From the Guidelines
The most common etiologies of abdominal pain in adults include appendicitis, acute cholecystitis, small-bowel obstruction, pancreatitis, renal colic, perforated peptic ulcer, cancer, and diverticulitis. These conditions are responsible for a significant proportion of abdominal pain cases, with about one-third of patients presenting to the emergency department having appendicitis, and another third having one of these other documented pathologies 1.
Common Causes of Abdominal Pain
- Appendicitis: requires prompt medical attention and possibly surgery
- Acute cholecystitis: often needs surgical removal of the gallbladder if symptomatic
- Small-bowel obstruction: may require surgery to relieve the obstruction
- Pancreatitis: treatment involves supportive care and possibly intervention to address the underlying cause
- Renal colic: typically managed with pain control and hydration, with possible intervention for kidney stones
- Perforated peptic ulcer: requires prompt medical attention and possibly surgery
- Cancer: treatment depends on the type and stage of cancer, but abdominal pain is a significant symptom that warrants thorough evaluation
- Diverticulitis: may require antibiotics or surgery, depending on the severity of the condition It is essential to note that abdominal pain can be a symptom of many different conditions, and a thorough evaluation, including imaging studies like CT scans, is often necessary to determine the underlying cause 1. In some cases, the cause of abdominal pain may not be immediately apparent, and a significant proportion of patients may have no diagnosis established despite thorough evaluation 1.
Importance of Imaging
Imaging plays a crucial role in evaluating patients with abdominal pain, particularly when the cause is not immediately apparent. CT scans, in particular, can help identify a wide range of pathologies, including those that may require urgent medical or surgical attention 1. In patients with fever and abdominal pain, imaging is especially important, as it can help identify conditions that require prompt intervention, such as intra-abdominal infections or abscesses 1.
Clinical Considerations
When evaluating patients with abdominal pain, it is essential to consider the patient's overall clinical presentation, including any accompanying symptoms like fever, vomiting, or bloody stool. These symptoms can indicate a more serious condition that requires urgent attention 1. Additionally, certain patient populations, such as the elderly or those with compromised immune systems, may require more thorough evaluation and prompt intervention due to the increased risk of serious complications 1.
From the Research
Etiologies of Abdominal Pain in Adults
The most common etiologies of abdominal pain in adults can be categorized into several key areas, including:
- Functional gastrointestinal disorders, such as functional dyspepsia, irritable bowel syndrome (IBS), and functional abdominal pain syndrome 2
- Inflammatory bowel disease (IBD), including Crohn's disease and ulcerative colitis, which can cause significant abdominal pain 3
- Other gastrointestinal disorders, such as pancreatitis, which can also cause abdominal pain 4
Functional Gastrointestinal Disorders
Functional gastrointestinal disorders are estimated to affect approximately 1 in 4 people in the United States 2. These disorders are characterized by:
- Disordered gastrointestinal motility and sensation
- Peripheral factors, such as postinfectious inflammation and luminal irritants
- Central factors, such as stress and anxiety
- Comorbid conditions, such as fibromyalgia and depression
Inflammatory Bowel Disease
Inflammatory bowel disease (IBD) is a significant cause of abdominal pain in adults 3. Abdominal pain in IBD can be due to:
- Inflammation and damage to the gastrointestinal tract
- Complications, such as narrowing of the intestine or fistulae
- Extraintestinal manifestations, such as arthritis or skin lesions
Other Gastrointestinal Disorders
Other gastrointestinal disorders, such as pancreatitis, can also cause abdominal pain 4. The causes of abdominal pain in these disorders can be complex and multifactorial, involving:
- Nociceptive, neuropathic, and cancer-related pain
- Peripheral and central sensitization
- Autonomic nervous system involvement
Diagnosis and Treatment
Diagnosis and treatment of abdominal pain in adults depend on the underlying cause 2, 3, 4, 5, 6. A comprehensive approach to diagnosis and treatment may involve:
- Medical history and physical examination
- Laboratory tests and imaging studies
- Pharmacological and non-pharmacological therapies, such as cognitive behavioral therapy and lifestyle modifications
- Surgical or endoscopic procedures, if necessary