Do not underestimate the stomach pain, it may be the result of disease
Tummy aches are a common occurrence in everyone's life, but today we are not talking about "tummy aches", but "tummy aches" caused by diseases, do not underestimate this situation, if the disease is not treated in time, there may be serious consequences.
What are the possible cases of stomach pain?
It can be caused by internal or external abdominal diseases or systemic or metabolic diseases: digestive, urinary, reproductive, respiratory, cardiovascular and other disorders.
From a therapeutic point of view, they are divided into two main categories.
Internal abdominal pain.
Often requires medication, is functional, and includes acute gastroenteritis, chronic gastritis, peptic ulcer, acute pancreatitis, etc.
Characteristics.
Mostly fever followed by abdominal pain; more abdominal pain without pressure pain; abdominal pain location is not fixed; abdominal pain can be reduced with position change; abdominal pain degree does not change significantly with time; abdominal pain does not change significantly with activity.
Surgical abdominal pain.
Mostly organic in nature and requiring aggressive surgical treatment of the disease.
Features.
Abdominal pain followed by fever; abdominal pain ina fixed location; often with pressure pain; abdominal pain does not change with position or ina forced position; abdominal pain gradually increases with time; abdominal pain is often aggravated by activity.
The possible causes of abdominal pain, the presence of life-threatening conditions, and the possible need for emergency surgery are usually determined based on the location and characteristics of the stomach pain.
In general.
The location of the first abdominal pain and the most obvious location of abdominal pain is often the location of the lesion, such as gastrointestinal perforation, cholecystitis, pancreatitis, etc.; and appendicitis is metastatic right lower abdominal pain.
Some abdominal pain is accompanied by radiating pain: for example, the pain can migrate to the ipsilateral abdomen due to the stimulation of the intercostal nerves by pleurisy or lobar pneumonia; cholecystitis can cause pain in the right upper abdomen/right back of the shoulder; kidney and ureteral stones, pain can radiate down the ureter; and orchitis can cause lower abdominal pain.
Etiology from the anatomical point of view.
_ | Upper abdomen often with cholecystitis, cholangitis, gastritis, gastroduodenal peptic ulcer (perforation), pancreatitis. |
| _ | Abdominal pain caused by the small intestine often around the umbilicus. |
| _ | Mesenteric lymphadenitis, appendicitis located in the right lower abdomen. |
| _ | Colonic lesions may be located in the right or left lateral abdomen or in the mid-upper abdomen |
| _ | Abdominal pain due to urinary stones often located in the lower back |
| _ | Ectopic pregnancy, ruptured corpus luteum, pelvic inflammatory disease, etc. Often present with abdominal pain in the lower pelvic abdomen |
Intestinal obstruction may present with total abdominal pain.
In addition, in addition to the consideration of abdominal organ diseases caused by abdominal cavity, attention should be paid to extra-abdominal lesions, such as.
1. Aortic coarctation.
Most often seen in hypertension, atherosclerosis and other hereditary diseases. Aortic intima fissures and exfoliation, forming aortic coarctation, causing pain in the upper abdomen; when the true lumen of the artery is compressed, causing ischemia of the heart and intestine or blood infiltration into the abdominal cavity, it can produce severe abdominal pain with nausea and vomiting, resembling acute abdomen and misdiagnosed.
2. Acute myocardial infarction.
The early stage may mainly present as acute severe epigastric pain with nausea, vomiting, abdominal muscle tension and abdominal pressure pain, and the abdominal pain symptoms are associated with stimulation of the vagus nerve, etc. In middle-aged and elderly patients, sudden onset of abdominal pain regardless of unexplained causes, electrocardiogram and myocardial enzymology should be improved to exclude acute myocardial infarction.
3. Diabetic ketoacidosis.
The abdominal pain varies in severity, spreading throughout the abdomen or limited to the epigastrium. In patients with combined diabetes mellitus, the possibility of diabetic ketoacidosis should be considered when unexplained abdominal pain occurs.
4. Testicular torsion.
Also known as spermatic cord torsion, it can cause left upper abdominal pain and requires early diagnosis and treatment.
5. Tetanus.
Abdominal pain is associated with tetanus spasmotoxin causing tense contractions and paroxysmal spasms of the abdominal muscles. (Note history of previous injury)
6. Abdominal epilepsy.
Seizure syndrome caused by abnormal excitation of the suboptic thalamus, often accompanied by varying degrees of symptoms of vegetative disorders, such as nausea, vomiting, abdominal pain is very easy to misdiagnose. The diagnosis of epilepsy was confirmed by EEG examination showing spike-wave and spike-slow wave in each lead, and the abdominal pain was no longer seized after the use of antiepileptic drugs.
7. Systemic lupus erythematosus.
Vasculitis and vascular embolism due to immune complex deposition, causing intestinal ischemia and hypoxia, coarse and short small intestinal villi, and infiltration of inflammatory cells in the submucosa leading to smooth muscle spasm in the gastrointestinal tract are related.
8. Allergic purpura.
The sudden onset of abdominal colic is the most common, and the patient tosses and turns unbearably. The pain is mostly around the umbilicus or lower abdomen and can be recurrent, accompanied by gastrointestinal symptoms such as nausea, vomiting, blood in the stool and vomiting blood, abdominal muscle tension and abdominal pressure, if there is no skin purpura, it is easily misdiagnosed as surgical emergency abdomen.
9. Guillain-Barre syndrome.
The first symptom may be severe abdominal pain with signs of peritoneal irritation. It is easily misdiagnosed as acute abdomen in the early stage and should be differentiated clinically. The cause of abdominal pain may be related to vegetative nerve dysfunction.
10. Rabies.
Rabies causing abdominal pain is thought to be the result of paroxysmal spasm of the sphincter of Oddi (Oddi) muscle caused by the action of rabies toxin.
11. Anti-infective drugs can cause associated abdominal pain.
Amoxicillin, Ribavirin, Metronidazole, Ciprofloxacin, Rifampin, Tinidazole, Penicillin, Cefradine, etc. It is often periumbilical or epigastric pain.
12. Crohn's disease, irritable bowel syndrome:
It is a clinically common functional gastrointestinal disorder characterized by abdominal pain and/or abdominal discomfort with changes in bowel habits and stool properties.
Acute abdominal pain is characterized by acute appendicitis, biliary tract disease, gastrointestinal perforation, intestinal obstruction, diverticulitis, pancreatitis, ureteral colic, and inflammatory bowel disease, in descending order of incidence.
The appearance of stomach pain should be promptly consulted, firstly to determine whether it is internal medicine or surgery, and secondly, to subdivide gastrointestinal surgery, hepatobiliary surgery, gastroenterology, gynecology, etc. If possible, associating factors related to abdominal pain as much as possible, going to the more definite department first, and then listening to the advice of the consulting doctor for early diagnosis and treatment.
Author | Peng Zheng, Beijing Shunyi District Hospital
Source: Beijing 114 Reservation