Most of us in our lifetime might have felt abdominal pain due to various reason. Some abdominal pain are not much severe ,but some tends to produce serious illness which should be ruled out earlier stages.Abdominal pain might be acute or chronic based on the duration.
Pain in abdomen accounts for 5-10% of emergency department cases in hospitals.Appendicitis hold for the most of the abdomen pain.
COMMON CLINICAL SIGNS AND SYMPTOMS :
Persistent nausea and vomiting
Skin that appears yellow
Appropriate diagnostic testing varies based on the clinical situation. A complete blood count is appropriate if infection or blood loss is suspected.
In patients with epigastric pain, simultaneous amylase and lipase measurements are recommended because an elevated lipase level with a normal amylase level is not likely to be caused by pancreatitis.13 Liver chemistries are important in patients with right upper quadrant pain. A urinalysis should be obtained in patients with hematuria, dysuria, or flank pain. A urine pregnancy test should be performed in women of childbearing age who have abdominal pain to narrow the differential diagnosis and to determine whether certain imaging studies are appropriate. Testing for chlamydia and gonorrhea is recommended for women at risk of sexually transmitted infections.Level of Urea should also be assessed.
INVESTIGATIONS FOR ACUTE PAIN:
An chest xray might show air under the diaphragm which is suggestive of perforation and a plain abdominal flim might show evidence of obstruction or ileus(inability of the intestine to contract normally).An abdominal ultrasound may indicate the presence of gall stones or renal stones.Ultrasonography reveals free fluid and detection of any abdominal abscess.Diagnostic Laprotomy should be considered when no investigation is applicable.
INVESTIGATIONS FOR CHRONIC PAIN:
Endoscopy or Ultrasound: If suggestive of Gall bladder disease or epigastric pain.
Colonoscopy: Is indicated in patients with rectal bleeding, altered bowel habits and obstruction suggestive of celiac diseases.
CT and MR angiography: Should be considered when pain is provoked by food in a patient with wide spread atheroscelerosis since this may lead to mesenteric ischaemia.
In a young patients with pain relieved by defecetion, bloating and alternating bowel habit are likely to have irritable bowel syndrome.
Ultrasound, CT and Faecal elastic are required for patients with upper abdominal pain radiating to back. A history of alcohol misuse, weight loss and diarrohea suggest pancreatic cancer or chronic pancreatitis.
Recurrent attacks of pain in the loins radiating to the flank with urinary symptoms suggest of ureteric stones. It is investigated by abdominal X-ray, ultrasound and CT urography.
Repeated negative result or vague symptoms which don’t fit any disease or organ and history of psychiatric disturbances suggests psychological origin.
Stool DNA Test: A noninvasive laboratory test that identifies DNA changes in the cells of a stool sample. A stool DNA test looks for an shed cells from polyps cells or cancer cells.
Flexible Sigmoidoscopy: It is similar to colonoscopy except doesn’t examine entire colon. The doctor can only see less than half of the colon and the entire rectum.
Fecal Immunochemical test: This test is used to detect colorectal cancer to look for occult blood in the stool.
Urine culture: It is used to rule out UTI.
TREATMENT AND PROGNOSIS :
The general approach is to close perforations, treat inflammatory conditions with antibiotics or resection and relieve obstruction. The speed of intervention and necessity for surgery depends on the organ that is involved and number of other factors of which the presence or absence of peritonitis is the most important.
Acute Appendicitis and Acute cholecystitis: This should be treated by early surgery since there is risk for perforations and non operative treatment leads to recurrent attacks. The appendicitis can be removed by conventional right iliac fossa skin crease incision or by laproscopy.
Acute diverticulitis: Depending on the peritoneal contamination and the state of the patient,primary anastomis is preferable to a Hartmann procedure.
Bowel Obstruction: Surgical resection with primary anastomosis is preferred.
Role of analgesic: Analgesics plays an vital role in reducing the pain but it might occult the disease.Nowadys literarure says that opioids can be used judiciously in treating those diseases.
Role of Antibiotics: Should be used in infection or abscess and it should be capable of acting against both gram positive and gram negative micro organisms.
Role of antacids: They play vital role in controlling the peptic ulcers.
Pain relief – your pain may not go away fully with painkillers, but it should ease.
Fluids – you may have fluids given into a vein to correct fluid loss and rest your bowel.
Medicines – for example, you may be given something to stop you vomiting.
Fasting – your doctor may ask you not to eat or drink anything until the cause of your pain is known.
Place a hot water bottle or heated wheat bag on your abdomen.
Soak in a warm bath. Take care not to scald yourself.
Drink plenty of clear fluids such as water.
Reduce your intake of coffee, tea and alcohol as these can make the pain worse.
When you are allowed to eat again, start with clear liquids, then progress to bland foods such as crackers, rice, bananas or toast. Your doctor may advise you to avoid certain foods.
Get plenty of rest.
Try over-the-counter antacids, to help reduce some types of pain.
Take mild painkillers such as paracetamol. Please check the packet for the right dose. Avoid aspirin or anti-inflammatory drugs unless advised to take them by a doctor.
Recovery Period :
Depends upon them type of surgery or the severity of the disease the duration of the cure differs. A recovery from surgery usually takes one to two months or even just six weeks depending upon the indivduals health.
Medicines used in the Treatment :
Piperacillin and tazobactam,ceftriaxone can be used postoperatively for appendicitis.
Acetaaminophen can be used to relieve pain.
Aluminium hydroxide and Magnesium Hydroxide contains antacids and hence they prevents peptic ulcer.
Aztreonam and cefixime can be used against UTI infections.
DAVIDSON PRINCIPLE AND PRACTICE OF GENERAL MEDICINE-22nd edition