Abdominal pain causes

Resident Survival Guide

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Abdominal pain Microchapters
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Causes Diffuse Abdominal Pain Left Upper Quadrant Left Flank Left Lower Quadrant Epigastric Quadrant Umbilical Region Pelvic Region Right Upper Quadrant Right Flank Right Lower Quadrant Intraperitoneal Extraperitoneal
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

The causes of abdominal pain vary with the distribution of the pain. The distribution can be determined by various methods, such as into either abdominal quadrants or nine sections.

Causes

Causes Based upon Location

Diffuse | Left Upper Quadrant | Left Flank | Left Lower Quadrant | Epigastric Region | Umbilical Region | Pelvic Region | Right Upper Quadrant | Right Flank | Right Lower Quadrant

Life Threatening Causes

Life-threatening causes include conditions that may result in death or permanent disability within the next 24 hours if left untreated.

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Common Causes

• Injury to the Abdominal wall
  • Abdominal cutaneous nerve entrapment syndrome
  • Mesenteric traction syndrome
  • Muscle trauma
  • Muscular infection
• Autoimmune:
  • sarcoidosis
  • vasculitis
• Diarrhea
• Digestive:
  • lactose intolerance
  • celiac sprue
• Distention of visceral surfaces such as the hepatic or renal capsule
• Endometriosis
• Functional pain:
  • Irritable bowel syndrome (affecting up to 20% of the population, IBS is the most common cause of recurrent, intermittent abdominal pain)
• Inflammation of bowel wall:
  • Crohn's disease
  • Diverticulitis
  • Gastroenteritis
  • Microscopic colitis
  • Ulcerative colitis
• Mechanical obstruction of hollow viscera such as the small intestine, the appendix associated with appendicitis, the large intestine (e.g. by intussusception), the biliary tree (e.g. by gallstones), or the ureter (e.g. by urinary calculi)
• Meningitis
• Metabolic disturbance:
  • Adrenal insufficiency
  • Black widow spider bite
  • C1-esterase inhibitor deficiency
  • Diabetic ketoacidosis
  • Lead poisoning,
  • Porphyria
  • Uremia
• Neurogenic pain:
  • Herpes zoster
  • Lyme disease (Lyme radiculitis or Bannwarth syndrome)
  • Tabes dorsalis
• Parietal peritoneal inflammation
  • Due to infection: inflamed or suppurative appendix in appendicitis, pelvic inflammatory disease
  • Due to chemical irritation: perforated gastric or peptic ulcer; pancreatitis, Mittelschmerz, ruptured ectopic pregnancy
  • Miscellaneous (Familial Mediterranean fever)
• Pelvic inflammatory disease
• Post-surgical adhesions
• Referred pain from:
  • Genitals (testicular torsion)
  • Coronary occlusion)
  • The spine (radiculitis secondary to arthritis)
  • The thorax (pneumonia
• Reproductive organs (in women):
  • Ectopic pregnancy
  • Mittelschmerz
  • Torsion of the ovary
• Vascular disturbances (leading to ischemia):
  • Embolism
  • Left renal vein entrapment
  • Sickle cell anemia
  • Superior mesenteric artery syndrome (Nutcracker syndrome)
  • Thrombosis
  • Torsional occlusion (volvulus)
  • Vascular rupture

Causes by Organ System

Cardiovascular	Abdominal aortic aneurysm, Budd-Chiari syndrome
Chemical / poisoning	Amanita phalloides, arsenic poisoning, barium nitrate, cresol,fluoride poisoning, grape seed extract, lead poisoning, oleander, parathion, pesticide, pyridine, snakebites, spider bite, tributyl phosphate
Dermatologic	No underlying causes
Drug Side Effect	Acetylsalicylic acid, Acarbose, aciclovir, Alosetron, aminocaproic acid, amlodipine and benazepril, Ambenonium, Atovaquone,Atovaquone-Proguanil, auranofin, azithromycin, Aztreonam, Basiliximab, Bethanechol chloride, bezafibrate, Bicalutamide,Bosutinib, Busulfan, caspofungin, cefdinir, Cefixime, cefuroxime, Cidofovir, cladribine, clidinium, clindamycin, clofibrate, contraceptive patch, dactinomycin, danazol, daptomycin, Deferasirox, Deferiprone, Desmopressin, Didanosine, diflunisal, Dimercaprol, donepezil, Doxorubicin Hydrochloride , drotrecogin alfa, dydrogesterone, Ecallantide, enoxaparin, Entacapone, Elosulfase alfa, erythromycin, ethcathinone, Etodolac, Etonogestrel, etoposide phosphate, Febuxostat, Fesoterodine, Flucytosine, Flurbiprofen, Fluvastatin, Ganirelix, Glyburide and Metformin, halofantrine, hydroxychloroquine, idarubicin, Imiglucerase, Indinavir, Interferon beta- 1b, Irinotecan hydrochloride, isoniazid, itraconazole, Ivacaftor, Ketorolac tromethamine, Lactulose, Lanreotide, lansoprazole, Lanthanum carbonate, Levonorgestrel, loperamide, lopinavir, loprazolam, Ivermectin, Loratadine, magnesium citrate, Mebendazole, Medroxyprogesterone, Megestrol, mercaptopurine, Mesna, methimazole, Methotrexate, methylphenidate, Metronidazole, mifepristone, Miglitol, misoprostol, moxifloxacin, muscarine, nafcillin, Naltrexone, Naproxen sodium, Naproxen and esomeprazole magnesium, Natalizumab, neuromuscular-blocking drugs, niclosamide, nitazoxanide, Norethindrone acetate and Ethinyl estradiol, Norgestrel and Ethinyl estradiol, octreotide injection, omeprazole, Olsalazine, orlistat, Oxcarbazepine, Pantoprazole, Paromomycin sulfate, Pasireotide, pazopanib hydrochloride, Papaverine, Piroxicam, pegaspargase, Pentamidine Isethionate, pentavalent antimonial, pentostatin, perindopril, phenazocine, permethrin, Pirfenidone, Potassium iodide, polyethylene glycol-electrolyte solution (PEG-ES), Potassium bicarbonate, Potassium citrate, praziquantel, prazosin and polythiazide, Primaquine phosphate, procainamide, procarbazine, Progesterone, propylthiouracil, Protirelin, Rabeprazole, Rasburicase, rifaximin, Ritonavir, roxithromycin, Sacrosidase, Sargramostim, Saquinavir mesylate, saxagliptin, Secretin human, Siltuximab, simvastatin, sorafenib, sucralfate, sulfasalazine, Sunitinib, thiotepa, tianeptine, Tigecycline, Tolmetin, topiramate, topotecan, Trametinib dimethyl sulfoxide, trastuzumab, Tretinoin, triclofos, valacyclovir, Vancomycin, vardenafil,vandetanib, vigabatrin, vinblastine, voriconazole, Zafirlukast,
Ear Nose Throat	No underlying causes
Endocrine	Multiple endocrine neoplasia type 1
Environmental	No underlying causes
Gastroenterologic	Abdominal cramps, abdominal cutaneous nerve entrapment syndrome, abdominal mass, accessory pancreas, acute pancreatitis, appendicitis, autoimmune hepatitis, autoimmune pancreatitis, bacterial gastroenteritis, bowel obstruction, caecitis, carcinoid syndrome, celiac disease, Charcot's triad, cholangiocarcinoma, cholangitis, cholecystitis, choledochal cysts, chronic pancreatitis, cirrhosis, clostridial necrotizing enteritis, colitis, colonic polyps, colorectal cancer, constipation, Crohn's disease, diverticulitis, duodenitis, dyspepsia, enteritis, epiploic appendagitis, gastric outlet obstruction, gastritis, gastroenteritis, gastrointestinal perforation, gastrointestinal stromal tumor, hemosuccus pancreaticus, ileitis, ileus, intestinal malrotation, intestinal pseudoobstruction, intussusception, irritable bowel syndrome, ischemic colitis, König's syndrome, Krukenberg tumor, malabsorption, Meckel's diverticulum, mesenteric ischemia, ogilvie syndrome, pancreatic cancer, pancreatitis, peptic ulcer, peritonitis, porcelain gallbladder, proctitis, pseudomembranous colitis, pseudomyxoma peritonei, toxic megacolon, ulcerative colitis, volvulus, Whipple's disease
Genetic	Gilbert's syndrome, Marfan syndrome, periodic fever syndrome, pyruvate carboxylase deficiency, Slone's disease
Hematologic	Capillary leak syndrome, cholesterol emboli syndrome, mastocytosis, porphyria
Iatrogenic	Adjustable gastric band, postcholecystectomy syndrome, short bowel syndrome, transfusion-associated graft versus host disease
Infectious Disease	African horse sickness, Anisakis, Ascaris infection, Astroviridae, Bacillus cereus, blastocystosis, Brachylaima, campylobacteriosis, cat scratch fever, Cestoda, Clostridium difficile, Colorado tick fever, Cryptosporidium parvum, Dengue fever, Ebola, Entamoeba histolytica, familial Mediterranean fever, fasciolopsiasis, fasciolosis, fungemia, Fusarium, Giardia lamblia, Hantavirus pulmonary syndrome, Helicobacter pylori infection, Henipavirus, hookworm, Hymenolepis infection, isosporiasis, leptospirosis, Mycobacterium avium complex, Norovirus, Opisthorchis infection, Paragonimus infection, Q fever, rheumatic fever, Rocky Mountain spotted fever, salmonellosis, scarlet fever, schistosomiasis, scombrotoxic fish poisoning, shigellosis, strongyloidiasis, toxocariasis, trichomoniasis, typhoid fever, Vibrio vulnificus, viral hepatitis , whipworm infection, yellow fever, yersiniosis
Musculoskeletal / Ortho	No underlying causes
Neurologic	Autonomic neuropathy
Nutritional / Metabolic	Diabetic ketoacidosis, food allergy, food intolerance, lactic acidosis, metabolic acidosis, pantothenic acid, Zieve's syndrome
Obstetric / Gynecologic	Cervical cancer, ectopic pregnancy, endometrial cancer, endometriosis, menstruation, ovarian cancer, ovarian cyst, ovarian hyperstimulation syndrome, ovarian torsion, pelvic inflammatory disease, placental abruption, pregnancy, Salpingitis, uterine fibroids, uterine rupture, uterine sarcoma
Oncologic	Desmoplastic small round cell tumor, liposarcoma, liver tumor, mesothelioma, sacrococcygeal teratoma
Ophthalmologic	No underlying causes
Overdose / Toxicity	4-Nitrophenol, cicutoxin, cinchonism, clitocybe dealbata, colchicine, hebeloma crustuliniforme, hypervitaminosis A, sorbitol, statins, tegaserod, tetrodotoxin
Psychiatric	No underlying causes
Pulmonary	Basal pneumonia, empyema, pleuritis, pulmonary embolism, pulmonary infarction, tuberculosis
Renal / Electrolyte	Hydronephrosis, hypercalcemia, hyperkalemia, hypocalcemia, nutcracker syndrome, polycystic kidney disease, pyelonephritis, ureterocele, urinary tract infection
Rheum / Immune / Allergy	Polyarteritis nodosa, systemic lupus erythematosus
Sexual	No underlying causes
Trauma	No underlying causes
Urologic	Prostate cancer, prostatitis
Miscellaneous	Alcoholic hepatitis, chronic fatigue syndrome, chronic functional abdominal pain, foreign body, ruptured spleen, side stitch, Situs inversus, Zollinger-Ellison syndrome

Causes in Alphabetical Order

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Acute Abdomen

Common causes of acute abdomen include:

• Acute appendicitis
• Acute cholecystitis
• Acute diverticulitis
• Acute intestinal ischemia
• Acute pancreatitis
• Acute peptic ulcer and its complications
• Acute peritonitis
• Acute ureteral colic
• Bowel perforation with free air or bowel contents in the abdominal cavity
• Bowel volvulus
• Diabetic ketoacidosis
• Ectopic pregnancy with tubal rupture

Chronic Functional Abdominal Pain

Common causes of CFAP stem from:

• Abdominal etiologies
• Gynecologic etiologies
  • Dysmenorrhea
  • Endometriosis
  • Müllerian abnormalities
  • Ovarian abnormalities
  • Pelvic inflammatory disease

References

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