Causes of abdominal pain in adults
- Authors
- 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
- Professor of Medicine
- Icahn School of Medicine at Mount Sinai
- Sumit R Majumdar, MD, MPH
Sumit R Majumdar, MD, MPH
- Professor
- 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
- Deputy Editor
- Daniel J Sullivan, MD, MPH
Daniel J Sullivan, MD, MPH
- Deputy Editor — Primary Care (Adult)
- Assistant Professor of Medicine
- Harvard Medical School
INTRODUCTION
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 acute abdominal pain 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 [1]. 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 [2]. 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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To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:Literature review current through: Jun 2017. | This topic last updated: Feb 22, 2016.The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.References- Ray BS, Neill CL. Abdominal Visceral Sensation in Man. Ann Surg 1947; 126:709.
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Topic Outline- INTRODUCTION
- 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
- Women
- Postoperative patients
- Sickle cell
- HIV
- INFORMATION FOR PATIENTS
- SUMMARY
- REFERENCES
GRAPHICS
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