Internal Medicine

Central abdominal pain

introduction

Abdominal pain is a very common symptom that most of the people are familiar with. Especially in small children, up to around the age of three, almost all diseases manifest themselves with abdominal pain, regardless of whether they have to do with the stomach or not. In older children, teens, and adults, abdominal pain is a fairly non-specific symptom. There are also causes of abdominal pain that actually have nothing to do with the stomach itself.

Classification of abdominal pain

For the classification of abdominal pain it is important to know where exactly the abdominal pain is and whether it radiates into another region of the body. Abdominal pain can affect the whole abdomen or only parts of the abdomen or, for example, radiate into the leg or shoulder. The doctor needs to know when and under what circumstances the pain started. Further information is provided by the course of the pain - is the abdominal pain permanent or only in phases? The strength and character (dull, pressing, stabbing, ...) give the doctor further important information, as well as other symptoms that occurred together with the abdominal pain (fever, nausea, vomiting, diarrhea, weight loss, ...)
Read more on the topic Abdominal pain and nausea and abdominal pain and diarrhea.

The worst form of abdominal pain is what is known as an "acute abdomen". This is a sudden onset illness that causes severe abdominal pain and gets worse very quickly.
The causes of the acute abdomen are diverse and often life-threatening, which is why rapid diagnosis and therapy are absolutely necessary. In any case, possible diagnostic methods include a detailed medical history and physical examination. Depending on the suspicion, the cause can be found through a blood sample, an ultrasound examination, an X-ray examination and various other imaging tests as well as an EKG. In many cases, however, no cause can be found in the acute abdomen, which is why an emergency operation is then carried out to look for the reason for the severe abdominal pain.

For more information, see Acute abdomen.

causes

Abdominal pain is a symptom that can appear in many different diseases. In adults, the cause of abdominal pain is usually to be found in the abdomen as well; the various diseases are discussed in more detail below depending on their location. Nevertheless, there are many other diseases whose cause lies outside the abdominal cavity.

Causes that affect the heart can be a heart attack, angina (tight chest), or inflammation of the pericardium. Vascular diseases are also possible causes: aneurysms (enlargements) of the main artery or vascular inflammation are possible.
Various metabolic diseases as well as diseases of the musculoskeletal system can lead to abdominal pain, including diabetes, the Addison's crisis and vertebral body invasions.
Abdominal pain is often caused by the urinary system: kidney and ureter stones, kidney or bladder infections are common causes of abdominal pain.
In women, an extrauterine pregnancy, endometriosis, ovarian cysts or inflammation of the ovaries and fallopian tubes are not uncommon causes of abdominal pain, which are then more likely to be localized in the lower abdomen.
Other causes of abdominal pain can be the lungs or various blood disorders.

Read more on the subject below Causes of Upper Abdominal Pain.

Accompanying complaints

Depending on the underlying cause, various symptoms can accompany the central abdominal pain:

Nausea and vomiting (see abdominal pain and nausea)
Constipation (see abdominal pain and constipation)
Diarrhea (see abdominal pain and diarrhea)
Flatulence (see abdominal pain and flatulence)
Heartburn (see symptoms of heartburn)
Pain when urinating and more frequent urination
Fever and chills (see abdominal pain and fever)
Chest tightness
Blood in stool or urine

Central abdominal pain and nausea

Nausea and vomiting are very common with central abdominal pain. The possible spectrum of diseases ranges from inflammation of the gastric mucosa or the pancreas to gallstones and food intolerance. In most cases, the nausea is initially significantly increased after eating. In order to be able to differentiate between these diseases diagnostically, an ultrasound is often performed in addition to a blood test. Inflammation, masses or gallstones can be shown very well here. A gastroscopy can also be helpful in some cases.

For more information, see Causes of Vomiting.

Central abdominal pain and flatulence

The combination of flatulence and abdominal pain is not uncommon. Often it is also accompanied by diarrhea or constipation. The strong gas development is due to intestinal bacteria in the large intestine. In addition to foods rich in fiber, digestive disorders lead to flatulence. These include stress-related irritable bowel syndrome, but also more severe diseases such as cirrhosis of the liver, chronic pancreatitis or Crohn's disease. But here too, intolerances should be considered. Almost all patients with lactose intolerance report suffering from abdominal pain, severe gas and nausea after consuming dairy products. The prolonged use of antibiotics can also lead to bloating, as this changes the bacterial intestinal flora and gas-forming bacteria can gain the upper hand.

For more information, see Causes of Flatulence.

Central abdominal pain and back pain

If back and abdominal pain occur at the same time and are new, this information can be decisive for further diagnosis. The diseases that come into question here also largely depend on the course of the pain. If the pain begins slowly and develops over several days, an inflammation of the pancreas can be the cause. The localization of pain is often given here as a belt and extends from the central upper abdomen to the back.
But an ascending urinary bladder inflammation can also lead to this combination. In this context, “ascending” means that the inflammation spreads from the urinary bladder to the ureter. Since the latter runs directly on the back muscles, irritation can take place here, which is perceived as back pain. An acute onset of pain, on the other hand, can indicate, for example, a kidney stone, a vertebral body fracture or an aortic aneurysm. A medical consultation is always recommended, especially if the back pain has recurred.

Read more on the subject below Causes of back pain.

Central abdominal pain after eating

Quite a few patients with central abdominal pain report that the pain mainly occurs after eating. This information alone helps to narrow down the range of possible diagnoses. The connection between eating and pain is very often seen in patients with inflammation of the stomach lining (gastritis).The pain is usually associated with loss of appetite and severe nausea. Inflammation of the pancreas or the biliary tract and gall bladder can also lead to severe pain after ingestion. This relationship is based on the fact that the digestive sects of these organs are increasingly excreted in the intestine after the ingestion of food, which leads to renewed irritation of the inflammation. Furthermore, in the case of eating-associated pain, intolerance must also be considered. Above all, this includes intolerance to lactose or gluten.

You can also find detailed information under Abdominal pain after eating.

diagnosis

A medical diagnosis should always begin with a detailed medical history and a physical examination. In many cases, doctors can already make a suspected diagnosis by providing information on the exact location, the quality of the pain, the course of the symptoms and other factors. Depending on the suspected diagnosis, further diagnostics can now be used to confirm this or to determine its severity. In addition to laboratory blood tests, ultrasound (sonography) is often used for abdominal pain. With these methods, most of the abdominal organs can be represented well, depending on the patient, without exposing the patient to radiation. In some cases, cross-sectional imaging, such as a CT or MRI, is necessary.

For more information, see Ultrasound of the bulge.

therapy

Treatment for abdominal pain can vary significantly depending on the underlying cause. The treatment of a simple gastrointestinal flu usually consists of symptomatic therapy with painkillers, medication for nausea and vomiting, and adequate fluid intake. If certain clinical pictures such as gastric mucosal inflammation, chronic inflammatory bowel disease or gallbladder inflammation are responsible for the symptoms, there are very specific therapies in each case, ranging from the administration of medication to surgery. The exact therapy methods can be found in the respective main articles (see cross links),
If you have bulging pain, you should generally choose a diet that is as gentle as possible. Extremely rich, fatty or spicy foods should be avoided. Mild soups are usually well tolerated and should contain sufficient salts in the event of diarrhea or vomiting. The local application of heat (heat pad) can also improve the symptoms.

Home remedies for central abdominal pain

There are numerous different home remedies that promise relief from pain when used. First of all, different tea infusions should be mentioned. In particular, peppermint, chamomile, caraway, fennel, aniseed or ginger tea are often used here. Here, care should be taken to allow sufficient steeping time so that all ingredients in the tea are dissolved and can develop their effect. In addition, depending on the underlying cause, heat can lead to a significant reduction in pain. We recommend either a hot water bottle or a cherry stone pillow that can be heated in the microwave. Warm and moist compresses are also said to have an effect, especially for cramping abdominal pain. A kitchen towel is dipped into a bowl of hot vinegar water, 1 tablespoon vinegar in 1 liter of water, and wringed out. Then you can lay it on your stomach, cover it with a dry cloth and let it work for 15 minutes.

Read more on the subject below Home remedies for stomach ache.

Homeopathy for central abdominal pain

Different homeopathic remedies are recommended depending on the quality of the pain felt and the accompanying symptoms. In the case of colic and cramp-like pain, remedies such as Colocynthis, Staphisagria or Nux vomica are used. In the case of burning abdominal pain, however, it is advisable to use Arsenicum album and Phosphorus. However, there are numerous other remedies that can be used for central abdominal pain: Bryonia, Lycopodium or Argentum nitricum. Basically, however, if the symptoms are very pronounced, it is always advisable to see a doctor in order to identify possible serious illnesses, prevent complications and ensure adequate therapy, for example with antibiotics.

Read about this too Homeopathy for gastrointestinal diseases.

Duration

Due to the multitude of different causes of central abdominal pain, it is difficult to give a generally valid duration of illness. While the pain caused by a kidney stone disappears after a few hours after treatment or spontaneous stone loss, it can drag on for several days to a few weeks in the case of inflammation of the pancreas or gastrointestinal flu. In the presence of endometriosis, on the other hand, without adequate therapy, the pain will recur over the course of the menstrual cycle and represent a long-term burden for the patient.

Abdominal pain after precise localization

Abdominal pain in the upper abdomen

In the upper abdomen are the lower parts of the esophagus, the stomach and the upper parts of the small intestine, as well as the large intestine and the pancreas. On the right side are the liver and biliary tract, on the left side the spleen. These organs can be the cause of upper abdominal pain. Other possible causes of upper abdominal pain are a heart attack or an aortic aneurysm.

The most common cause of abdominal pain is functional bowel discomfort called dyspepsia in around 50% of cases. Symptoms of dyspepsia usually appear after eating and are manifested in abdominal pain in the upper abdomen, malaise and a feeling of fullness. There are no organic causes of dyspepsia.
Esophagus: In reflux disease, acidic stomach contents flow back into the esophagus, resulting in heartburn, acid regurgitation and pain in the middle upper abdomen. Inflammation and tumors of the lower esophagus can also cause pain in the middle upper abdomen. (see reflux disease)
Stomach and small intestine: Inflammation of the lining of the stomach causes aching pain in the middle and left upper abdomen, which is accompanied by loss of appetite, nausea and vomiting. Ulcer pain is found in the left upper abdomen and usually gets worse after eating. A mucosal ulcer in the small intestine is more likely to cause pain in the right upper abdomen and get better after eating. Ulcers in the stomach and small intestine can occur perforate (break through). The associated perforation pain begins suddenly and violently, after which the patients experience a phase of pain relief before the pain increases again. Tumors of the stomach can trigger a feeling of pressure in the upper abdomen, tumors of the small intestine can trigger pain. (see gastric mucosal inflammation and gastric ulcer)
Pancreas: In many cases, inflammation of the pancreas begins suddenly with severe pain in the upper abdomen, which radiates in all directions and extends around the body in a belt-like manner. Other pancreatic disorders produce similar symptoms. A pancreatic tumor is more likely to cause pain radiating to the back than stomach pain. (see pancreatitis)
Gallbladder: Inflammation of the gallbladder, often caused by a gallstone, can also cause abdominal pain under the rib. Some patients continue to report that the pain radiates into the right arm. (see gallbladder inflammation)
Bowel: In the case of bowel obstruction (ileus), bowel movements come to a standstill, either through mechanical obstruction or through paralysis of the bowel loops. A bowel obstruction has many causes and is an absolute emergency! The intestinal obstruction can be painful, but it can also be painless. If left untreated, peritonitis develops and the abdomen becomes hard as a board without any action on the part of the patient, which is a clear sign for the doctor to recognize the intestinal obstruction. (see intestinal lock)
Other causes: Central pain in the upper abdomen can be triggered by a heart attack, which can radiate into the left arm. Other causes that come from the chest are:
- Pulmonary embolism,
- Lung infection,
- Pleurisy,
- Pneumothorax,
- Inflammation of the kidney pelvis

Read more on the topic Upper abdominal pain.

Abdominal pain in the lower abdomen

in the Lower abdomen are the lower ones Shares of Small intestine and des Colon. You can also find the bladder and the ureter. Additionally for women uterus, Ovaries and Fallopian tubes.

Large intestine: The two most common inflammatory diseases of the colon are Crohn's disease and Ulcerative colitis. In most cases, Crohn's disease affects the transition from the small to the large intestine and thereby resolves colicky pain in the right lower abdomen; diarrhea and flatulence may also occur. In ulcerative colitis, which mainly affects the rectum and the lower sections of the large intestine, the cramping pain especially in the left lower abdomen, in addition, patients have bloody slimy diarrhea.
A Diverticulitis is an inflammation of protuberances in the large intestinal wall, these protuberances are favored by a diet low in fiber. In 95% of cases the diverticulitis takes place in the left lower abdomen (Sigmoid diverticulitis) and causes intermittent pain. The remaining cases cause pain in the middle or lower right abdomen.
appendicitis: It is colloquially called appendicitis and is played in right lower abdomen from. In the beginning it causes diffuse pain around the navel, which then migrate downwards.
bladder and ureter: A bladder infection causes cramp-like pain in the middle lower abdomenwho have favourited patients complain about Burning sensation when urinating, The urine test often shows inflammatory cells and red blood cells. Ureteral stones trigger colic-like pain on the affected side, which can radiate into the lower abdomen and groin. Accompanying nausea, vomiting, and fever are common.
Inguinal hernia: An inguinal hernia resolves drawing pains in the lower abdomen that can radiate into the thigh. The pain improves when lying down and gets worse when standing. If parts of the intestine are pinched in the inguinal hernia, severe cramp-like pain occurs.
Vessels: In the Pelvic vein thrombosis it occurs through a vascular occlusion in the venous system Pain in the lower abdomen, in the back and in the strip. Patients feel that their thighs are tight and swollen. The diagnosis can be made through an ultrasound scan. A Aortic aneurysm can also be detected by an ultrasound examination, it causes either diffuse or tearing pain, which can start either suddenly or slowly.
Gynecological causes: In women with pelvic pain, one should also Inflammation of the uterus, fallopian tubes, or ovaries be thought. Also one Ovarian cyst, Fallopian or ectopic pregnancy are possible causes of pain in the lower abdomen.

Abdominal pain on the right side

in the right upper abdomen are the liver, the Gallbladder and the Biliary tract.

liver: One Inflammation of the liver (hepatitis) can have infectious or autoimmune causes, for example. A common symptom is a tenderness in the right upper abdomen and the Jaundice. Jaundice can or does not have to occur. Tumors and cystic diseases of the liver can also cause pressure pain in the upper abdomen.
After a accident can it to Liver rupture (Liver rupture), the pain starts suddenly. The patients often suffer from circulatory shock.

Figure abdominal pain right

Illustration of the right abdominal cavity
1. Liver -
  Hepar
2. Gallbladder -
  Vesica biliaris
3. Stomach -
  Guest
4. Large intestine, transverse part -
  Transverse colon
5. Small intestine -
  Intestine tenue
6. Colon, ascending part -
  Ascending colon
7. Appendix - Caecum
8. Appendix -
  Appendix vermiformis
9. Fallopian tubes - Tuba uterina
10. Ovary - Ovary
11. Uterus - uterus
You can find an overview of all Dr-Gumpert images at: medical illustrations

Abdominal pain on the left side

The spleen is located in the upper left abdomen. After an accident, a ruptured spleen can cause pain in the upper left abdomen. Patients develop cardiovascular shock as blood leaks into the abdominal cavity. With a large tear, circulatory shock begins a few moments after the accident; with a small tear, hours or days can pass before the situation becomes critical.
If the splenic artery, the artery that supplies the spleen with blood, or one of its smaller sub-branches is blocked by an embolus in the bloodstream, a splenic infarction occurs. In splenic infarction, spleen tissue dies because it is not supplied with oxygen. The splenic infarction causes pain in the left upper abdomen that radiates into the shoulder. In many cases, it is triggered by inflammation of the heart valves, from which inflammatory components separate and land in the spleen.

Read more on the topic Pain in the left upper abdomen

In the left lower abdomen, diverticulitis and ulcerative colitis are common causes of pain, see “Lower abdomen”. Kidney and urinary tract disorders can also trigger left side abdominal pain.

Read more on the topic Pain in the left lower abdomen

Figure stomach pain left

Illustration of the left abdominal cavity
1. Heart -
  Cor
2. Liver -
  Hepar
3. Spleen -
  Sink
4. Stomach -
  Guest
5. Pancreas -
  Pancreas
6. Colon -
  Intestine tenue
7. Small intestine - Intestinum crassum
8. Fallopian tubes - Tuba uterina
9. Ovary - Ovary
10. Uterus - uterus
You can find an overview of all Dr-Gumpert images at: medical illustrations

Abdominal pain up to the chest

There are various possible causes for abdominal pain under the chest.
- Reflux disease: In reflux disease, acidic stomach contents flow back into the esophagus, resulting in heartburn, acid regurgitation and pain in the middle upper abdomen.
- Abscesses (encapsulated collection of pus): A liver abscess can be triggered by various infections. An abscess of the spleen is rare, but it can also be caused by various infections. If these abscesses spread, a subphrenic abscess (located below the diaphragm) can develop.
  The patients have abdominal pain under the chest and a high fever. The pain is often dependent on breathing.
- Pneumonia: Pneumonia, which affects the lower sections of the lungs, can cause pain under the chest and is detected by the typical examination with a stethoscope.
- Pleurisy (pleurisy): If the lower parts of the pleura are particularly affected, the patients experience pain under the chest, which is mostly dependent on the breath.
Abdominal pain in pregnancy

Abdominal pain during pregnancy can be caused by pregnancy or related to other organs in the abdomen. During pregnancy, the skin of the abdomen can tear because of the stretching, which is felt to be rather superficial pain. By the end of pregnancy, exercise and sinking pains are normal. Like other women, pregnant women can of course suffer from all the diseases described here that cause abdominal pain: gallstones, gallbladder inflammation, kidney pelvic inflammation, kidney stone, etc. The life-threatening HELLP syndrome causes pain in the right upper abdomen. The patients feel sick, they are sick and they are sensitive to light. Blood clotting worsens. A visit to the doctor is essential!

Read more on the topic Abdominal pain in pregnancy

Abdominal pain around the belly button
- Appendicitis: Appendicitis often begins with abdominal pain around the belly button, which then migrates towards the right lower abdomen.
- Chronic inflammatory bowel diseases such as Crohn's disease and ulcerative colitis can also manifest as abdominal pain around the abdomen. Acute inflammatory bowel disease, such as gastrointestinal flu, is often accompanied by abdominal pain around the navel.
- Mesenteric infarction: A blockage of the arteries that supply the intestine with blood can result, for example, from an embolus in the case of atrial fibrillation or heart valve inflammation. Atherosclerosis is also a possible cause. A mesenteric infarction causes diarrhea and cramping pain in the central abdomen and around the belly button. If left untreated, peritonitis and paralyzing intestinal obstruction occur.
- In children and adolescents, a volvulus (twisted bowel) or intussusception (invagination) can be the cause of abdominal pain around the navel.
For more information, see Pain in the navel.