Chapter 014. Abdominal Pain (Part 1)

Harrisons Internal Medicine Chapter 14. Abdominal PainAbdominal Pain: IntroductionThe correct interpretation of acute abdominal pain is challenging. Since proper therapy may require urgent action, the unhurried approach suitable for the study of other conditions is sometimes denied. Few other clinical situations demand greater judgment, because the most catastrophic of events may be forecast by the subtlest of symptoms and signs. A meticulously executed, detailed history and physical examination are of great importance. The etiologic classification in Table 14-1, although not complete, forms a useful basis for the evaluation of patients with abdominal pain.Table 14-1 Some Important Causes of...
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Chapter 014. Abdominal Pain (Part 1) Chapter 014. Abdominal Pain (Part 1) Harrisons Internal Medicine > Chapter 14. Abdominal Pain Abdominal Pain: IntroductionThe correct interpretation of acuteabdominal pain is challenging. Since proper therapy may require urgent action, theunhurried approach suitable for the study of other conditions is sometimes denied.Few other clinical situations demand greater judgment, because the mostcatastrophic of events may be forecast by the subtlest of symptoms and signs. Ameticulously executed, detailed history and physical examination are of greatimportance. The etiologic classification in Table 14-1, although not complete,forms a useful basis for the evaluation of patients with abdominal pain. Table 14-1 Some Important Causes of Abdominal PainPain Originating in the AbdomenParietal peritoneal inflammationBacterial contaminationPerforated appendix or other perforated viscusPelvic inflammatory diseaseChemical irritationPerforated ulcerPancreatitisMittelschmerzMechanical obstruction of hollow visceraObstruction of the small or large intestineObstruction of the biliary treeObstruction of the ureterVascular disturbancesEmbolism or thrombosisVascular rupturePressure or torsional occlusionSickle cell anemiaAbdominal wallDistortion or traction of mesenteryTrauma or infection of musclesDistension of visceral surfaces, e.g. by hemorrhageHepatic or renal capsulesInflammation of a viscusAppendicitisTyphoid feverTyphlitisPain Referred from Extraabdominal SourceCardiothoracicAcute myocardial infarctionMyocarditis, endocarditis, pericarditisCongestive heart failurePneumoniaPulmonary embolusPleurodyniaPneumothoraxEmpyemaEsophageal disease, spasm, rupture, inflammationGenitaliaTorsion of the testisMetabolic CausesDiabetesUremiaHyperlipidemiaHyperparathyroidismAcute adrenal insufficiencyFamilial Mediterranean feverPorphyriaC1 esterase inhibitor deficiency (angioneurotic edema)Neurologic/Psychiatric CausesHerpes zosterTabes dorsalisCausalgiaRadiculitis from infection or arthritisSpinal cord or nerve root compressionFunctional disordersPsychiatric disordersToxic CausesLead poisoningInsect or animal envenomations Black widow spiders Snake bites Uncertain Mechanisms Narcotic withdrawal Heat stroke The diagnosis of acute or surgical abdomen is not an acceptable onebecause of its often misleading and erroneous connotation. The most obvious ofacute abdomens may not require operative intervention, and the mildest ofabdominal pains may herald an urgently correctable lesion. Any patient withabdominal pain of recent onset requires early and thorough evaluation andaccurate diagnosis.