Abdominal Pain

Reviewed By Anil Ghimire, MD

Pain felt between the ribcage and pelvis is called abdominal pain. It is a very common symptoms experienced by just about everyone at some point of time in their life. Abdominal pain can be generalised over entire abdomen or more commonly localised to one area. Based on the anatomic structure that gives rise to the pain, abdominal pain can be localised as epigastric (upper abdomen), right upper quadrant, left upper quadrant, right lower quadrant, left lower quadrant pain and hypogastric (lower abdomen) pain. Abdominal pain can be mild or severe. Most abdominal cases are not serious but sometimes it can be sign of serious illness. Abdominal pain can be short lived (acute) or occur over days and weeks (chronic).


Causes of Abdominal Pain

Location of pain provides important clue as to the cause of abdominal pain. Therefore, it is important to think the cause of abdominal pain based on locations. However, there are no absolute boundaries to define these location, hence, significant overlaps exist.

Epigastric (upper abdominal pain)

  • Gastroesophageal reflux disease (GERD)
  • Peptic ulcer disease (PUD)
  • Gastritis
  • Non-ulcer dyspepsia
  • Pancreatitis


Right upper quadrant pain

  • Cholecystitis
  • Gallstone
  • Hepatitis
  • Pancreatitis
  • Kidney diseases (stone, infection, tumor)
  • Duodenal ulcer
  • Pyloric stenosis


Left upper quadrant pain

  • Diseases of spleen (enlargement, infection, abscess, infarction, injury)
  • Kidney diseases (stone, infection, tumor)
  • Disease of large intestine ( fecal impaction, diverticulosis)


Right lower quadrant pain

  • Appendicitis
  • Ovarian cyst
  • Ectopic pregnancy
  • Ureteral stone
  • Ovulation pain
  • Intestinal tuberculosis


Left lower quadrant pain

  • Diverticulitis
  • Crohn’s disease
  • Colon cancer
  • Ectopic pregnancy
  • Ureteral stone
  • Ovulation pain


Diffuse abdominal pain:

  • Gastroenteritis, diarrhea, dysentery
  • Intestinal obstruction
  • Appendicitis
  • Intussusception
  • Peritonitis from ruptured viscus or tuberculosis
  • Worm infestation such as hookworm, pinworm, roundworm and tapeworm infestation
  • Diabetic ketoacidosis
  • Irritable bowel syndrome
  • Lead poisoning


Hypogastric pain:

  • Disease of urinary bladder (infection, tumor)
  • Disease of uterus and female reproductive organs (endometriosis, PID)


Referred pain: Sometimes pain originating from surrounding structure are felt in the abdomen

  • Pneumonia, pneumothorax
  • Angina and heart attack
  • Radicular pain from degenerative disease of thoracic vertebra
  • Shingles or zoster involving nerves supplying abdominal skin


Treatment Options

Treatment of the abdominal pain depends on the cause. Causes of abdominal pain can be diagnosed after consultation with doctor and by diagnostic investigation such as video X-ray, plain X-ray and by blood test, urine test and stool test.

  • Gastroenteritis is treated with oral rehydration solution. Only bacterial gastroenteritis needs treatment with antibiotics
  • Worm infestation is treated with antihelminthic drugs
  • Acute and chronic gastritis is treated acid lower agents
  • Paracetamol/ibuprofen is beneficial for menstrual pain.
  • Surgery may be needed in intestinal obstruction, appendicitis, peritonitis.
  • Avoid high doses of NSAIDS as it may worsen gastritis or peptic ulcer disease.


Home Remedies

  • Maintain personal and food hygiene. Have safe drinking water to prevent gastroenteritis.
  • Have oral rehydration solution for diarrhea and dysentery.
  • Have rice water for abdominal pain with diarrhea.
  • Have small but frequent meal.
  • Take adequate rest and warm liquid diet if pain is caused by menstruation.
  • Avoid lifting of heavy objects.
  • Avoid alcohol, smoking and hot/spicy food because these may cause gastric irritation and bleeding in the presence of gastritis and gastric ulcer.


When to visit the Doctor

You should see a doctor immediately if you have any of the following:

  • Bloodin the stool (red blood or black colored stool)
  • Vomiting blood
  • A swollen abdomen or an abdomen that is tender to the touch
  • Severe persistent or rapidly worsening abdominal pain
  • Abdominal pain with fever
  • A recent abdominal injury
  • Abdominal pain during pregnancy

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