When abdominal pain occurs, many people rush to take a No-shpy or Phthalazol pill, believing that they have a problem with the digestive organs. However, the stomach can hurt due to a dozen reasons that are absolutely not related to either the stomach or the intestines. This phenomenon even has a medical term - abdominal syndrome. What it is? The name comes from the Latin "abdomen", which translates as "stomach". That is, everything that is connected with this area of the human body is abdominal. For example, the stomach, intestines, bladder, spleen, kidneys are abdominal organs, and gastritis, pancreatitis, cholecystitis, colitis and other gastrointestinal problems are abdominal diseases. By analogy, abdominal syndrome is all the troubles in the abdomen (heaviness, pain, tingling, spasms and other bad sensations). With such complaints of the patient, the task of the doctor is to correctly differentiate the symptoms,to avoid misdiagnosis. Let's see how this is done in practice and what are the features of pain in each disease.
Human Abdomen
To make it easier to deal with the question: "Abdominal syndrome - what is it?" and to understand where it comes from, you need to clearly understand how our stomach is arranged, what organs it has, how they interact with each other. On the anatomical pictures, you can see a schematic tube of the esophagus, a baggy stomach, an intestine wriggling like a snake, on the right under the ribs the liver, on the left the spleen, at the very bottom of the bladder with ureters stretching from the kidneys. Here, it seems, is all. In reality, our abdominal cavity has a more complex structure. Conventionally, it is divided into three segments. The border of the upper is - on the one hand - a dome-shaped muscle called the diaphragm. Above it is the chest cavity with the lungs. On the other hand, the upper segment is separated from the middle by the so-called mesentery of the colon. This is a two-layer fold, with the help of which all the organs of the gastrointestinal tract are attached to the posterior plane of the abdomen. In the upper segment there are three sections - hepatic, pancreatic and omental. The middle segment extends from the mesentery to the beginning of the small pelvis. It is in this part of the abdomen that the umbilical zone is located. And, finally, the lower segment is the pelvic area, in which the organs of the genitourinary and reproductive systems have found their place.
Any violations (inflammation, infection, mechanical and chemical influences, pathologies of formation anddevelopment) in the activity of each organ located in the above three segments cause abdominal syndrome. In addition, there are blood and lymphatic vessels and nerve nodes in the peritoneum. Among them, the most famous are the aorta and the solar plexus. The slightest problem with them also provokes abdominal pain.
To summarize: abdominal syndrome can be caused by any currently known disease of the gastrointestinal tract and genitourinary system, problems with the vessels and nerve plexuses of the peritoneum, chemical effects (poisoning, drugs), mechanical compression (squeezing) by neighboring organs of everything that located in the peritoneum.
The pain is sharp
Differential diagnosis of abdominal pain syndrome, as a rule, begins with determining the location and nature of pain. The most life-threatening and difficult to bear by a person is, of course, acute pain. It occurs suddenly, abruptly, often without any apparent cause that provoked it, manifested by attacks lasting from several minutes to an hour.
Acute pain may be accompanied by vomiting, diarrhea, fever, chills, cold sweat, loss of consciousness. Most often they have exact localization (right, left, bottom, top), which helps to establish a preliminary diagnosis.
Diseases that cause this abdominal syndrome are:
1. Inflammatory processes in the peritoneum - acute and recurrent appendicitis, Meckel's diverticulitis, peritonitis, acute cholecystitis or pancreatitis.
2. Intestinal obstruction or strangulated hernia.
3. Perforation (perforation, hole) of the peritoneal organs, which occurs with a stomach and / or duodenal ulcer and diverticulum. This also includes ruptures of the liver, aorta, spleen, ovary, tumors.
In cases with perforation, as well as appendicitis and peritonitis, the life of the patient is 100% dependent on the correct diagnosis and urgent surgical intervention.
Additional Research:
- blood test (makes it possible to assess the activity of the inflammatory process, determine the blood group);
- x-ray (shows the presence or absence of perforation, obstruction, hernia);
- ultrasound;
- if there is a suspicion of bleeding in the gastrointestinal tract, do esophagogastroduodenoscopy.
Chronic pains
They build up gradually and last for many months. At the same time, the sensations are, as it were, blunted, pulling, aching, often “spilled” along the entire peritoneum of the peritoneum, without a specific localization. Chronic pain may subside and return again, for example, after any meal. In almost all cases, such an abdominal syndrome indicates chronic diseases of the abdominal organs. These could be:
1) gastritis (pain in the upper segment, nausea, heaviness in the stomach, belching, heartburn, problems with defecation);
2) stomach and / or duodenal ulcer in the early stages (pain in the pit of the stomach on an empty stomach, at night or shortly after eating, heartburn, sour belching, bloating, flatulence,nausea);
3) urolithiasis (pain in the side or lower abdomen, blood and/or sand in the urine, painful urination, nausea, vomiting);
4) chronic cholecystitis (pain in the upper segment on the right, general weakness, bitterness in the mouth, low temperature, persistent nausea, vomiting - sometimes with bile, belching);
5) chronic cholangitis (pain in the liver, fatigue, yellowness of the skin, low temperature, in acute form, pain can radiate to the heart and under the shoulder blade);
6) oncology of the gastrointestinal tract in the initial stage.
Pain recurring in children
Recurrent pains are called pains that recur after a certain period of time. They can occur in children of any age and in adults.
In newborns, intestinal colic becomes a common cause of pain in the tummy (can be identified by sharp piercing crying, restless behavior, bloating, refusal of food, arching of the back, chaotic quick movements of the arms and legs, regurgitation). An important sign of intestinal colic is that when they are eliminated, the baby becomes calm, smiles, and eats well. Heat, tummy massage, dill water help to cope with the disease. With the growing up of the baby, all these troubles go away by themselves.
A much more serious problem is abdominal syndrome in somatic pathology in children. "Soma" in Greek means "body". That is, the concept of "somatic pathology" means any disease of the organs of the body and any of their congenital oracquired defect. In newborns, the most common are:
1) infectious diseases of the gastrointestinal tract (temperature up to critical levels, refusal to eat, lethargy, diarrhea, regurgitation, vomiting with a fountain, crying, in some cases discoloration of the skin);
2) pathology of the digestive tract (hernia, cyst and others).
Establishing a diagnosis in this case is complicated by the fact that the baby is not able to show where it hurts and explain his feelings. Differential diagnosis of abdominal pain syndrome in newborns is carried out using additional examinations, such as:
- coprogram;
- ultrasound;
- blood test;
- esophagogastroduodenoscopy;
- abdominal barium x-ray;
- daily pH-metry.
Pain recurrent in adults
In older children (mostly school age) and adults, the causes of recurring abdominal pain are so numerous that they are divided into five categories:
- infectious;
- inflammatory (no infection);
- functional;
- anatomical (associated with a particular organ);
- microbiological (cause various parasites that settle in the digestive tract).
What is infectious and inflammatory pain, more or less clear. What does functional mean? If they are indicated in the diagnosis, then how to understand the term "abdominal syndrome in children"? What it is? The concept of functional pain can be explained as follows: patients are worried about abdominal discomfort for no apparent reason and without organ diseasesperitoneum. Some adults even believe that the child is lying about his pain, as long as he does not find any violations. However, such a phenomenon exists in medicine, and it is observed, as a rule, in children older than 8 years. Functional pain can be caused by:
1) abdominal migraine (abdominal pain turns into headache, accompanied by vomiting, nausea, refusal to eat);
2) functional dyspepsia (a completely he althy child has pain in the upper abdomen and disappears after a bowel movement);
3) intestinal irritation.
Another controversial diagnosis is "SARS with abdominal syndrome" in children. Treatment in this case has some specifics, since babies have symptoms of both a cold and an intestinal infection. Often doctors make such a diagnosis for children who have the slightest signs of SARS (for example, a runny nose), and confirmation of diseases of the digestive tract is not detected. The frequency of such cases, as well as the epidemic nature of the disease, deserves more detailed coverage.
ARI with abdominal syndrome
This pathology is more often observed in preschoolers and younger schoolchildren. It is extremely rare in adults. In medicine, acute respiratory infections and acute respiratory viral infections are classified as a single type of ailment, since RH (respiratory diseases) are most often caused by viruses, and they automatically go into the category of RVI. The easiest way to "catch" them in children's groups - school, kindergarten, nursery. In addition to the well-known respiratory flu, a great danger is alsothe so-called "stomach flu", or rotavirus. It is also diagnosed as SARS with abdominal syndrome. In children, the symptoms of this disease appear 1-5 days after infection. The clinical picture is as follows:
- complaining about abdominal pain;
- vomit;
- nausea;
- temperature;
- diarrhea;
- runny nose;
- cough;
- red throat;
- painful to swallow;
- lethargy, weakness.
As you can see from the list, there are symptoms of both a cold and an intestinal infection. In rare cases, a child may indeed have a common cold plus a gastrointestinal disease, which doctors must clearly distinguish. Diagnosis of rotavirus infection is extremely difficult. It includes enzyme immunoassay, electron microscopy, diffuse precipitation, and a variety of reactions. Often, pediatricians make a diagnosis without such complex tests, only on the basis of the clinical manifestation of the disease and on the basis of anamnesis. With a rotavirus infection, although there are symptoms of a cold, it is not the ENT organs that are infected, but the gastrointestinal tract, mainly the large intestine. The source of infection is a sick person. Rotaviruses enter the body of a new host with food, through dirty hands, household items (for example, toys) that the patient used.
Treatment of acute respiratory viral infections with abdominal syndrome should be based on the diagnosis. So, if abdominal pain in a child is caused by pathological waste products of respiratory viruses, the underlying disease is treated, plus rehydration of the body by takingsorbents. If a rotavirus infection is confirmed, it makes no sense to prescribe antibiotics to the child, since they have no effect on the pathogen. Treatment consists of taking activated charcoal, sorbents, dieting, drinking plenty of water. If the child has diarrhea, probiotics are prescribed. Prevention of this disease is vaccination.
Paroxysmal pain without bowel disease
To make it easier to determine what caused the abdominal syndrome, the pains are divided into categories according to the place in the abdomen where they are felt the most.
Paroxysmal pain without symptoms of dyspepsia occurs in the middle segment (mesogastric) and lower (hypogastric). Possible reasons:
- worm infection;
- Payr syndrome;
- pyelonephritis;
- hydronephrosis;
- genital problems;
- intestinal obstruction (incomplete);
- stenosis (compression) of the celiac trunk;
- IBS.
If the patient has just such an abdominal syndrome, treatment is prescribed based on additional examinations:
- advanced blood test;
- stool culture for worm eggs and intestinal infections;
- urinalysis;
- Ultrasound of the digestive tract;
- irrigography (irrigoscopy with barium beam method);
- dopplerography of abdominal vessels.
Abdominal pain with bowel problems
All five categories of recurrent pain can be observed in the lower and middle segments of the peritoneum withbowel problems. There are a lot of reasons why such an abdominal syndrome occurs. Here are just a few:
- helminthiasis;
- allergic to any food;
- ulcerative colitis nonspecific (diarrhea is also observed, and the stool can be with pus or blood, flatulence, loss of appetite, general weakness, dizziness, weight loss);
- celiac disease (more common in young children when they start feeding their cereal-based formula);
- infectious diseases (salmonellosis, campylobacteriosis);
- pathologies in the large intestine, for example, dolichosigma (elongated sigmoid colon), while prolonged constipation is added to the pain;
- disaccharidase deficiency;
- hemorrhagic vasculitis.
The last disease appears when blood vessels in the intestines become inflamed and, as a result, swell, thrombosis occurs. The reasons are a violation in the processes of blood circulation and a shift in hemostasis. This condition is also known as hemorrhagic abdominal syndrome. It differentiates in three degrees of activity:
I (mild) - symptoms are mild, determined by blood ESR.
II (moderate) - there are mild pains in the peritoneum, the temperature rises, weakness and headache appear.
III (severe) - high temperature, severe headache and abdominal pain, weakness, nausea, vomiting with blood, urine and feces with blood impurities, bleeding in the stomach and intestines, perforation.
When pain occurs in the middle and lower parts of the peritoneum with suspicion of any problems with the intestines, the diagnosis includes:
- advanced blood test (biochemical and general);
- coprogram;
- fibrocolonoscopy;
- irrigography;
- stool culture;
- blood test for antibodies;
- hydrogen test;
- EGD and biopsy of small intestine tissue;
- immunological tests;
- sugar curve.
Pain in the upper segment of the peritoneum (epigastrium)
Most often, abdominal syndrome in the upper segment of the peritoneum is a consequence of eating and can manifest itself in two forms:
- dyspepsia, that is, with disruption of the stomach ("hungry pains" passing after eating);
- dyskinetic (bursting pain, feeling of overeating, regardless of the amount of food taken, belching, vomiting, nausea).
The causes of such conditions can be gastroduodenitis, hypersecretion of hydrochloric acid in the stomach, infections, worms, diseases of the pancreas and / or biliary tract, impaired gastroduodenal motility. In addition, pain in the epigastrium can provoke Dunbar's syndrome (pathology of the celiac trunk of the aorta when it is squeezed by the diaphragm). This ailment can be congenital, hereditary (often) or acquired when a person has an overgrowth of neurofibrous tissue.
The celiac trunk (a large short branch of the peritoneal aorta) when compressed is pressed against the aorta, strongly narrowed inits mouth. This causes abdominal ischemic syndrome, the diagnosis of which is carried out using a contrast x-ray (angiography). The celiac trunk, together with other blood vessels of the abdominal cavity, supplies blood to all organs of the gastrointestinal tract. When squeezed, the delivery of blood, and hence the supply of the organs with the necessary substances, does not occur in full, which leads to their oxygen starvation (hypoxia) and ischemia. The symptoms of this disease are similar to those observed in gastritis, duodenitis, stomach ulcers.
If the intestine experiences a lack of blood supply, ischemic colitis, enteritis develops. If insufficient blood is supplied to the liver, hepatitis develops, and the pancreas responds to failures in the blood supply with pancreatitis.
In order not to make a mistake with the diagnosis, additional examinations of patients with suspected abdominal ischemic syndrome should be carried out. Endovascular diagnosis is an advanced method in which blood vessels are examined by inserting a catheter with x-ray properties into them. That is, the method will allow you to see problems in the vessels without surgical intervention. Endovascular diagnostics is used for any diseases of the vessels of the abdominal cavity. If there are indications, endovascular operations are also performed. Abdominal ischemic syndrome can be suspected by the following complaints of the patient:
- constant pain in the abdomen, especially after eating, when performing any physical work or emotional stress;
- feelings of fullness and heaviness in the upper segmentperitoneum;
- burp;
- heartburn;
- a feeling of bitterness in the mouth;
- diarrhea or, conversely, constipation;
- frequent headaches;
- shortness of breath;
- throbbing in the abdomen;
- weight loss;
- general fatigue and weakness.
Only an external examination of the patient, as well as standard diagnostic methods (blood, urine, ultrasound) are not decisive in detecting this disease.
Spinal abdominal syndrome
This type of pathology is one of the most difficult to detect. It lies in the fact that patients have clear signs of problems with the gastrointestinal tract (abdominal pain, vomiting, belching, heartburn, diarrhea or constipation), but they are caused by diseases of the spine or other parts of the musculoskeletal system. Often, doctors do not immediately correctly determine the cause, so they carry out treatment that does not bring results. So, according to statistics, about 40% of patients with osteochondrosis of the thoracic region are treated for diseases of the intestines and stomach that do not exist in them. Even sadder picture with diseases of the spine. Pain in such cases is most often aching, dull, absolutely not associated with eating, and if patients have constipation or diarrhea, they are not treated by classical methods. The following diseases can cause vertebral abdominal syndrome:
- spondylosis;
- scoliosis;
- tuberculosis of the spine;
- syndromes associated with tumor changes in the spinal column;
- visceral syndromes (Gutzeit).
The saddest thing is that patients who complain of abdominal pain and do not have gastrointestinal pathologies are often perceived as malingerers. To find out the cause of unexplained abdominal pain, it is necessary to use additional diagnostic methods, such as spondylography, X-ray, MRI, X-ray tomography, echospondylography and others.
