Disease Description (Causes and Symptoms)
- Definition: Abdominal pain is a symptom caused by abnormalities in many organs inside the abdominal cavity (the gastrointestinal tract, liver and biliary tract, pancreas, genitourinary organs, etc.), as well as blood vessels and nerves. It has a very wide range of possible causes.
- Main causes: Gallbladder diseases (gallstones, cholecystitis), gastrointestinal diseases (gastritis, gastric ulcer), duodenal diseases, pancreatitis (acute or chronic), appendicitis, enteritis, intestinal obstruction, intestinal adhesions, gastrointestinal tumors (gastric cancer, colorectal cancer, etc.), biliary obstruction (common bile duct stones), kidney and urinary tract stones, gynecological diseases (ectopic pregnancy, ovarian cysts or inflammation), vascular diseases (abdominal aortic aneurysm or aortic dissection), infectious diseases (food poisoning, enteritis), metastatic cancer, and others.
- Pathophysiology summary: Pain occurs due to inflammation, ischemia, distension, or irritation of an organ itself (e.g., increased pressure in the gallbladder), irritation of the mesentery (acute peritonitis), increased intestinal pressure caused by intestinal obstruction, or problems with nerve conduction.
- Symptom characteristics (clues by location)
- Right upper abdomen: Gallbladder or liver disease (may radiate to the right shoulder)
- Left upper abdomen: Stomach- or pancreas-related diseases
- Right lower abdomen: Appendicitis, colorectal diseases, gynecological diseases (in women)
- Entire abdomen (widespread pain): Acute peritonitis, intestinal obstruction, systemic infection
- Warning signs (possible emergency): Sudden onset of severe pain, persistent vomiting, high fever, abdominal distension, difficulty breathing, changes in consciousness, bloody stool or black stool, fainting, low blood pressure, and others.
Treatment Methods
- Basic principle: Treatment based on the cause is essential (after diagnosis, standard treatment appropriate to the cause is provided).
- Medical treatment
- Pain control: NSAIDs, acetaminophen; short-term opioids when necessary (as directed by a doctor).
- Fluids and electrolyte replacement: In cases of dehydration or vomiting.
- Antibiotics: Appropriate antibiotics are selected for infectious causes (peritonitis, cholecystitis, etc.).
- Endoscopic treatment: For biliary obstruction (endoscopic retrograde cholangiopancreatography (ERCP)), etc.
- Surgical/Procedural treatment
- Emergency surgery: For acute appendicitis, intestinal perforation, suspected necrosis due to intestinal obstruction, rupture of an abdominal aortic aneurysm, and others.
- Elective surgery: Cholecystectomy (for gallbladder stones or cholecystitis), tumor resection, and others.
- Vascular treatment: Stenting or surgery for aortic disease, and others.
- Lifestyle management and supportive care
- Dietary control: Restrictions according to the cause (e.g., limiting fat may help with gallstones or gallbladder disease).
- Abstaining from alcohol (to prevent pancreatitis) and maintaining regular bowel habits.
- Precautions
- If the cause is unknown or the pain is severe, visit an emergency medical institution without delay.
- Prolonged, unsupervised use of strong painkillers may delay diagnosis.
- Complications (risks if untreated)
- Peritonitis, sepsis, intestinal necrosis or perforation, bleeding, shock, chronic pain, and functional impairment.
Checklist Before an Outpatient Visit (Including Example Questions)
- Items to bring
- List of medications currently being taken (including prescription drugs, nonprescription drugs, and supplements)
- Previous medical certificates and test results (blood test results, imaging reports/films)
- Pain diary (time the pain began, duration, intensity, aggravating or relieving factors, accompanying symptoms)
- Recent meals, travel history, trauma, and menstrual cycle (for women)
- Items to record (useful when explaining symptoms during the consultation)
- Exact location of the pain (whether it moves), character (sharp, cramping, dull), and whether it radiates (to the shoulder, back, etc.)
- When the pain began and its course (acute/chronic), and medications being taken (such as anticoagulants)
- Accompanying symptoms such as fever, vomiting, changes in bowel movements (diarrhea/constipation/bloody stool), urinary abnormalities, and difficulty breathing
- Examples of questions to ask yourself before an outpatient visit
- Did the pain begin suddenly, or did it gradually worsen?
- Is there a relationship between eating and the pain? (Worsening or improving after meals)
- Have you had similar pain before? How was it treated?
Examples of General Questions to Ask the Doctor
- What is the most likely cause of this pain? What additional tests are needed?
- Is this an emergency requiring immediate treatment or hospitalization?
- What are the main side effects of the medication you plan to prescribe? Are there any drug interactions to be aware of while taking it?
- How likely is the pain to recur, and what lifestyle changes can reduce the risk of recurrence?
- When and in what order of priority will tests (CT, ultrasound, endoscopy, etc.) be performed?
Examples of Disease-Specific Questions
- In cases of right lower abdominal pain (suspected appendicitis)
- Does this condition require immediate surgery, or would observation and additional testing be appropriate?
- In cases of right upper abdominal pain (suspected gallbladder or biliary tract disease)
- If ultrasound or blood tests (liver function tests and biliary tract tests) do not establish the diagnosis, what test would you recommend next? What are the indications for cholecystectomy?