stomach pain (or stomach ache) can be one of the symptoms associated with transient disorders or serious disease. Making a definitive diagnosis of the cause of abdominal pain can be difficult, because many diseases can result in this symptom. stomach pain is a common problem. Most frequently the cause is benign and/or self-limited, but more serious causes may require urgent intervention.
Causes
The following is an incomplete list of possible causes of stomach pain.[1]
* Gastrointestinal
o Inflammatory: gastroenteritis, appendicitis, gastritis, esophagitis, diverticulitis, Crohn's disease, ulcerative colitis, microscopic colitis
o Obstruction: hernia, intussusception, volvulus, post-surgical adhesions, tumours, superior mesenteric artery syndrome, severe constipation, hemorrhoids
o Vascular: embolism, thrombosis, hemorrhage, sickle cell disease, stomach angina, blood vessel compression (such as celiac artery compression syndrome)
o digestive: peptic ulcer, lactose intolerance, celiac sprue (affecting 1:133 people), food allergies, Jasohnstritis
* Bile system
o Inflammatory: cholecystitis, cholangitis
o Obstruction: cholelithiasis, tumours
* Liver
o Inflammatory: hepatitis, liver abscess
* Pancreatic
o Inflammatory: pancreatitis
* Renal and urological
o Inflammation: pyelonephritis, bladder infection
o Obstruction: kidney stones, urolithiasis, Urinary retention, tumours
o Vascular: left renal vein entrapment
* Gynecological or obstetric
o Inflammatory: pelvic inflammatory disease
o Mechanical: ovarian torsion
o Endocrinological: menstruation, Mittelschmerz
o Tumors: endometriosis, fibroids, ovarian cyst, ovarian cancer
o Pregnancy: ruptured ectopic pregnancy, threatened abortion
* stomach wall
o muscle strain or trauma
o muscular infection
o neurogenic pain: herpes zoster, radiculitis in Lyme disease, stomach cutaneous nerve entrapment syndrome (ACNES), tabes dorsalis
* Referred pain
o from the thorax: pneumonia, pulmonary embolism, ischemic heart disease, pericarditis
o from the spine: radiculitis
o from the genitals: testicular torsion
* Metabolic disturbance
o uremia, diabetic ketoacidosis, porphyria, C1-esterase inhibitor deficiency, adrenal insufficiency, lead poisoning, black widow spider bite, narcotic withdrawal
* Blood vessels
o aortic dissection, stomach aortic aneurysm
* Immune system
o sarcoidosis
o vasculitis
o familial Mediterranean fever
* Idiopathic
o irritable bowel syndrome (affecting up to 20% of the population, IBS is the most common cause of recurrent, intermittent stomach pain)
[edit] Acute stomach Pain
Acute abdomen can be defined as severe, persistent stomach pain of sudden onset that is likely to require surgical intervention to treat its cause. The pain may frequently be associated with nausea and vomiting, stomach distention, fever and signs of shock. One of the most common conditions associated with acute stomach pain is acute appendicitis, a condition where mucus or fecal matter hardens, becomes rock-like, and blocks the opening.
Selected causes of acute abdomen
* Traumatic : blunt or perforating trauma to the stomach, bowel, spleen, liver, or kidney
* Inflammatory :
o Infections such as appendicitis, cholecystitis, pancreatitis, pyelonephritis, pelvic inflammatory disease, hepatitis, mesenteric adenitis, or a subdiaphragmatic abscess
o Perforation of a peptic ulcer, a diverticulum, or the caecum
o Complications of inflammatory bowel disease such as Crohn's disease or ulcerative colitis
* Mechanical :
o Small bowel obstruction secondary to adhesions caused by previous surgeries, intussusception, hernias, benign or malignant neoplasms
o Large bowel obstruction caused by colorectal cancer, inflammatory bowel disease, volvulus, fecal impaction or hernia
* Vascular : occlusive intestinal ischemia, usually caused by thromboembolism of the superior mesenteric artery
[edit] Recurrent stomach Pain in Children and Adolescents
Recurrent stomach pain (RAP) occurs in 5–15% of children 6–19 years old. In a community-based study of middle and high school students, 13–17% had weekly stomach pain. Using criteria for irritable bowel syndrome (IBS), 14% of high school students and 6% of middle school students fit the criteria for adult IBS. As with other difficult to diagnose chronic medical problems, patients with RAP account for a very large number of office visits and medical resources in proportion to their actual numbers. Most patients with RAP benefit from reassurance and techniques to manage anxiety and stress, which are frequently associated with episodes.
[edit] Medical Assessment
When a physician assesses a patient to determine the etiology and subsequent treatment for stomach pain the patients history of the presenting complaint and physical examination should derive a diagnosis in over 90% of cases.
It is important also for a physician to remember that stomach pain can be caused by problems outside the abdomen, especially heart attacks and pneumonias which can occasionally present as stomach pain.
Investigations that would aid diagnosis include
* Blood tests including full blood count, electrolytes, urea, creatinine, liver function tests, pregnancy test and lipase.
* Urinalysis
* Imaging including erect chest X-ray and plain films of the abdomen
* An electrocardiograph to rule out a heart attack which can occasionally present as stomach pain
If diagnosis remains unclear after history, examination and basic investigations as above then more advanced investigations may reveal a diagnosis. These as such would include
* Computed Tomography of the abdomen/pelvis
* stomach or pelvic ultrasound
* Endoscopy and colonoscopy (not used for diagnosing acute pain)
