may be associated with a positive fecal blood test. A gastrointestinal barium meal or endoscopy can establish the diagnosis.
If you have a previous history of stomach or duodenal ulcer or similar symptoms, a sudden upper mid-abdominal pain, such as a knife-like cut, will rapidly spread to the whole abdomen. The whole abdominal tenderness will be detected during examination, and the abdominal muscles will be tense and rigid. Bounce pain, disappearance of bowel sounds, pneumoperitoneum and transplanted dullness, and reduction or disappearance of liver dullness are suggestive of perforation of the stomach and duodenum. A plain radiograph of the abdomen confirms the presence of free gas under the diaphragm and the diagnosis of inflammatory exudate by abdominal puncture.
3. Acute appendicitis: Most patients first experience persistent mid-abdominal pain at the onset of the disease, and after a few hours, they transfer to the right lower abdomen, showing persistent dull pain with paroxysmal aggravation. There are also a few patients who feel right lower quadrant pain when they develop symptoms. Middle-upper abdominal painful dysmenorrhea is a characteristic of acute appendicitis pain after a few hours of turning to right lower abdominal pain. May be accompanied by fever and malignancy. Examination may have tenderness at the McGills point and muscle tension, which is a typical sign of appendicitis. Combined with the total number of white blood cells and an increase in neutrophils, the diagnosis of acute appendicitis can be definite. If acute appendicitis is not diagnosed and treated in a timely manner, persistent pain in the right lower abdomen appears after 1 to 2 days, tenderness around Myersian point, muscle tension, and rebound pain are obvious, and the total number of white blood cells and neutrophils are significantly increased. Gangrene appendicitis. If there is a lumpy mass on the right lower abdomen and the edge, an appendix mass has formed.
4. Cholecystitis and gallstones: This disease occurs in middle-aged and elderly women. Chronic cholecystitis often feels pain in the right upper abdomen, worsens after eating a fat meal, and radiates to the right shoulder. Acute cholecystitis often occurs after a fat meal, with persistent severe pain in the right upper abdomen, radiation to the right shoulder, and often accompanied by fever and malignant vomiting. Patients with gallstone disease often have chronic cholecystitis. Gallstones can cause paroxysmal colic in the right upper abdomen when they enter or move in the bile ducts, and they also radiate to the right shoulder and back. Often accompanied by malignancy. Physical examination showed marked tenderness and muscle tension in the right upper quadrant, and a positive Murphy sign was characteristic of cystitis. If there is jaundice, it means that the biliary tract has been obstructed. If it can be broken, it means that the obstruction is complete. The total number of white blood cells and neutrophils increased significantly during acute cholecystitis. Ultrasound and X-ray examination can confirm the diagnosis.
5. Acute pancreatitis: Sudden onset after a full meal, persistent severe pain in the middle and upper abdomen, often accompanied by malignant vomiting and fever. Deep tenderness in the upper abdomen, muscle tension and rebound pain are not obvious. A significant increase in serum amylase can confirm the diagnosis. However, the increase in serum amylase is usually 6 to 8 hours after the onset of disease, so if the serum amylase is not high in the early stage of the disease, it may not be possible to line up the disease. If abdominal pain spreads to the whole abdomen, and symptoms of shock appear rapidly, examination shows full abdominal tenderness, muscle tension and rebound pain, and even ascites and peri-umbilical, ventral skin plaques, suggesting hemorrhagic necrotizing pancreatitis. At this time, the blood amylase was significantly increased or not increased. The plain X-ray film showed that the stomach and small intestine were fully expanded and the colon was mostly airless and collapsed. CT scan showed enlarged pancreas and disappearance of surrounding fatty layer.
6, intestinal obstruction: intestinal obstruction can be seen in patients of all ages, children are caused by ascariasis, intussusception and so on. Adults are more likely to cause hernia or intestinal adhesions, while the elderly can be caused by colon cancer. The pain of intestinal obstruction is mostly around the umbilicus, with paroxysmal colic, accompanied by vomiting and stopping defecation. Sign examination showed obvious bowel type, abdominal tenderness, hyperactive bowel sounds, and even the sound of gas over water. If the abdominal pain is persistent pain with paroxysmal aggravation, abdominal tenderness is obviously accompanied by muscle tension and rebound pain, or if ascites is found, and rapid shock is present, it is indicated as strangulated intestinal obstruction. X-ray plain film examination, if found that the intestinal cavity is inflated, and most fluids usually diagnose the intestinal obstruction can be established.
7, abdominal organ rupture: common spleen rupture due to external forces, liver cancer nodules due to external forces or spontaneous rupture, spontaneous rupture of ectopic pregnancy. Sudden onset, persistent severe pain involving the entire abdomen, often accompanied by shock. Examination usually found to be tenderness in the abdomen, muscle tension, and rebound pain. Signs of hemorrhage in the abdominal cavity are often found. A blood clot in the abdominal cavity can confirm the rupture of the abdominal organs. Ectopic pregnancy rupture and bleeding, such as failure to puncture the posterior fornix in the abdominal cavity, often with positive results. Real-time ultrasound examination, alpha protein test, CT examination, gynecological examination, etc. can help the differential diagnosis of common organ rupture.
8, ureteral stones: abdominal pain often occurs suddenly, mostly paroxysmal colic on the left or right abdomen, and radiates to the perineum. Abdominal tenderness is not obvious. The symptoms of hematuria-based disease can be seen in the onset of pain, and abdominal X-rays and intravenous pyelography can be clearly diagnosed.
9, acute myocardial infarction: seen in middle-aged and elderly people, the infarcted area such as the plantar surface, especially those with larger areas have upper abdominal pain. Most of the pain occurs suddenly after exertion, tension, or a full meal, showing persistent colic, and radiating to the left shoulder or the inside of the arms. Often accompanied by nausea, but with shock. During the physical examination, the upper abdomen may have mild tenderness, no muscle tension, and rebound pain, but the auscultation of the heart usually has arrhythmia. An electrocardiogram can confirm the diagnosis.
10. Lead poisoning: seen in people who have been exposed to lead dust or soot for a long time, and occasionally see people who have accidentally ingested a large amount of lead compounds. Lead poisoning is divided into acute and chronic. Whether acute or chronic, paroxysmal abdominal colic is a feature. The onset is sudden, mostly in the umbilicus. Often accompanied by bloating, constipation, and loss of appetite. During the examination, there were no obvious abdominal signs, no fixed tenderness points, and bowel sounds were usually weakened. In addition, lead lines are visible at the edges of the gums, which are characteristic signs of lead poisoning. Peripheral basophilic red blood cells can be seen in the surrounding blood, and an increase in blood lead and urine lead can confirm the diagnosis.