genitourinary (GU), musculoskeletal, or vascular disorder; drug use; or ingestion of toxins. At
times, such pain signals life-threatening complications.
Abdominal pain arises from the abdominopelvic viscera, the parietal peritoneum, or the capsules of the liver, kidney, or spleen. It may be acute or chronic and diffuse or localized. Visceral pain develops slowly into a deep, dull, aching pain that’s poorly localized in the epigastric, periumbilical, or lower midabdominal (hypogastric) region. In contrast, somatic (parietal, peritoneal) pain produces a sharp, more intense, and well-localized discomfort that rapidly follows the insult. Movement or coughing aggravates this pain.
Pain may also be referred to the abdomen from another site with the same or similar nerve
supply. This sharp, well-localized, referred pain is felt in skin or deeper tissues and may coexist
with skin hyperesthesia and muscle hyperalgesia.
Mechanisms that produce abdominal pain include stretching or tension of the gut wall, traction
on the peritoneum or mesentery, vigorous intestinal contraction, inflammation, ischemia, and sensory nerve irritation.
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| Abdominal Pain: Types and Locations |
History and Physical Examination
If the patient has no life-threatening signs or symptoms, take his history. Ask him if he has
had this type of pain before. Have him describe the pain—for example, is it dull, sharp, stabbing,
or burning? Ask if anything relieves the pain or makes it worse. Ask the patient if the pain is constant or intermittent and when the pain began. Constant, steady abdominal pain suggests organ perforation, ischemia, or inflammation or blood in the peritoneal cavity. Intermittent, cramping abdominal pain suggests the patient may have an obstruction of a hollow organ.
had this type of pain before. Have him describe the pain—for example, is it dull, sharp, stabbing,
or burning? Ask if anything relieves the pain or makes it worse. Ask the patient if the pain is constant or intermittent and when the pain began. Constant, steady abdominal pain suggests organ perforation, ischemia, or inflammation or blood in the peritoneal cavity. Intermittent, cramping abdominal pain suggests the patient may have an obstruction of a hollow organ.
If pain is intermittent, find out the duration of a typical episode. In addition, ask the patient
where the pain is located and if it radiates to other areas.Find out if movement, coughing, exertion, vomiting, eating, elimination, or walking worsens
or relieves the pain. The patient may report abdominal pain as indigestion or gas pain, so have him describe it in detail.Ask the patient about substance abuse and any history of vascular, GI, GU, or reproductive disorders. Ask the female patient the date of her last menses and if she has had changes in her menstrual pattern or dyspareunia.
Also ask about appetite changes and the onset and frequency of nausea or vomiting. Find out about increased flatulence, constipation, diarrhea, and changes in stool consistency. When was his last bowel movement? Ask about urinary frequency, urgency, or pain. Is the urine cloudy or pink?
Perform a physical examination. Take the patient’s vital signs, and assess skin turgor and mucous membranes. Inspect his abdomen for distention or visible peristaltic waves and, if indicated, measure his abdominal girth. Auscultate for bowel sounds and characterize their motility. Percuss all quadrants, noting the percussion sounds. Palpate the entire abdomen for masses, rigidity, and tenderness. Check for costovertebral angle (CVA) tenderness, abdominal tenderness with guarding, and rebound tenderness.
