If You Think About Rarer Diseases At The Outset, Chances Of Making A Correct Diagnosis Is Also Rare.
By Dr. Sudip Chakraborty
Unlike chest pain, abdominal pain often doesn’t receive the seriousness it deserves & diagnosis is quite often delayed. With a wide range of causes, right from benign conditions like indigestion to extremely dangerous diseases like pancreatitis and cancer, abdominal pain always is a tough nut to crack. This list is by no means complete because of word limit. Gynaecological causes will be addressed by respective specialist.
1) Always watch out for associated danger signs like unnatural blood loss from any orifice, passing black pasty stool, significant unintentional loss of more than 10% body weight in less than 6 months, difficulty in swallowing solid foods, nocturnal pain awakening the person from sleep, progressive swelling\lump in abdomen etc.
2) On the contrary vague pain of long duration without much loss of weight or change in appetite, pain reducing after passing motion, associated stress or having a personality of anxiousness or an obsession that daily complete evacuation of bowel is a must for good health doesn’t usually has anything serious causative factor.
3) Pain just below lower right rib margin, increasing on deep breathing, often radiating to back and associated with fullness and early loss of appetite, may be due to gall bladder stones.
4) Sharp pain in and around umbilicus with nausea and vomiting, partially relieving on leaning forward position could be due to pancreatitis. Common in alcoholics and in patients with gall stones.
5) Gastric pain is very commonly heard but honestly it is nonspecific and I always try to know what exactly one means by that. Many a lives has been lost by attributing symptoms to gas. Right from gall bladder & pancreatic stones to stomach cancer, patients can have symptoms similar to GAS. Explaining associated symptoms especially in high risk groups like smoker, alcoholics, elderly patient and having family history of above diseases, should be carefully looked for.
6) Pain due to hollow organ pathology like bowel and ureter (tube connecting kidneys to urinary bladder) is usually colicky which means it comes and goes in waves. So colicky pain in either side of back or front of abdomen associated with urinary problems like blood in urine, difficulty\increased frequency or blockage of urine is usually suggestive of genito urinary disease, commonly kidney stone here in Islands.
7) Similarly colicky pain associated with vomiting (bilious or feculent) progressively increasing abdominal fullness, not passing stool or wind, could be due to intestinal obstruction. Patient having pain over lower right side of abdomen with localized rigidity along with vomiting & fever can have appendicitis.
8) Pain of gastric\duodenal ulcer is usually around umbilicus or above, related with meals either aggravating or relieving it, often waking him at night, may be associated with vomiting often self induced to relieve the pain temporarily.
9) Pain along with yellowish urine and eyes, generalized itching, nausea, swelling of legs and abdominal distension, reddish spots in body, altered sleep pattern, easy briusablity suggests liver as the culprit organ.
10) Rarer causes are actually not that rare unless we specifically look for, of course after one has exhausted the common causes first. Like abdominal migraine( instead of headache, patient having abdominal pain) and Celiac disease which is due to allergy to wheat and its products, presenting as recurrent loose motions, loss of weight, frequent oral ulcer, feeling of indigestion etc. Never thought I could see above patients here but have more than 20 such documented patients now.