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Jun 05, 2006

Diagnosis: Intestinal pain

by SirGan

SteadyHealth.com - Health Topics Forum Index -> Gastrointestinal Disorders -> Intestinal Problems & Bowel Movements

Intestinal pain is one specific sensation of discomfort, distress, or agony in the abdominal region. It is generally associated with functional disorders, tissue injuries, or diseases. There are some rules about this pain and every patient should know something about it. When someone is complaining about intestinal pain, we should know that it is in fact- abdominal pain, because rarely person can tell exactly that the pain originating from intestine!
The fact is also that, although the intestinal or abdominal pain can arise from the tissues of the abdominal wall that surround the abdominal cavity, the term abdominal pain generally is used to describe pain originating from organs within the abdominal cavity. These organs include:
  • Organs related to digestion -the stomach, the end of the esophagus, the small and large intestines, the liver, the gallbladder, and the pancreas.
  • The abdominal aorta - a large blood vessel that runs straight down from the thorax into the inside of the abdomen.
  • The appendix - an organ in the lower right abdomen that no longer serves much function.
  • The kidneys - two bean shaped organs that lie deep within the abdominal cavity.
However, the pain may originate from somewhere else -- like your chest or pelvic region. You may also have a generalized infection affecting many parts of your body, like the flu or strep throat. What are the borders of abdomen? Well, the abdomen is an anatomical area that is bounded by the lower margin of the ribs above, the pelvic bone below, and the flanks on each side.

The term- “referred” pain

Patient should also know that, in some rare cases, pain felt in abdomen doesn’t have to be related to any organ in abdominal cavity! There is one theory that explains this: Abdominal pain has the unusual ability to travel along deep nerve pathways and emerge at sites away from the source of the problem. For example, the lower lungs, the kidneys, and the uterus or ovaries can project pain into the abdomen. This type of pain is called "referred" pain because it, although originating outside the abdomen, is being referred to in the abdominal area.
Some of the referred pain examples are:
  • Right shoulder can project into diaphragm, gall bladder, liver capsule…
  • Left shoulder can project into diaphragm, spleen, tail of pancreas, stomach, splenic flexure, pneumoperitoneum
  • Right scapula pain can project into gall bladder, biliary tree…
  • Left scapula projects into spleen, tail of pancreas…

Type of pain

If we look on the fact how long the pain lasts- then we should know that abdominal pain can be acute and sudden in onset or the pain can be chronic and longstanding.
By intense, abdominal pain may be minor and of no great significance, or it can reflect a major problem involving one of the organs in the abdomen. It can also be:
  • Visceral pain, related to the organs, which is often dull, crampy and aching
  • Parietal pain, related to the walls of the abdomen, which is often sharp, secure and persistent. The pain associated with inflammation of the abdominal pain is steady and aching, and worsened by changes in the tension of peritoneum caused by pressure or positional change. 
  • The pain associated with abdominal vascular disturbances (thrombosis or embolism) can be sudden or gradual in onset, and can be severe or mild. Pain associated with the rupture of an abdominal aortic aneurysm may radiate to the back, flank or genitals.
Problem is that the intensity of the pain does not always reflect the seriousness of the condition causing the pain. That’s why; every pain should be reported to health provider! The severity of the condition has more to do with the suddenness of the pain, especially if it is sharp and localized to one region, rather than spread throughout your abdomen.

Possible causes of pain

 
Non-abdominal causes:
 
  • Pneumonia (lung infection)
  • Myocardial infarction (heart attack)
  • Pleurisy (irritation of the lining around the lungs)
  • Pulmonary embolism (blood clots to the lungs)
Abdominal wall pain:
  • Shingles (herpes zoster infection)
  • Costochondritis (inflammation of the rib cartilages)
  • Injury (blunt trauma, muscle pulls)
  • Nerve irritation (neuropathy)
  • Hernias (protrusions of structures through the abdominal wall)
  • Scars
Inflammatory conditions of the upper abdomen:
  • Ulcer disease (duodenal ulcer, gastric ulcer)
  • Esophagitis (gastroesophageal reflux disease)
  • Gastritis (irritation of the lining of the stomach)
  • Pancreatitis (inflammation of the pancreas)
  • Cholecystitis (inflammation of the gall bladder)
  • Choledocholithiasis (passage of gall stones through the bile duct)
  • Hepatitis (infection or inflammation of the liver)
  • Colitis (infection or inflammation of the colon)
Functional problems of the abdomen:
  • Non-ulcer dyspepsia (discomfort after eating not due to ulcers)
  • Sphincter of Oddi dysfunction (problems with the bile duct valve)
  • Functional abdominal pain (pain without clear cause)
  • Irritable bowel syndrome (pain associated with bowel movements)
Cancers of the upper abdomen:
  • Hepatoma (liver cancer)
  • Cholangiocarcinoma (bile duct or gall bladder cancer)
  • Pancreatic cancer
  • Stomach cancer
  • Lymphoma (cancer of the immune cells)
Vascular problems:
  • Mesenteric vascular insufficiency (blocked arteries or veins)
  • Abdominal aortic aneurysm (swelling of the main artery in the belly)
Inflammatory conditions in the mid-and lower abdomen:
  • Enteritis (infections of the small bowel, Crohn’s disease)
  • Colitis (infection or inflammation of the colon)
  • Diverticulitis (inflammation of pouches that form in the colon)
  • Appendicitis
Bowel obstruction:
  • Adhesions (scars in the belly that form after surgery or inflammation)
  • Tumor
  • Inflammation
  • Colon Cancer
Urinary tract problems:
  • Kidney stones
  • Urinary tract infections (kidneys, bladder)
  • Tumors of the kidneys or bladder
Pelvic problems in women:
  • Ovarian cysts or cancer
  • Infection of the tubes (salpingitis)
  • Ectopic pregnancy
  • Fibroid tumors of the uterus (womb)
  • Malignant tumors of the uterus or cervix
  • Endometriosis
  • Adhesions (scars)
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Although, there are several possible causes of intestinal and abdominal pain, there are seven most common causes and they are:
1.    Intestinal illness
2.    Food poisoning
3.    Gas
4.    Upset stomach or heartburn
5.    Sore abdominal muscles
6.    Menstrual cramps
7.    Constipation

Localization of pain

  • Navel area
Pain that is localized near the bellybutton can be related to a small intestine disorder or an inflammation of appendix. This condition is called appendicitis. The appendix is a small, finger-like organ that projects out from colon on the lower right side of your abdomen. Problem is that if it gets obstructed, it may become inflamed and filled with pus.
  • Upper middle abdomen
The middle area of the abdomen is called the epigastric area! Pain in this region is, in most cases associated with stomach disorders. Persistent pain in this area may also signal a problem with duodenum, pancreas or gallbladder.
  • Upper left abdomen
Although, it's very uncommon to experience pain here, when it is present- it may suggest a colon, stomach, spleen or pancreas problem.
  • Upper right abdomen
Inflammation of the gallbladder often cause intense pain in the upper right abdomen. 
  • Lower middle abdomen
Pain below the navel may indicate that there is some underlying colon disorder. For women, pain in this area may also indicate a urinary tract infection or pelvic inflammatory disease.
  • Lower left abdomen
Pain here most often suggests a problem in the lower colon. There are several conditions that can hit this area such as inflammatory bowel disease or an infection in the colon known as diverticulitis.
  • Lower right abdomen
Inflammation of the colon may cause pain in your lower right abdomen. The pain of appendicitis may also spread to the lower right abdomen.

When the person should be concerned?

Patient should know that every pain is always abnormal condition, but no one should panic. Although some could indicate on some serious conditions- it may not be a medical emergency. Mild pain or chronic pain should be discussed with your doctor when it is convenient. Severe pain should be discussed with doctor. Some of the serious signs are
  • fever,
  • diarrhea,
  • persistent constipation,
  • blood in the stools,
  • persistent nausea or vomiting,
  • vomiting blood,
  • severe tenderness of the belly,
  • jaundice
  • swelling of the abdomen

Treatment of intestinal pain

  • Medications
The drugs used most commonly for this purpose are:
    • Antidepressant drugs, like Amitriptyline or Trazadone. These medications can be taken in very low doses that minimize side effects and have little or no antidepressant effects.
    • Anti-inflammatory medications - Sometimes these medications are used to reduce inflammation or affect the function of an organ, thereby relieving pain.
    • Analgesics - Occasionally, pain must be treated with drugs that reduce pain.

Tips for soothing pain

  • Intestinal illnesses, food poisoning or sore abdominal muscles –child should be warmed into hot bath and his tummy should be gently rub.
  • Gas pain – massage the tummy to try to move the gas bubbles along. A warm bath may also help.  
  • Upset stomach or heartburn – Antacids are usually used to relieve heartburn! A drink of milk can also sooth heartburn.
  • Menstrual cramps – The most common medication used for relieving menstrual cramps is Ibuprofen!
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    Article sources
    • www.askdrsears.com
    • www.nlm.nih.gov
    • www.mayoclinic.com