Abdominal pain
Abdominal pain | |
---|---|
Other names | Stomach ache, tummy ache, belly ache, belly pain, gastralgia |
Abdominal pain can be characterized by the region it affects. | |
Specialty | Gastroenterology,general surgery |
Causes | Serious:Appendicitis,perforatedstomach ulcer,pancreatitis,ruptureddiverticulitis,ovarian torsion,volvulus,rupturedaortic aneurysm,lacerated spleenor liver,ischemic colitis,ischaemic myocardial conditions[1] Common:Gastroenteritis,irritable bowel syndrome[2] |
Abdominal pain,also known as astomach ache,is asymptomassociated with both non-serious and serious medical issues. Since the abdomen contains most of the body's vital organs, it can be an indicator of a wide variety of diseases. Given that, approaching the examination of a person and planning of adifferential diagnosisis extremely important.[3]
Common causes ofpainin theabdomenincludegastroenteritisandirritable bowel syndrome.[2]About 15% of people have a more serious underlying condition such asappendicitis,leaking or rupturedabdominal aortic aneurysm,diverticulitis,orectopic pregnancy.[2]In a third of cases, the exact cause is unclear.[2]
Signs and symptoms
[edit]The onset of abdominal pain can be abrupt, quick, or gradual. Sudden onset pain happens in a split second. Rapidly onset pain starts mild and gets worse over the next few minutes. Pain that gradually intensifies only after several hours or even days has passed is referred to as gradual onset pain.[4]
One can describe abdominal pain as either continuous or sporadic and ascramping,dull, or aching. The characteristic of cramping abdominal pain is that it comes in brief waves, builds to a peak, and then abruptly stops for a period during which there is no more pain. The pain flares up and off periodically. The most common cause of persistent dull or aching abdominal pain is edema or distention of the wall of a hollow viscus. A dull or aching pain may also be felt due to a stretch in the liver and spleen capsules.[4]
Causes
[edit]The most frequent reasons for abdominal pain aregastroenteritis(13%),irritable bowel syndrome(8%), urinary tract problems (5%),inflammation of the stomach(5%) andconstipation(5%). In about 30% of cases, the cause is not determined. About 10% of cases have a more serious cause including gallbladder (gallstonesorbiliary dyskinesia) orpancreasproblems (4%),diverticulitis(3%),appendicitis(2%) andcancer(1%).[2]More common in those who are older,ischemic colitis,[5]mesenteric ischemia,andabdominal aortic aneurysmsare other serious causes.[6]
Acute abdomen
[edit]Acute abdomenis a condition where there is a sudden onset of severe abdominal pain requiring immediate recognition and management of the underlying cause.[7]The underlying cause may involve infection,inflammation,vascular occlusionor bowel obstruction.[7]
The pain may elicitnauseaandvomiting,abdominal distention,feverand signs ofshock.[7]A common condition associated with acute abdominal pain isappendicitis.[8]Here is a list of acute abdomen causes:
Surgical causes[edit] |
Source:[7] Inflammatory[edit]
Mechanical[edit]
Vascular[edit]
Source:[9]
|
---|---|
Medical causes[edit] |
Source:[7] Diabetic ketoacidosis(DKA). |
Gynecological causes[edit] |
Source:[11] Pelvic inflammatory disease(PID) and abscess. Hemorrhagicovarian cyst. Adnexal orovarian torsion. |
By system
[edit]A more extensive list includes the following:[citation needed]
- Gastrointestinal
- GI tract
- Inflammatory:gastroenteritis,appendicitis,gastritis,esophagitis,diverticulitis,Crohn's disease,ulcerative colitis,microscopic colitis
- Obstruction:hernia,intussusception,volvulus,post-surgicaladhesions,tumors,severeconstipation,hemorrhoids
- Vascular:embolism,thrombosis,hemorrhage,sickle cell disease,abdominal angina,blood vessel compression (such as celiac artery compression syndrome),superior mesenteric artery syndrome,postural orthostatic tachycardia syndrome
- Digestive:peptic ulcer,lactose intolerance,celiac disease,food allergies,indigestion
- Glands
- Bile system
- Inflammatory:cholecystitis,cholangitis
- Obstruction:cholelithiasis
- Liver
- Inflammatory:hepatitis,liver abscess
- Pancreatic
- Inflammatory:pancreatitis
- Bile system
- GI tract
- Renal and urological
- Inflammation:pyelonephritis,bladder infection
- Obstruction:kidney stones,urolithiasis,urinary retention
- Vascular:left renal vein entrapment
- Gynaecological or obstetric
- Inflammatory:pelvic inflammatory disease
- Mechanical:ovarian torsion
- Endocrinological:menstruation,Mittelschmerz
- Tumors:endometriosis,fibroids,ovarian cyst,ovarian cancer
- Pregnancy: rupturedectopic pregnancy,threatened abortion
- Abdominal wall
- muscle strain or trauma
- muscular infection
- neurogenicpain:herpes zoster,radiculitisinLyme disease,abdominal cutaneous nerve entrapment syndrome(ACNES),tabes dorsalis
- Referred pain
- from thethorax:pneumonia,pulmonary embolism,ischemic heart disease,pericarditis
- from thespine:radiculitis
- from thegenitals:testicular torsion
- Metabolic disturbance
- uremia,diabetic ketoacidosis,porphyria,C1-esterase inhibitor deficiency,adrenal insufficiency,lead poisoning,black widow spiderbite,narcoticwithdrawal
- Blood vessels
- Immune system
- Idiopathic
- irritable bowel syndrome(IBS) (affecting up to 20% of the population, IBS is the most common cause of recurrent and intermittent abdominal pain)
By location
[edit]The location of abdominal pain can provide information about what may be causing the pain. The abdomen can be divided into four regions called quadrants. Locations and associated conditions include:[12][13]
- Diffuse
- Epigastric
- Heart:myocardial infarction,pericarditis
- Stomach:gastritis,stomach ulcer,stomach cancer
- Pancreas:pancreatitis,pancreatic cancer
- Intestinal:duodenal ulcer,diverticulitis,appendicitis
- Right upper quadrant
- Liver:hepat Omega ly,fatty liver,hepatitis,liver cancer,abscess
- Gallbladder and biliary tract:inflammation,gallstones,worm infection,cholangitis
- Colon:bowel obstruction,functional disorders,gas accumulation,spasm,inflammation,colon cancer
- Other:pneumonia,Fitz-Hugh-Curtis syndrome
- Left upper quadrant
- Splen Omega ly
- Colon:bowel obstruction,functional disorders, gas accumulation, spasm, inflammation, colon cancer
- Peri-umbilical (the area around the umbilicus, i.e., the belly button)
- Appendicitis
- Pancreatitis
- Inferior myocardial infarction
- Peptic ulcer
- Diabetic ketoacidosis
- Vascular:aortic dissection,aortic rupture
- Bowel:mesenteric ischemia,Celiac disease,inflammation, intestinal spasm, functional disorders,small bowel obstruction
- Lower abdominal pain
- Right lower quadrant
- Colon:intussusception,bowel obstruction,appendicitis(McBurney's point)
- Renal:kidney stone(nephrolithiasis),pyelonephritis
- Pelvic:cystitis,bladder stone,bladder cancer,pelvic inflammatory disease,pelvic pain syndrome
- Gynecologic:endometriosis,intrauterinepregnancy,ectopic pregnancy,ovarian cyst,ovarian torsion,fibroid (leiomyoma),abscess,ovarian cancer,endometrial cancer
- Left lower quadrant
- Bowel:diverticulitis,sigmoid colon volvulus,bowel obstruction,gas accumulation,Toxic megacolon
- Rightlow back pain
- Liver:hepat Omega ly
- Kidney:kidney stone(nephrolithiasis), complicated urinary tract infection
- Left low back pain
- Spleen
- Kidney:kidney stone(nephrolithiasis), complicated urinary tract infection
- Low back pain
- Kidney pain (kidney stone,kidney cancer,hydronephrosis)
- Ureteral stonepain
Mechanism
[edit]Region | Blood supply[14] | Innervation[15] | Structures[14] |
---|---|---|---|
Foregut | Celiac artery | T5 - T9 | Pharynx
Proximalduodenum |
Midgut | Superior mesenteric artery | T10 – T12 | Distalduodenum
Proximaltransverse colon |
Hindgut | Inferior mesenteric artery | L1 – L3 | Distaltransverse colon
Superioranal canal |
Abdominal pain can be referred to asvisceral painorperitonealpain. The contents of the abdomen can be divided into theforegut,midgut,andhindgut.[14]Theforegutcontains thepharynx,lowerrespiratory tract,portions of theesophagus,stomach,portions of theduodenum(proximal),liver,biliary tract(including thegallbladderandbile ducts), and thepancreas.[14]The midgut contains portions of theduodenum(distal),cecum,appendix,ascending colon,and first half of thetransverse colon.[14]The hindgut contains the distal half of the transverse colon,descending colon,sigmoid colon,rectum,and superioranal canal.[14]
Each subsection of the gut has an associated visceral afferent nerve that transmits sensory information from the viscera to the spinal cord, traveling with the autonomic sympathetic nerves.[16]The visceral sensory information from the gut traveling to the spinal cord, termed the visceral afferent, is non-specific and overlaps with the somatic afferent nerves, which are very specific.[17]Therefore, visceral afferent information traveling to the spinal cord can present in the distribution of the somatic afferent nerve; this is whyappendicitisinitially presents with T10 periumbilical pain when it first begins and becomes T12 pain as the abdominal wall peritoneum (which is rich with somatic afferent nerves) is involved.[17]
Diagnosis
[edit]A thorough patient history and physical examination is used to better understand the underlying cause of abdominal pain.
The process of gathering a history may include:[18]
- Identifying more information about thechief complaintby eliciting ahistory of present illness;i.e. a narrative of the current symptoms such as the onset, location, duration, character, aggravating or relieving factors, and temporal nature of the pain. Identifying other possible factors may aid in the diagnosis of the underlying cause of abdominal pain, such as recent travel, recent contact with other ill individuals, and for females, a thoroughgynecologichistory.
- Learning about the patient's past medical history, focusing on any prior issues or surgical procedures.
- Clarifying the patient's current medication regimen, including prescriptions, over-the-counter medications, and supplements.
- Confirming the patient's drug and food allergies.
- Discussing with the patient any family history of disease processes, focusing on conditions that might resemble the patient's current presentation.
- Discussing with the patient any health-related behaviors (e.g. tobacco use, alcohol consumption, drug use, and sexual activity) that might make certain diagnoses more likely.
- Reviewing the presence of non-abdominal symptoms (e.g.,fever,chills,chest pain,shortness of breath,vaginal bleeding) that can further clarify the diagnostic picture.
- UsingCarnett's signto differentiate betweenvisceral painand pain originating in the muscles of the abdominal wall.[19]
After gathering a thorough history, one should perform aphysical examin order to identify important physical signs that might clarify the diagnosis, including acardiovascular exam,lung exam, thorough abdominal exam, and for females, agenitourinaryexam.[18]
Additional investigations that can aid diagnosis include:[20]
- Blood tests includingcomplete blood count,basic metabolic panel,electrolytes,liver function tests,amylase,lipase,troponin I,and for females, a serumpregnancy test.
- Urinalysis
- Imaging including chest and abdominalX-rays
- Electrocardiogram
If diagnosis remains unclear after history, examination, and basic investigations as above, then more advanced investigations may reveal a diagnosis. Such tests include:[20]
- Computed tomographyof the abdomen/pelvis
- Abdominal or pelvicultrasound
- Endoscopyorcolonoscopy
Management
[edit]The management of abdominal pain depends on many factors, including the etiology of the pain. Some dietary changes that some may participate in are: resting after a meal, chewing food completely and slowly, and avoiding stressful and high excitement situations after a meal. Some at home strategies like these can avoid future abdominal issues, resulting in the need of professional assistance.[21]In the emergency department, a person presenting with abdominal pain may initially require IV fluids due to decreased intake secondary to abdominal pain and possible emesis or vomiting.[22]Treatment for abdominal pain includes analgesia, such as non-opioid (ketorolac) and opioid medications (morphine,fentanyl).[22]Choice ofanalgesiais dependent on the cause of the pain, asketorolaccan worsen some intra-abdominal processes.[22]Patients presenting to the emergency department with abdominal pain may receive a "GI cocktail" that includes anantacid(examples includeomeprazole,ranitidine,magnesium hydroxide,andcalcium chloride) andlidocaine.[22]After addressing pain, there may be a role forantimicrobialtreatment in some cases of abdominal pain.[22]Butylscopolamine(Buscopan) is used to treat cramping abdominal pain with some success.[23]Surgical management for causes of abdominal pain includes but is not limited tocholecystectomy,appendectomy,and exploratorylaparotomy.[citation needed]
Emergencies
[edit]Below is a brief overview of abdominal pain emergencies.
Condition | Presentation | Diagnosis | Management |
---|---|---|---|
Appendicitis[24] | Abdominal pain, nausea, vomiting, fever
Periumbilical pain, migrates to RLQ |
Clinical (history and physical exam)
Abdominal CT |
Patient made NPO (nothing by mouth)
IV fluids as needed General surgery consultation, possibleappendectomy Antibiotics Pain control |
Cholecystitis[24] | Abdominal pain (RUQ, radiates epigastric), nausea, vomiting, fever,Murphy's sign | Clinical (history and physical exam)
Imaging (RUQ ultrasound) |
Patient made NPO (nothing by mouth)
IV fluids as needed General surgery consultation, possiblecholecystectomy Antibiotics Pain, nausea control |
Acute pancreatitis[24] | Abdominal pain (sharp epigastric, shooting to back), nausea, vomiting | Clinical (history and physical exam)
Labs (elevatedlipase) Imaging (abdominal CT, ultrasound) |
Patient made NPO (nothing by mouth)
IV fluids as needed Pain, nausea control Possibly consultation ofgeneral surgeryorinterventional radiology |
Bowel obstruction[24] | Abdominal pain (diffuse, crampy),biliousemesis,constipation | Clinical (history and physical exam)
Imaging (abdominal X-ray, abdominal CT) |
Patient made NPO (nothing by mouth)
IV fluids as needed Nasogastric tubeplacement General surgeryconsultation Pain control |
Upper GI bleed[24] | Abdominal pain (epigastric),hematochezia,melena,hematemesis,hypovolemia | Clinical (history & physical exam, includingdigital rectal exam)
Labs (complete blood count,coagulation profile,transaminases,stool guaiac) |
Aggressive IV fluid resuscitation
Blood transfusionas needed Medications:proton pump inhibitor,octreotide Stable patient: observation Unstable patient: consultation (general surgery,gastroenterology,interventional radiology) |
LowerGI bleed[24] | Abdominal pain,hematochezia,melena,hypovolemia | Clinical (history and physical exam, includingdigital rectal exam)
Labs (complete blood count,coagulation profile,transaminases,stool guaiac) |
Aggressive IV fluid resuscitation
Blood transfusionas needed Medications:proton pump inhibitor Stable patient: observation Unstable patient: consultation (general surgery,gastroenterology,interventional radiology) |
Perforated Viscous[24] | Abdominal pain (sudden onset of localized pain),abdominal distension,rigid abdomen | Clinical (history and physical exam)
Imaging (abdominal X-ray or CT showing free air) Labs (complete blood count) |
Aggressive IV fluid resuscitation
General surgeryconsultation Antibiotics |
Volvulus[24] | Sigmoid colon volvulus:Abdominal pain (>2 days, distention, constipation)
Cecal volvulus: Abdominal pain (acute onset), nausea, vomiting |
Clinical (history and physical exam)
Imaging (abdominal X-ray or CT) |
Sigmoid:Gastroenterologyconsultation (flexibile sigmoidoscopy)
Cecal:General surgeryconsultation (right hemicolectomy) |
Ectopic pregnancy[24] | Abdominal and pelvic pain, bleeding
If ruptured ectopic pregnancy, the patient may present with peritoneal irritation andhypovolemic shock |
Clinical (history and physical exam)
Labs:complete blood count,urine pregnancy test followed with quantitative bloodbeta-hCG Imaging:transvaginal ultrasound |
If patient is unstable: IV fluid resuscitation, urgentobstetrics and gynecologyconsultation
If patient is stable: continue diagnostic workup, establishOBGYNfollow-up |
Abdominal aortic aneurysm[24] | Abdominal pain, flank pain, back pain, hypotension, pulsatile abdominal mass | Clinical (history and physical exam)
Imaging: Ultrasound,CT angiography,MRA/magnetic resonance angiography |
If patient is unstable: IV fluid resuscitation, urgent surgical consultation
If patient is stable: admit for observation |
Aortic dissection[24] | Abdominal pain (sudden onset of epigastric or back pain), hypertension, new aorticmurmur | Clinical (history and physical exam)
Imaging: Chest X-ray (showing widenedmediastinum),CT angiography,MRA,transthoracic echocardiogram/TTE,transesophageal echocardiogram/TEE |
IV fluid resuscitation
Blood transfusionas needed (obtaintype and cross) Medications: reduce blood pressure (sodium nitroprussideplusbeta blockerorcalcium channel blocker) Surgery consultation |
Liver injury[24] | After trauma (bluntorpenetrating), abdominal pain (RUQ), right rib pain, right flank pain, right shoulder pain | Clinical (history and physical exam)
Imaging:FASTexamination, CT of abdomen and pelvis |
Resuscitation (advanced trauma life support) with IV fluids (crystalloid) andblood transfusion
If patient is unstable:generalortrauma surgeryconsultation with subsequentexploratory laparotomy |
Splenic injury[24] | After trauma (bluntorpenetrating), abdominal pain (LUQ), left rib pain, left flank pain | Clinical (history and physical exam)
Imaging:FASTexamination, CT of abdomen and pelvis |
Resuscitation (advanced trauma life support) with IV fluids (crystalloid) andblood transfusion
If patient is unstable:generalortrauma surgeryconsultation with subsequentexploratory laparotomyand possiblesplenectomy If patient is stable: medical management, consultation ofinterventional radiologyfor possiblearterial embolization |
Outlook
[edit]One well-known aspect of primary health care is its low prevalence of potentially dangerous abdominal pain causes. Patients with abdominal pain have a higher percentage of unexplained complaints (category "no diagnosis" ) than patients with other symptoms (such asdyspneaorchest pain).[25]Most people who suffer from stomach pain have a benign issue, likedyspepsia.[26]In general, it is discovered that 20% to 25% of patients with abdominal pain have a serious condition that necessitates admission to an acute care hospital.[27]
Epidemiology
[edit]Abdominal pain is the reason about 3% of adults see their family physician.[2]Rates ofemergency department(ED) visits in the United States for abdominal pain increased 18% from 2006 through to 2011. This was the largest increase out of 20 common conditions seen in the ED. The rate of ED use for nausea and vomiting also increased 18%.[28]
Special populations
[edit]Geriatrics
[edit]More time and resources are used on older patients with abdominal pain than on any other patient presentation in the emergency department (ED).[29]Compared to younger patients with the same complaint, their length of stay is 20% longer, they need to be admitted almost half the time, and they need surgery 1/3 of the time.[30]
Age does not reduce the total number ofT cells,but it does reduce their functionality. The elderly person's ability to fight infection is weakened as a result.[31]Additionally, they have changed the strength and integrity of their skin andmucous membranes,which are physical barriers to infection. It is well known that older patients experience altered pain perception.[32]
The challenge of obtaining a sufficient history from an elderly patient can be attributed to multiple factors. Reduced memory or hearing could make the issue worse. It is common to encounter stoicism combined with a fear of losing one's independence if a serious condition is discovered. Changes in mental status, whether acute or chronic, are common.[33]
Pregnancy
[edit]Unique clinical challenges arise when pregnant women experience abdominal pain. First off, there are many possible causes of abdominal pain during pregnancy. These include intraabdominal diseases that arise incidentally during pregnancy as well as obstetric or gynecologic disorders associated with pregnancy. Secondly, pregnancy modifies the natural history and clinical manifestation of numerous abdominal disorders. Third, pregnancy modifies and limits the diagnostic assessment. For instance, concerns about fetal safety during pregnancy are raised by invasive exams and radiologic testing. Fourth, while receiving therapy during pregnancy, the mother's and the fetus' interests need to be taken into account.[34]
See also
[edit]References
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- ^Hung A, Calderbank T, Samaan MA, Plumb AA, Webster G (1 January 2021)."Ischaemic colitis: practical challenges and evidence-based recommendations for management".Frontline Gastroenterology.12(1): 44–52.doi:10.1136/flgastro-2019-101204.ISSN2041-4137.PMC7802492.PMID33489068.
- ^Spangler R, Van Pham T, Khoujah D, Martinez JP (2014)."Abdominal emergencies in the geriatric patient".International Journal of Emergency Medicine.7:43.doi:10.1186/s12245-014-0043-2.PMC4306086.PMID25635203.
- ^abcdePatterson JW, Kashyap S, Dominique E (2023),"Acute Abdomen",StatPearls,Treasure Island (FL): StatPearls Publishing,PMID29083722,retrieved23 September2023
- ^"Appendicitis".The Lecturio Medical Concept Library.Retrieved1 July2021.
- ^Arendt-Nielsen L, Svensson P (March 2001)."Referred Muscle Pain: Basic and Clinical Findings".The Clinical Journal of Pain.17(1): 11–19.doi:10.1097/00002508-200103000-00003.ISSN0749-8047.PMID11289083.
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- ^Burnett LS (April 1988)."Gynecologic causes of the acute abdomen".The Surgical Clinics of North America.68(2): 385–398.doi:10.1016/s0039-6109(16)44484-1.ISSN0039-6109.PMID3279553.
- ^Masters P (2015).IM Essentials.American College of Physicians.ISBN978-1-938921-09-4.
- ^LeBlond RF (2004).Diagnostics.US: McGraw-Hill Companies, Inc.ISBN978-0-07-140923-0.
- ^abcdefMoore KL (2016). "11".The Developing Human Tenth Edition.Philadelphia, PA: Elsevier, Inc. pp. 209–240.ISBN978-0-323-31338-4.
- ^Hansen JT (2019). "4: Abdomen".Netter's Clinical Anatomy, 4e.Philadelphia, PA: Elsevier. pp. 157–231.ISBN978-0-323-53188-7.
- ^Drake RL, Vogl AW, Mitchell AW (2015). "4: Abdomen".Gray's Anatomy For Students(Third ed.). Churchill Livingstone Elsevier. pp. 253–420.ISBN978-0-7020-5131-9.
- ^abNeumayer L, Dangleben DA, Fraser S, Gefen J, Maa J, Mann BD (2013). "11: Abdominal Wall, Including Hernia".Essentials of General Surgery, 5e.Baltimore, MD: Wolters Kluwer Health.
- ^abBickley L (2016).Bates' Guide to Physical Examination & History Taking.Philadelphia, Pennsylvania: Lippincott Williams & Wilkins.ISBN978-1-4698-9341-9.
- ^Karen M. Myrick, Laima Karosas (6 December 2019).Advanced Health Assessment and Differential Diagnosis: Essentials for Clinical Practice.Springer Publishing Company. p. 250.ISBN978-0-8261-6255-7.
- ^abCartwright SL, Knudson MP (April 2008)."Evaluation of acute abdominal pain in adults".American Family Physician.77(7): 971–8.PMID18441863.
- ^"Indigestion: MedlinePlus Medical Encyclopedia".medlineplus.gov.Retrieved2 May2023.
- ^abcdeMahadevan SV.Essentials of Family Medicine 6e.p. 149.
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- ^Gulacti U, Arslan E, Ooi MW, Tuck J, Mattu A, Dubosh NM, et al. (1 February 2001)."Abdominal Pain and Emergency Department Evaluation".Emergency Medicine Clinics of North America.19(1). Elsevier: 123–136.doi:10.1016/S0733-8627(05)70171-1.ISSN0733-8627.PMID11214394.Retrieved28 December2023.
- ^Chandramohan R, Pari L, Schrock JW, Lum M, Örnek N, Usta G, et al. (1 May 1991)."Probability of appendicitis before and after observation".Annals of Emergency Medicine.20(5). Mosby: 503–507.doi:10.1016/S0196-0644(05)81603-8.ISSN0196-0644.PMID2024789.Retrieved28 December2023.
- ^Skiner HG, Blanchard J, Elixhauser A (September 2014)."Trends in Emergency Department Visits, 2006–2011".HCUP Statistical Brief(179). Rockville, MD: Agency for Healthcare Research and Quality.
- ^SA B, LZ R (1987)."Old people in the emergency room: age-related differences in emergency department use and care".Journal of the American Geriatrics Society.35(5). J Am Geriatr Soc: 398–404.doi:10.1111/j.1532-5415.1987.tb04660.x.ISSN0002-8614.PMID3571788.S2CID30731138.Retrieved28 December2023.
- ^Rodríguez-Lomba E, Pulido-Pérez A, Ricciardi R, Marcello PW, Kuki I, Nakane S, et al. (1 February 1976)."Abdominal pain: An analysis of 1,000 consecutive cases in a university hospital emergency room".The American Journal of Surgery.131(2). Elsevier: 219–223.doi:10.1016/0002-9610(76)90101-X.ISSN0002-9610.PMID1251963.Retrieved28 December2023.
- ^Weyand CM, Goronzy rJ (2016)."Aging of the Immune System. Mechanisms and Therapeutic Targets".Annals of the American Thoracic Society.13(Suppl 5). American Thoracic Society: S422–S428.doi:10.1513/AnnalsATS.201602-095AW.PMC5291468.PMID28005419.
- ^Ed S (1964)."Sensitivity to Pain in Relationship to Age".Journal of the American Geriatrics Society.12(11). J Am Geriatr Soc: 1037–1044.doi:10.1111/j.1532-5415.1964.tb00652.x.ISSN0002-8614.PMID14217863.S2CID26336124.Retrieved28 December2023.
- ^Isani MA, Kim ES, Mateu PB, Tormo FB, Thilakarathna K, Xie G, et al. (1 May 2006)."Abdominal Pain in the Elderly".Emergency Medicine Clinics of North America.24(2). Elsevier: 371–388.doi:10.1016/j.emc.2006.01.010.ISSN0733-8627.PMID16584962.Retrieved28 December2023.
- ^Souza Fd, Ferreira CH, Young RC, Cerit L, Lejong M, Louryan S, et al. (1 March 2003)."Abdominal pain during pregnancy".Gastroenterology Clinics of North America.32(1). Elsevier: 1–58.doi:10.1016/S0889-8553(02)00064-X.ISSN0889-8553.PMID12635413.Retrieved28 December2023.
Further reading
[edit]- Shinar Z, Dembitsky W, Smith ME, Moak JH, Traub SJ, Saghafian S, et al. (1 September 2011)."Abdominal pain in the ED: a 35 year retrospective".The American Journal of Emergency Medicine.29(7). W.B. Saunders: 711–716.doi:10.1016/j.ajem.2010.01.045.ISSN0735-6757.PMID20825873.Retrieved28 December2023.
- Farmer AD, Aziz Q (2014)."Mechanisms and management of functional abdominal pain".Journal of the Royal Society of Medicine.107(9): 347–354.doi:10.1177/0141076814540880.ISSN0141-0768.PMC4206626.PMID25193056.
- Akasaka E, Sawamura D, Rokunohe D, Sawamura D, Talukdar R, Reddy DN, et al. (1 February 2006)."Abdominal Pain in Children".Pediatric Clinics of North America.53(1). Elsevier: 107–137.doi:10.1016/j.pcl.2005.09.009.ISSN0031-3955.PMID16487787.S2CID17103933.Retrieved28 December2023.
External links
[edit]- Abdominal Painat Wikibooks
- Cleveland Clinic
- Mayo Clinic