Causes of abdominal pain in adults
- Robert M Penner, BSc, MD, FRCPC, MSc
Robert M Penner, BSc, MD, FRCPC, MSc
- Assistant Clinical Professor
- University of Alberta, Canada
- Mary B Fishman, MD
Mary B Fishman, MD
- Associate Professor of Medicine
- Icahn School of Medicine at Mount Sinai
- Sumit R Majumdar, MD, MPH
Sumit R Majumdar, MD, MPH
- University of Alberta Medical School, Canada
- Section Editors
- Andrew D Auerbach, MD, MPH
Andrew D Auerbach, MD, MPH
- Section Editor - Hospital Medicine
- Professor of Medicine
- University of California, San Francisco
- Mark D Aronson, MD
Mark D Aronson, MD
- Editor-in-Chief — Primary Care (Adult); Hospital Medicine
- Section Editor — General Medicine
- Professor of Medicine
- Harvard Medical School
The evaluation of abdominal pain requires an understanding of the possible mechanisms responsible for pain, a broad differential of common causes, and recognition of typical patterns and clinical presentations. This topic reviews the etiologies of abdominal pain in adults. The emergent and non-urgent evaluation of abdominal pain of adults discussed elsewhere. (See "Evaluation of the adult with abdominal pain in the emergency department" and "Evaluation of the adult with abdominal pain".)
Abdominal pain in pregnant and postpartum women and patients with HIV is discussed elsewhere. (See "Approach to abdominal pain and the acute abdomen in pregnant and postpartum women" and "Evaluation of abdominal pain in the HIV-infected patient".)
PATHOPHYSIOLOGY OF ABDOMINAL PAIN
●Neurologic basis for abdominal pain – Pain receptors in the abdomen respond to mechanical and chemical stimuli. Stretch is the principal mechanical stimulus involved in visceral nociception, although distention, contraction, traction, compression, and torsion are also perceived . Visceral receptors responsible for these sensations are located on serosal surfaces, within the mesentery, and within the walls of hollow viscera. Visceral mucosal receptors respond primarily to chemical stimuli, while other visceral nociceptors respond to chemical or mechanical stimuli.
The events responsible for the perception of abdominal pain are not completely understood, but depend upon the type of stimulus and the interpretation of visceral nociceptive inputs in the central nervous system (CNS). As an example, the gastric mucosa is insensitive to pressure or chemical stimuli. However, in the presence of inflammation, these same stimuli can cause pain . The threshold for perceiving pain may vary among individuals and in certain diseases. (See "Definition and pathogenesis of chronic pain", section on 'Pathogenesis of pain'.)
●Localization – The type and density of visceral afferent nerves makes the localization of visceral pain imprecise. However, a few general rules are useful:
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- PATHOPHYSIOLOGY OF ABDOMINAL PAIN
- UPPER ABDOMINAL PAIN SYNDROMES
- Right upper quadrant pain
- Epigastric pain
- Left upper quadrant pain
- LOWER ABDOMINAL PAIN SYNDROMES
- DIFFUSE ABDOMINAL PAIN SYNDROMES
- LESS COMMON CAUSES
- SPECIAL POPULATIONS
- Postoperative patients
- Sickle cell
- INFORMATION FOR PATIENTS