1.What are the possible causes of stomach pain (abdominal pain)?
Abdominal pain is a very common symptom of gastrointestinal diseases, and the causes are very complex and include roughly the following.
(i) Acute abdominal pain.
(1) Peritoneal inflammation: such as acute purulent peritonitis due to gastrointestinal perforation, cirrhosis of the liver complicated by spontaneous peritonitis, etc.
(2) Acute inflammation of abdominal organs: such as acute gastroenteritis, acute pancreatitis, acute cholecystitis, etc.
(3) Obstruction or dilatation of cavernous organs: such as intestinal obstruction, biliary tract stones, biliary ascariasis, urinary tract stones, etc.
(4) Visceral torsion or rupture: such as intestinal torsion, intestinal strangulation, mesenteric or greater omental torsion, ovarian torsion, hepatic and splenic rupture, ectopic pregnancy, etc.
(5) Intra-abdominal vascular obstruction: such as ischemic enteropathy, entrapped abdominal aortic aneurysm, etc.
(6) Abdominal involvement pain due to thoracic diseases: such as pneumonia, pulmonary infarction, angina pectoris, myocardial infarction, acute pericarditis, pleurisy, esophageal hiatal hernia, etc.
(7) Abdominal wall diseases: such as abdominal wall contusions, abscesses and abdominal wall herpes zoster.
(8) Abdominal pain caused by systemic diseases: such as abdominal allergic purpura, uremia, lead poisoning, hematoporphyria, etc.
(ii) Chronic abdominal pain.
(1) Chronic inflammation of intra-abdominal organs: such as reflux esophagitis, chronic gastritis, chronic cholecystitis and biliary tract infection, chronic pancreatitis, chronic ulcerative colitis, tuberculous peritonitis, Crohn’s disease, etc.
(2) Tension changes in the cavernous organs: such as gastrointestinal spasm, gastrointestinal or biliary tract motility disorders, etc.
(3) Gastric and duodenal ulcers.
(4) Torsion or obstruction of abdominal organs: such as chronic gastric and intestinal torsion.
(5) Stretching of organ envelope: such as liver stasis, liver abscess, liver cancer, etc.
(6) Poisoning or metabolic disorders: such as uremia, lead poisoning, etc.
(7) Tumor compression and infiltration: Malignant tumors are more common and are related to tumor compression and infiltration involving sensory nerves.
(8) Gastrointestinal nerve dysfunction: such as gastrointestinal neurosis.
According to statistics, acute abdominal pain in the elderly is most common in biliary tract diseases, followed by intestinal obstruction caused by various causes (which is also seen in intestinal tumors), hernia impaction, acute appendicitis, in addition to angina pectoris, myocardial infarction also often have acute abdominal pain, especially should be noted.
2.What are the common causes of abdominal pain in children?
Abdominal pain is one of the most common symptoms in pediatrics. The causes of abdominal pain are many and involve almost all diseases. It can be either an intra-abdominal organ lesion or an extra-abdominal lesion; it can be organic or functional; it can be a medical disorder or a surgical disorder, or even a medical disorder at first, but later the condition develops and the surgical condition predominates. In terms of treatment, some abdominal pains require urgent surgery, while others do not; some abdominal pains are initially treated conservatively and later require surgery. For those who need surgery urgently, if misdiagnosis or omission delays surgery, it can cause serious consequences and even endanger life; on the contrary, for those who do not need surgery, performing unnecessary surgery will not only increase the patient’s pain, but also aggravate the condition. Therefore, we should pay great attention to the diagnosis and differential diagnosis of abdominal pain in pediatric patients. The causes of abdominal pain in pediatric patients are generally as follows.
(a) Pediatric internal diseases.
(1) Intra-abdominal diseases: acute gastritis, gastroenteritis, gastric and duodenal ulcers, intestinal spasmodic colic, intestinal and biliary ascariasis, mesenteric lymphadenitis, acute necrotizing enterocolitis, viral hepatitis, congenital common bile duct cyst, various pancreatitis, various peritonitis, liver abscess, subdiaphragmatic abscess, urinary tract infection, bacterial dysentery, etc.
(2) Extra-abdominal diseases: respiratory diseases (upper respiratory tract infection, tonsillitis, lobar pneumonia, acute pleurisy), cardiovascular diseases (acute heart failure, pericarditis, myocarditis), allergic diseases (allergic violet scar, urticaria, asthma), neurological diseases (intercostal neuralgia, abdominal epilepsy), metabolic diseases (hypoglycemia, uremia, porphyria), infectious diseases (typhoid fever, epidemic encephalomyelitis) and sepsis, herpes zoster, lead poisoning, etc.
(b) Pediatric surgical diseases: acute appendicitis, gastric and duodenal ulcers combined with perforation, mechanical intestinal obstruction, intussusception, mesenteric artery embolism, acute intestinal torsion, ileal diverticulitis complicated by perforation, obstruction, primary or secondary peritonitis, inguinal hernia, urinary tract stones, hydronephrosis, hepatic rupture, splenic rupture, ovarian cyst torsion, testicular torsion, iliac fossa abscess, etc.
3.What are the clues to presume the cause of pediatric abdominal pain?
Due to the poor expressive ability of children, medical history statements are often incomplete or even absent. The causes of pediatric abdominal pain are complex, which requires the child’s parents to cooperate with the medical staff with the utmost patience to identify the cause as soon as possible and provide the right treatment. The following are listed as information that can be helpful to the doctor in making a diagnosis.
(1) Age: Abdominal pain in children of different ages varies in terms of their prevalent diseases. For example, intestinal cramps are mostly seen in young infants under 3 months of age, often due to improper feeding or excessive swallowing of air. Intussusception, incarcerated hernia, and intestinal infections are most common in children under 2 years of age, while acute appendicitis and intestinal parasitic diseases are relatively uncommon. Gastrointestinal infections, intestinal parasitosis, mesenteric lymphadenitis, biliary ascariasis, lobar pneumonia, abdominal epilepsy, and allergic purpura are more common in older children.
(2) The urgency of abdominal pain: the urgency of onset is often of great importance for differential diagnosis. Those with rapid onset or paroxysmal increase are often surgical diseases, such as acute appendicitis, strangulated intestinal obstruction, gastrointestinal perforation, intussusception and inguinal hernia impaction. However, it should be noted that sometimes the etiology of chronic abdominal pain and acute abdominal pain can be the same, because the nature of the disease changes at different stages, for example, ulcer disease is originally chronic abdominal pain, but when combined with perforation, it becomes acute abdominal disease. Therefore, for those who have chronic abdominal pain, if the abdominal pain turns into continuous or sudden severe pain, the possibility of acute abdominal disease should be noted.
(3) The nature of abdominal pain: abdominal pain can be paroxysmal pain, continuous pain or mild vague pain. Paroxysmal pain or colic with obstructive diseases, if the abdominal pain is relieved after local hi-press or heat application, it is often the spasm of stomach, intestines, bile ducts and other cavernous organs; persistent abdominal pain is more often seen in gastrointestinal perforation; persistent dull pain, intensifies when changing position and refuses to press, often due to inflammation of abdominal organs, peritoneal stretching, tumor and stimulation of peritoneal organs. Occult pain is mostly seen in peptic ulcers. Radicular pain is the pain of a localized lesion that spreads to other parts of the body through nerves or adjacent organs, such as lobar pneumonia causing ipsilateral epigastric pain. Abdominal pain with difficulty in defecation or urination may be due to blockage of fecal masses or urinary tract infection or stones. In conclusion, the pain of organic abdominal lesions is characterized by.
① persistent dull pain with paroxysmal intensification;
② localized pressure pain is obvious;
(iii) abdominal muscle tension;
(4) Abdominal pain is characterized by the following features
(4) Site of abdominal pain: generally the site of abdominal pain is consistent with the site of the lesion.
(5) Concomitant symptoms: the relationship between abdominal pain and fever should be noted.
(6) Past history: the child should be asked in detail whether there are similar abdominal pain episodes, stool discharge and skin purpura history, should know whether there is any trauma before the onset, dietary hygiene and what kind of food eaten, etc., all help the diagnosis of the cause of abdominal pain.
4.What tests are often done for pediatric abdominal pain?
Laboratory tests: routine examination of blood and urine and stool can sometimes provide information of diagnostic value, such as a gradual decrease in hemoglobin and red blood cells, which should alert the presence of internal bleeding. An elevated total white blood cell count is often indicative of inflammatory lesions. Observation of the nature of the stool can help in the diagnosis of intestinal infection and intussusception. The presence of more red blood cells or pus cells in the urine suggests a urinary tract infection. If necessary, blood and urine pancreatic amylase should be tested.
X-ray examination: chest X-ray can show lung, pleural and cardiac lesions. Abdominal fluoroscopy and radiography, if free gas under the diaphragm is found, it suggests gastrointestinal perforation; trapezoidal fluid plane in the intestine and more inflation in the intestinal cavity suggest intestinal obstruction. If intussusception is suspected, air enema can be performed to assist in diagnosis and repositioning treatment, but is contraindicated in suspected visceral perforation. Abdominal plain film or intravenous pyelogram may be taken for suspected urinary tract lesions.
B-mode ultrasound: abdominal B-mode ultrasound is performed when gallstone, liver abscess or subphrenic abscess is suspected.
5.What information should I tell the doctor when I go to see him/her because of stomach pain?
First of all, you should tell the doctor about the abdominal pain, including when the pain started, the degree and urgency of the pain, the location of the pain (maybe the whole stomach hurts, but point out the most painful place to the doctor, whether the pain changes over time, etc.), how the pain is (divided into dull pain and sharp pain, dull pain such as distension, vague pain, jumping pain, etc., sharp pain such as needle-like pain, burning pain, twisting pain, cutting pain, etc.), and whether the pain is constant or good for a while. Does it hurt all the time or does it get better after a while or does it hurt more sharply every once in a while, does it run to other places when it hurts (such as to the shoulders, back, thighs, etc.), does it have other conditions when it hurts (such as nausea and vomiting, diarrhea, blood in the stool, chest tightness, panic, coughing, not farting and defecating after it hurts, after overeating, after eating something unclean, fever first or fever after it hurts)? Next, tell the doctor if you have had any previous illnesses, including ulcer disease, liver disease, cholecystitis, pancreatitis, and a history of abdominal surgery and trauma. Women of childbearing age should also tell the doctor about their menstruation and whether they have any vaginal bleeding.
Tip: If the patient can describe the condition himself, he should try to describe it himself, because he himself knows best the development of the condition and some subjective feelings, anyone else describing it for him will cause the decay of information.
6.My stomach hurts like hell, but when I go to the hospital, the doctor asks this and that, checks this and that, but does not give me pain relief, is this doctor’s level too poor?
On the contrary, this is a sign that the doctor is responsible for you. You should know that abdominal pain reflects the severity of your condition, and changes in the degree and location of abdominal pain have important diagnostic value. If you do not find out where the problem of your abdominal pain is before you take the risk of stopping the pain, it is likely to cover up the changes in your condition and delay your diagnosis and treatment.
My wife went to see a general surgeon for her stomach pain, but the doctor told my wife to see an obstetrician and gynecologist after a while.
There are few women of childbearing age with acute abdominal pain caused by obstetrical and gynecological diseases, including ectopic pregnancy, ovarian cyst torsion, dysmenorrhea, pelvic inflammatory disease, etc. Therefore, it is normal for women of childbearing age to ask the obstetrics and gynecology department to rule out this department when they have acute abdominal pain, not to stall you.
Tips: Acute abdominal pain is an emergency, the patient’s family should remain calm and calm the patient when accompanying the patient to the doctor, do not shout and scream in the consultation room or ward, which on the one hand affects the patient’s mood, increases the patient’s anxiety and elevates the stress state in the patient’s body to a higher level, on the other hand interferes with the doctor’s consultation and treatment, disrupts the doctor’s clinical thinking and ultimately interferes with the accuracy and efficiency of the doctor’s consultation and treatment of the patient. So it is not good for the patient in any way. The correct approach is to calm the patient, encourage the patient to be strong, and cooperate with the doctor’s treatment requirements as much as possible, which is the real love of the patient’s help rather than helping.