The abdominal pains are often the only sign for which the patient consults.

 

 

Topographical anatomy of the pain

It is necessary to know the anatomy of the abdomen. The abdomen is divided into quadrants, there are 9 of them: osseous, muscular and cutaneous marks are used.
The 9 quadrants :

  • The epigastric quadrant : thereare located the pains coming from the stomach, the duodenum and the pancreas.
  • The umbilical quadrant: pains coming from the small intestine.
  • The hypogastrium quadrant: the bladder, the genital organs.
  • The right hypochondrium quadrant: the liver, the gallblader.
  • The left hypochondrium quadrant: the spleen.
  • The right and left  side quadrant: colons and ureters.
  • The right iliac fossa : the appendix and the right ovary.
  • The left iliac fossa : the sigmoid colon and the left ovary.

Characterization of the abdominal pain

The beginning: progressive, sudden (if sudden pain: emergency).
The type: burning pain, torsion, gravity, embarrassment, cramp.
The intensity: weak or strong.
The location: topographical anatomy (for example: left side), diffuse or localized pain.
The irradiation: upwards, downwards, right side, left side, behind
The evolution: pain increases or decreases, by crisis, the rythm during the day, in the year.
The modification: pain worsened or decreased according to the position of the food

Localizations of the pains and their meanings

Epigastric pain

The ulcer

The pain is the only sign of the disease. The pain is rythmed: there are two variations, in the course of the day and the year (it should be noted that the gastro-duodenal ulcer is the most frequent). The standard pain is the late postprandial pain (3 to 4 hours later) it is also called “the painful hunger”, because it is a pain which is calmed by the food in the year the painful crises are in spring and the autumn.

Cancer

The pain hasn’t a rhythm, it is non regular.

Gastritis

The pain is of burning type, increased by the intake  of acid food or drugs.

The backward flow gastro-œsophagien

The pain is high (behind the xyphoid). The standart pain is a burning pain with an irradiation ascending and behindthe sternum it is called: pyrosis. Pyrosis is postprandial, postural (the pain increases when the patient is leaning ahead), a night pain.

The pancreatitis:

The characteristic pain is the celiac plexus syndrome (painful syndrome by irritation of the celiac plexus), of strong intensity, the irradiation is penetrating from the back. The pain is early postprandial, it is calmed by the position leaning ahead and the intake of acetylsalicylic acid.

Pain of the right hypochondriac

The biliary colic crisis

The crisis is caused by a biliary lithiasis (= a small stone is blocked temporarily in the cystic channel, starting the crisis) pain with posterior ascending irradiation, also called suspenders pain (the patient mimes the path of suspenders to describe the pain)
The intensity of the pain is very strong: cut the breathing. It is a very late postprandial pain (often night pain), calmed by the position folded into two on the right-sided. It is also an atypical pain when it is localized in the epigastric quadrant or the thorax, it perhaps weak, or to present only one irradiation.

The liver:

The hepatic pain can be caused by:

  • a cardiac liver.
  • an abscess of the liver.
  • a tumor
  • of the steatosis, cirrhosis the hepatic pains are much rarer in other quadrantls

Pain of the left hypochondriac

Pains in the case of spleen diseases:

  • Leukemia
  • Parasitic splenomegaly
  • Splenomegaly caused by portal hypertension, it can be caused by a cirrhosis of the liver

Left side, right side, left and right iliac fossa

  • Pains in urinary pathologies
  • Pains in pathologies of the colon
  • Colitis (the term of colitis is also employed in the direction of functional colopathies and not inevitably in term of inflammatory phenomena).
  • Pain induce by tumors of the colon, at the level of the right iliac fossa (but rare).

The hypogastric quadrant

Pains of the genitals (pains present also in the right or left iliac fossa or both), chronic pains in connection with the menstruation.
Acute pains
The nonspecific abdominal pain
It accounts for 50% of the abdominal pains, it perhaps strong, diffuses, localized, it is a functional digestive disorder often being psychomotor.
An Appendicitis
20% of the pains, pain of the characteristic iliac fossa.
A cholécystite
Induce a pain in the right hypochondriac quadrant.
A sigmoidite
Induce a pain in the left iliac fossa.
Occlusion and peritonitis
Diffuse pains. They are serious urgencies
With these acute pains are often associated digestive signs: vomiting, diarrheas,… A deterioration of the general state, fever

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