Abdominal Pain

Associated symptoms

• Fever and chills: inflammatory/infective diseases or infarction.
• Weight loss suggests malignancy, malabsorption, tuberculosis, IBD ischaemia.
• Nausea/vomiting indicates obstruction, infection, IBD or metabolic disease.
• Dysphagia or odynophagia suggests oesophageal disease
• Haematemesis indicates oesophageal, gastric and duodenal disease
• Jaundice is either due to haemolytic or hepatobiliary disorders.
• Diarrhoea : malabsorption or infection, IBD, secretory tumours (Zollinger- Ellison’s syndrome).
• Dysuria / haematuria suggests urinary diseases
• Vaginal/penile discharge indicates genitourinary disorders.
• Hematochezia indicates colorectal disease
• Skin/joint/eye involvement indicates inflammatory bowel disease.

Predisposing Factors

How to approach a patient with Abdominal painY

What is the site of pain? • How severe is it? • Is it continuous or intermittent? • Does it radiate to any site or direction? • What is duration of pain? • Are there any pain-free intervals, if yes, what is their duration? • Is pain related to meal? • Does it disturb sleep at night? • What are the aggravating factors? • What are relieving factors (e.g. food, vomiting or antacid)? Appetite • Is it increased or decreased? • If reduced, is appetite poor or the patient is afraid of taking food due to pain?  

Medical causes of abdominal pain

• Porphyrias: Acute Intermittent Porphyria.

• Lead Poisoning.

• Metabolic and Endocrine Diseases.

  • Diabetic precoma
  • Pheochromocytoma
  • Addison disease

• Familiar hyperlipidemia

• Inferior MI

• Polycythemia, congenital spherocytosis

• Sic;le cell disease

Working diagnosis