Abdominal Pain - Is it serious?
By Craig W. Morrision, M.D.
Significance of pain is determined by two factors- characteristics and context. Severity does not always reflect seriousness. Severe intermittent pains may be associated with gas cramps or viral gastroenteritis. Appendicitis can be relatively painless until perforation.
Sources of abdominal pain can be visceral (intestinal or organs such as a gall bladder), parietal (membranes surrounding abdominal cavity), referred, neurogenic, or psychogenic. Visceral pain occurs due to stretching or spasm of a hollow tube of muscle (intestinal wall or Fallopian tube) or capsular membrane of a solid organ (liver or ovary). Parietal pain occurs with inflammation of membrane beneath muscles of the abdominal wall. Pains can be referred from different organs outside the abdominal cavity. Neurogenic pain can be due to the disease processes (diabetes and shingles, or primary back problems). Psychogenic pains can be a result of stress.
Locations and time patterns of abdominal pain are important. Pain in the upper abdomen, occurring with fasting, may be related to ulcers. Pain experienced shortly after eating may be related to the digestive process. Pain in a patient who has had previous surgery within the abdominal cavity may be related to scar tissue and bowel obstruction. Pain accompanying other symptoms (nausea, vomiting, diarrhea) is usually associated with the intestinal tract. Menstrual pain may suggest a problem with a reproduction organ. Mid-cycle pain may be due to a complication of ovulation.
If abdominal pain is severe, if there has been recent trauma, if pain persists for longer than 2-3 days, if there is pain during pregnancy, or if the abdominal wall is tender to the touch, there is need for medical evaluation in an urgent care setting. If the pain is associated with nausea, vomiting, fever, blotting, constipation, bleeding or a stiff board-like abdominal wall, then a potential may be indicated. For milder, self-limited pains in the abdomen, avoid eating solid foods and just take sips of water or clear fluids for the following 24-hours or until they become more definitive.