What is the primary reason for abdominal pain in dengue (Dengue Fever)?

Primary Causes of Abdominal Pain in Dengue Fever

Abdominal pain in dengue fever is primarily caused by plasma leakage leading to serosal inflammation, liver involvement, and direct viral effects on the gastrointestinal tract. 1, 2

Pathophysiological Mechanisms

• Abdominal pain is a recognized warning sign of dengue fever progression, particularly as patients transition from febrile to critical phase 2, 3
• Plasma leakage into the peritoneal cavity causes serosal inflammation and irritation, manifesting as abdominal pain 1, 4
• Hepatic involvement with inflammation and enlargement (hepatomegaly) contributes significantly to right upper quadrant pain 2, 5
• Gallbladder wall thickening due to plasma leakage serves as an early ultrasonographic marker of plasma leakage and can cause localized pain 4, 5

Clinical Significance

• Abdominal pain is classified as a critical warning sign in the WHO classification system, indicating potential progression to severe dengue 6, 3
• The pooled prevalence of abdominal pain in dengue patients is approximately 3.6% overall, with higher rates (5.3%) reported in studies from the United States, Australia, South Korea, and the Netherlands compared to China (2.7%) 7
• Abdominal pain may present as generalized discomfort or localized pain, particularly in the right upper quadrant due to liver involvement 7, 5

Associated Findings

• Abdominal pain often coincides with other warning signs including:
  • Persistent vomiting 2, 3
  • Clinical fluid accumulation (ascites, pleural effusion) 2, 4
  • Mucosal bleeding 2
  • Lethargy or restlessness 2
  • Rising hematocrit with concurrent thrombocytopenia 2, 4

Diagnostic Considerations

• Ultrasonography is valuable for detecting early signs of plasma leakage including:
  • Gallbladder wall thickening (positive likelihood ratio 2.14) 4
  • Free fluid in peritoneal cavity (ascites) 4, 5
  • Pleural effusion 5
• Laboratory findings that may accompany abdominal pain include:
  • Elevated liver enzymes (AST, ALT) 5
  • Abnormal coagulation parameters (PT, APTT) 5
  • Thrombocytopenia 2, 5

Clinical Pitfalls

• Abdominal pain may be misdiagnosed as acute surgical conditions, leading to unnecessary interventions 8
• Rare complications like rectus sheath hematoma can occur after severe retching and vomiting, mimicking acute abdominal conditions 8
• Failure to recognize abdominal pain as a warning sign may delay appropriate management of impending severe dengue 1, 2

Management Implications

• Presence of abdominal pain warrants close monitoring and consideration for hospitalization 1, 2
• Careful fluid management is essential, with adequate hydration to prevent progression to shock 1
• Acetaminophen is recommended for pain relief; NSAIDs and aspirin should be avoided due to increased bleeding risk 1
• Daily monitoring of complete blood count is essential to track disease progression 1, 6