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Abdominal Pain and Gastric problems:
Diagnosis and Treatment

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1.Anatomy of the abdomen

The abdomen is the area that falls between your chest and pelvis that is commonly referred to as your belly. It consists of stomach, liver, small intestine, large intestine, gallbladder, spleen, kidneys, diaphragm, and pancreas among other organs. The front of the abdomen consists of a tissue layer known as fascia, and the back of the abdomen consists of spine and back muscles. Blood vessels are connected with the abdomen, mainly theinferior vena cava and aorta and its branches.

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2.What is abdominal pain?

What is abdominal pain?

Abdominal pain is also referred to as stomachache or stomach pain and can be of varying intensity. It occurs between the chest and the pelvis and it can be felt either as sharp localized pain or as dull intermittent pain depending on the causes. There are cases of pain abdomen radiating to other parts of the body like the shoulders, scrotal region and the back in particular cases.

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3.Causes of abdominal pain

Abdominal pain may be caused due to various reasons. The following are some of the common causes of abdominal pain:

  • Acid reflux causes heartburn and pain in the abdomen area. Acid reflux is when the contents of the stomach go back into the esophagus backwards.GERD stands for gastroesophageal reflux disease. GERD can cause chronic pain in the abdomen. It can sometimes lead to other complications like difficulty in swallowing food and other complications.
  • Appendicitis causes pain in the abdomen, and it is a condition where the appendix is inflamed. The appendix is found in the colon in the right side of lower abdominal region.
  • Abdominal pain can be caused by cholecystitis. In this condition, the gallbladder gets inflamed and causes severe stomach pain on the right side.
  • Constipation is one of the most common causes of abdominal pain. If your bowel movements are irregular and if you pass hard stools with straining to pass stools then constipation may be the cause of pain abdomen.
  • Crohn’s disease can cause pain in the abdomen. In this disease, the colon and the small intestine are usually affected because they get inflamed. This is usually associated with altered bowel habitis like loose stools or constipation.
  • Diarrhea causes lower abdominal pain and can be caused by an infection, reaction to a medicine, or due to food poisoning.
  • Flatulence can cause bloating and pain in the stomach. This pain due to gas is usually mild, but excessive flatulence may be disturbing.
  • Gallstones can cause abdominal pain and stomach ache. In this condition, gallstones form in the gallbladder due to an increased amount of cholesterol in the bile, among other reasons.
  • One of the causes of abdominal pain is gastritis. This is when the stomach is inflamed and is often accompanied by nausea. Alcohol, smoking, medications like pain killer and spicy food may result in gastritis.
  • Gastroenteritis is known as the stomach flu, and it is a condition that causes the intestines and the stomach to be inflamed. This can cause stomach upset and abdominal pain.
  • Hyperacidity causes excess acidity and gas, which in turn can cause pain in your abdomen area. Hyperacidity can be caused by medicines, stress, smoking, and eating junk food.
  • Irritable bowel syndrome, or IBS, is one of the leading causes of abdominal cramps and pain. Another name for it is an irritable colon. It causes chronic abdominal pain associated with either constipation or increased frequency of stools with features of weight loss or loss of appetite.
  • Renal calculi or kidney stones can cause pain in the abdomen, which can be quite severe. These can develop in your kidneys, bladder, ureters, or urethra.
  • Lactose intolerance is one of the causes of abdominal pain and stomach cramps. In this condition, your body is unable to digest lactose properly.
  • Organ rupture can cause severe abdominal pain initially localised to the site of rupture followed by diffuse spread of pain like appendicular rupture, gall bladder perforation or a perforated ulcer in the small intestine or stomach. Diffuse pain is due to peritonitis which is irritation and inflammation in the wall of abdomen and layer surrounding the abdominal organs.
  • Peptic ulcer causes abdominal pain, and in this, there are ulcers in the small intestine and the stomach. It is usually caused by bacterial infection called H.Pylori added with stress, smoking, medications like pain killers etc
  • Stress can cause you to experience abdominal pain. When you are worried about something or when you are in a stressful situation, then you can experience abdominal pain because of increased bowel contractions.
  • Stomach cancer causes above navel pain. It can cause cramps in the stomach, bloating, burning, recurrent vomiting, early satiety, reduced appetite, black coloured motions, blood in vomitings or reduced hemoglobin in blood with fatigue.
  • Vomiting can cause belly pain as tissues are irritated due to the backward flow of acid in the stomach.
  • Pancreatitis can cause severe abdominal pain associated with episodes of vomitings. It is caused due to irritation and inflammation to pancreas which is the site of production of digestive enzymes and insulin. The most common causes are alcohol and gall bladder stones. Pancreatitis can be life threatening and hence needs urgent medical care for management.
  • Intestinal obstruction can cause severe abdominal pain due to increased intestinal contractions in a obstructed bowel. It is associated with vomitings, distention of abdomen, inability to pass flatus. It may be caused due to hernias, twisting of bowel, previous surgeries, tumours or crohn's, tuberculosis and many other rare conditions. It may be life threatening if not recognised early and treated.

Apart from these causes, abdominal pain can be caused due to pulled muscles, food intolerances, celiac disease, hepatitis, cysts, organ cancer, or cardiac conditions.

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4.Types of abdominal pain

There are three types of abdominal pain that you can experience; cramp-like, localized, or colicky.

Localized abdominal pain is when only one area of the abdomen is aching. This type of abdominal pain is usually caused due to issues associated with a single organ. Examples of localized abdominal pain are stomach ulcers.

Colicky abdominal pain is when you have a sharp, severe spasmodic pain which cannot be localised to one place which is waxing and waning persisting for few minutes reducing and recurring again.. This type of abdominal pain can last long if left untreated. You can experience this due to kidney stones, intestinal obstruction etc

Cramp-like abdominal pain is when you experience pain similar to cramps. Sometimes this type of pain goes away without you doing anything. Women can experience this pain due to menstruation. Other causes of this type of pain include constipation, flatulence, or diarrhea, irritable bowel syndrome etc.

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5.Do you need to see a doctor?

Do you need to see a doctor?

Mild abdominal pain usually subsides without any treatment. But it is still a good idea to contact your doctor if you have abdominal pain which is recurrent and disturbing because it can indicate other health issues. You should see your doctor when you have any of the following problems in addition to abdominal pain.

  • You have a high fever.
  • You are unable to touch your abdomen because of severe pain.
  • You have a difficulty in breathing under normal conditions.
  • You start to cough up or vomit blood or pass black coloured stools
  • You notice a blood in stools
  • Your eyes and skin are becoming yellow.
  • You feel nauseous most of the time and feel like you want to throw up.
  • You notice bloating and distention of abdomen along with pain.
  • You are unable to sit comfortably because the pain is unbearable.
  • You experience continuous abdominal pain that lasts for more than 6 hours.
  • You feel constipated.
  • You start to lose weight, although you haven’t done anything out of the ordinary.
  • You feel uncomfortable while urinating due to a burning sensation.
  • You are pregnant, and you feel abdominal pain.

You should call emergency services when you are injured, and when you have severe unbearable abdominal pain. Additionally, if you experience pain or pressure in your chest along with abdominal pain, then you should contact emergency services.

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6.Diagnosis of abdominal pain: Essential tests

Diagnosis of abdominal pain

Your doctor will take a detailed history of the onset of pain, site of pain and the severity. He will inquire about the associated symptoms like vomiting, jaundice etc. Then he/she will perform a detailed clinical examination. He will press your abdomen to understand where you feel pain and to check for any swelling in the abdomen. With utmost gentleness he/she will try to localise the site of pain, type of pain and the likely reason of pain. With the help of a stethoscope, your doctor will listen so that he can understand what is going on with your abdomen and the problems that exists. This information enables your doctor to order particular tests needed for diagnosis and mangement of the current problem. The following are some of the tests that are used to diagnose abdominal pain after a physical examination.

Upper endoscopy is a test that enables your doctor to examine your esophagus, stomach and small part of small intestine. Upper endoscopy is also known as esophagogastroduodenoscopy or OGD. A thin and flexible tube, called an endoscope, is put into your mouth and gradually proceeded through the throat into the food pipe, stomach and the intestines. At the end of the tube is a camera that enables your doctor to view your stomach and small intestine thoroughly.

An abdominal ultrasound is another test that is used to create images of your abdomen area organs. It uses sound waves of high-frequency to create images on a screen that your doctor can then study to determine why you are having abdominal pain. It can easily detect issues that are affecting your organs in the abdomen. It is usually used as first method of screening for abdominal problems like gall stones, kidney stones, pancreatitis and other problems.

If your doctor feels that the cause of your abdominal pain is appendicitis, cholecystitis, pancreatitis or cancers, he may perform a computed tomography commonly known as CT scan. In this, detailed images of your abdomen are created with the help of a computer and X-rays. This helps your doctor see where the problem lies in your abdomen.

When your doctor thinks the cause of your abdominal pain is due to liver problems, he might get routine blood tests, USG abdomen. He may perform a biopsy if the routine tests are not conclusive. In this test, a piece of tissue is taken to diagnose organ problems due to which you are having abdominal pain. A biopsy can be used to diagnose cancer, as well.

Lower GI endoscopy is another test used to diagnose abdominal pain. It is also known as a colonoscopy. This test is used to determine problems in the colon and rectum, such as bleeding or cancer. In this procedure, an endoscope is inserted through the anus opening so that the colon and rectum can be thoroughly analyzed. The scope can be advanced into the last part of small intestines for evaluation of of problems in the last part of intestines.

MRI or Magnetic resonance imaging is a test that is used to check organs in the abdomen, such as the pancreas, Gall bladder and liver. In an MRI test, detailed images of the abdomen are created with the help of radio waves in a magnetic field. A scanner is used to produce abdomen images that help your doctor determine the root cause of your abdominal pain.

Your doctor can perform an abdominal X-ray to diagnose abdominal pain and gastric problems. In this test, your abdomen’s X-ray is taken. This enables your doctor to take a look at all the organs particularly intestines in the abdominal area. Issues such as perforation in your abdomen can be seen by your doctor when an X-ray is done.

ERCP or Endoscopic retrograde cholangiopancreatography is a test used to examine the liver, gallbladder, and pancreas. A special endoscope is used in ERCP, and it is used to examine your digestive system. This helps your doctor take a thorough look at the ducts of bile flow called as common bile duct and pancreatic duct along with ducts connecting the gall bladder and the ducts in liver. This procedure also helps in removing stones in the bile duct and pancreatic ducts and helps in relieving of any obstruction in ducts with or without placement of stent.

Barium Upper GI series is a test that can help diagnose abdominal pain caused due to ulcers, abnormal communication between organs, reflux, obstruction, changes due to disturbed absorption and other problems. You are required to swallow a solution of barium followed by multiple X ray images as barium solution flows through the esophaus, stomach and intestines.

One of the leading causes of abdominal pain is a gastric outlet obstruction or gastroparesis (slow emptying of food in stomach). If your doctor believes that your pain is linked to that, he might suggest gastric emptying study. In this test, your doctor tests the rate at which your food passes through your stomach. A scanner is used to view the movement of the food in this test.

pH testing can be used by your doctor to check your esophagus’s acid levels. A thin catheter is inserted through your nose, and the acid levels in the esophagus are monitored and examined by your doctor. Your doctor can diagnose problems such as GERD that causes abdominal pain with the help of pH testing.

Apart from the tests described above, your doctor might take urine, blood, or stool samples to check for infections that may be causing abdominal pain. Sometimes abdominal pain is caused due to viral infections, bacterial infections, or parasitic infections.

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7.Prevention of abdominal pain

Any type of abdominal pain is uncomfortable, but there are ways in which you can prevent it. The following are some easy ways to avoid abdominal pain from occurring.

  • You should start to exercise if you don’t do so already. You can start with walking and then progressively increase the intensity. You can speak to your doctor and create an exercise plan as per your lifestyle.
  • You should drink more water regularly so that you stay hydrated throughout the entire day. Insufficient water in your body can cause abdominal pain, which is why drinking an adequate amount of water every day is recommended to help prevent abdominal pain.
  • You should eat healthy meals. Include whole-grain foods, fruits, and vegetables in your diet. You can exercise more control over healthy eating by preparing meals at home whenever possible. Try to avoid fried foods and junk food as much as possible.
  • You should aim to eat smaller meals. If you are used to eating larger meals, start breaking them up so that you eat smaller meals throughout the day. This can help curb abdominal pain and gastric problems.
  • You should take your time when you are eating your meals. You should spend time chewing your food properly whenever you eat instead of gulping down food all at once. This decreases your chances of indigestion, which in turn reduces your chances of abdominal pain.
  • You should not lie down to rest as soon as you finish eating. Instead, you should wait for a minimum of one to two hours after you eat to lie down. When you lie down quickly after eating, you are likely to experience heartburn.
  • If you are suffering from any issue, you should follow your doctor’s advice. For example, if you have Crohn’s disease, your doctor will tell you about a particular diet plan that you should follow to prevent abdominal pain.
  • You can manage stress to ensure you don’t get abdominal pain. Many people experience abdominal pain when they are highly stressed. You should speak to your doctor about stress management and ensure you can manage your stress to avoid the pain.
  • You should ensure you stay away from getting infections as one of the causes of abdominal pain is stomach viruses. For this, you should ensure you regularly wash your hands, especially before you eat and when you are in public places.
  • You should avoid overeating. Some people get stomach related issues and abdominal pain when they start to eat way more than they should. Add fiber to your diet and ensure you are not over-eating. Overeating healthy food is not going to do you much good either.
  • Follow healthy lifestyle. Avoid excessive alcohol intake, quit smoking and avoid tobacco chewing. Reduce tea/coffe in a day to one or two small cups.

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8.Natural treatments and home remedies

Natural treatments and home remedies

You can try the following natural home remedies to find relief when you have abdominal pain or gas trouble.

  • You can use a heating pad to feel better. This helps with various types of abdominal pain, including cramps in the lower abdomen.
  • You can take one tablespoon of apple cider vinegar with a teaspoon of honey and mix it in a cup of water. This can help you feel better from abdominal pain.
  • If there are certain trigger foods, you should avoid those foods. For example, avoiding spicy foods has helped many people find relief.
  • Peppermint is a great idea for lower abdomen pain. You can make peppermint tea or chew the peppermint leaves.
  • You can drink plenty of water daily. This can help you feel better.
  • You can use ginger for relief from abdominal pain. You can take ginger supplements or cut it and make tea with ginger for pain relief in the stomach.
  • You can follow the BRAT diet, which stands for bananas, rice, applesauce, and toast. This diet can help ease pain symptoms.
  • You can start meditation, yoga, and exercising regularly - all of this helps to calm your mind and relieve pain.

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9.Abdominal pain FAQs: All your concerns addressed

Q.   Is it advisable to take over-the-counter pain relief medicines?

  1. While it may seem like a good idea, it isn’t. Often, it doesn’t take long for people to get pain relief medicines over-the-counter only to realize that their pain is getting worse. When you take medicines such as ibuprofen during abdominal pain, there is a chance that your stomach might feel increasingly irritated. This can worsen the pain and make it go from mild to severe in a short period. Avoid taking over-the-counter medicines and contact your doctor instead. He is best equipped to help you feel relief.

Q.   What are some of the treatments that are available for abdominal pain?

  1. There are many treatments available for abdomen pain. The treatment depends on the cause of the abdomen pain. For people with GERD, histamine blockers, PPIs are prescribed by doctors so that acid production is blocked, and you find get relief from the pain. Antacids can be given for heartburn or burning pain abdomen. Your doctor can prescribe antibiotics in the case of infection and severe stomach pain. People who experience pain due to constipation can be prescribed with laxatives. Motility agents are treatment options that are used for people with gastroparesis.
  1. In some cases, surgery might be required for effective treatment of abdominal pain. This is usually necessary when you are suffering from chronic problems such as appendicitis, aneurysms, or cholecystitis. There are two types of surgeries that your doctor can recommend. You can have open surgery or laparoscopic surgery, depending on the cause of your abdominal pain.

Q.   I am a woman and experience pain every now and then in the area of the reproductive organs. What can be the cause, and should I be worried?

  1. Any pain in your abdomen should not be ignored. Women may experience pain or heaviness in the lower abdomen due to many reasons. You may be experiencing pain because of ectopic pregnancy, miscarriage, menstruation, pelvic inflammatory disease, fibroids, or endometriosis. Since you can better describe the frequency and intensity of the pain in your lower abdomen, it is best if you consult your doctor so that he can diagnose the problem and treat you before further complications arise.

Q.   Is it necessary for me to consult my doctor when I have frequent pain, even if it is not severe?

  1. Yes, it is important. Although the abdominal pain might not seem severe in the beginning, it can become chronic if you don’t get yourself treated in time. Not all conditions show symptoms. So, if you are feeling discomfort, and even if it is a little bit, there is no harm in getting yourself checked by your doctor to ensure you are not suffering from a serious condition. Many conditions show zero symptoms until they reach the final stage. Therefore, you shouldn’t take any chances when it comes to your health and wellbeing. If anything in your body seems amiss, then consult your doctor instead of waiting.

Q.   Is there any way to tell what may be causing abdomen pain?

  1. While it is recommended that you consult your doctor, there are some ways to tell what may be the cause of abdominal pain. If you are having pain in no particular area, it may be caused because of urinary tract infection, Crohn’s disease, the flu, appendicitis, or irritable bowel syndrome. Pain in the lower abdomen can be caused by intestinal obstruction, appendicitis, irritable bowel syndrome, colitis, constipation, ectopic pregnancy. Upper abdominal pain may be caused due to gastritis, ulcer disease, pancreatitis, gallstones, or hepatitis and rarely heart attack and pneumonia.
  1. If you are experiencing pain in the centre of the abdomen, it may be due to an injury, appendicitis, uremia, or gastroenteritis. Lower abdomen pain in the left can be caused by an infection in the kidney, cancer, hernia. Left upper abdominal pain may be caused by cancer, enlarged spleen, heart attack, or kidney infection. Right lower abdomen pain is caused by flu, hernia, cancer, or appendicitis. If you have pain in upper abdomen’s right side, it may be due to pneumonia, hepatitis, cholecystitis, or an injury.
  2. Those mentioned above are just general guidelines. If you feel any pain in the abdomen region, it is highly recommended to contact your doctor. If you are having severe pain, it is best if you call emergency services right away without any delay.

Q.   How do you know when abdominal pain is serious?

  1. You should see your primary healthcare physician if there is mild pain in the abdomen lasting more than a couple of days, or if you have severe stomach pain along with other symptoms. Seek help immediately if you have the following symptoms.
  1. A sharp, sudden and severe abdominal pain
  2. Pain in the chest, neck or shoulder
  3. High fever
  4. Difficult breathing
  5. Stiff or hard abdomen
  6. Consistent nausea or vomiting
  7. Blood vomits
  8. Bloody diarrhoea
  9. Black or tarry stools

Q.   What does it mean when you push on your stomach and it hurts?

  1. If you feel pain when pressure is applied to an area of your abdomen, it might be due to abdominal tenderness. If you still feel the pain even after the pressure is removed, it is known as rebound tenderness or Blumberg sign.
  1. Abdominal tenderness is usually a sign of inflammation or other acute problems with one or more organs around the tender area. Tenderness could also result due to twisted or blocked organs. Some common causes of abdominal tenderness are –
  2. Appendicitis or swelling of the appendix
  3. Abdominal abscess caused by a burst intestine, appendix or ovary, inflammatory bowel disease, or infection
  4. Meckel’s diverticulum
  5. Diverticulitis or inflammation of the inner lining of the intestines
  6. In women specifically, the following can lead to abdominal tenderness –
  7. Inguinal hernia
  8. Twisted fallopian tube
  9. Ruptured ovarian cyst
  10. Ruptured ectopic pregnancy
  11. Pelvic inflammatory disease

Q.   What are the symptoms of gas pain?

  1. Pain due to gas may feel like knots inside the stomach or abdomen. Individuals also describe that they feel the gas moving through their intestines. You may also feel the pain up in your chest. Some of the common symptoms include –
  1. A pressure in the abdomen
  2. Bloating and distention
  3. Burping
  4. Flatulence
  5. Pain due to gas can last a few minutes to a few hours. It generally doesn’t need any treatment, but the pain has lasted for more than twenty-four hours, it could be the sign of some serious issue. In such a case, it is recommended to visit a doctor as soon as possible.

Q.   What does the pain of pancreatitis feel like?

  1. Acute pancreatitis may cause a pain that starts in the upper abdomen and last for a few days. You may feel severe or constant pain in the abdomen which could also reach to the back and other areas. The pain may be mild in the beginning but become more intense when food is eaten. Individuals with acute pancreatitis tend to look very sick.
  1. Some of the symptoms to watch out for are –
  2. Swollen and tender abdomen
  3. Fever
  4. Nausea
  5. Vomiting
  6. Rapid pulse
  7. Dehydration, low blood pressure, heart, lungs or kidney failure may also result in severe cases. Death may occur if there’s bleeding in the pancreas.

Q.   What are the treatment options for appendicitis?

  1. Appendicitis can be treated by surgically removing the appendix by a procedure called an appendectomy. It can be performed as an outpatient operation. To treat any remaining infection, antibiotics may be prescribed. Generally, an appendectomy can be of the following types.
  1. Open surgery: In open surgery, an incision is made in the lower right abdomen to operate on the appendix. This is performed when the appendix has burst and the area around it has to be treated for an infection.
  2. Laparoscopy: This procedure involves making a few small incisions on the body. The surgeon administers a tube called a cannula through one of the incisions to have a better look at the appendix. A laparoscope may be inserted through another incision to guide the surgeon and operate on the appendix. Laparoscopy procedures have lower risks than open surgery and also allow the patient to recover faster.

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