Unraveling Acute Abdominal Pain: A Tale from Urgent Care
In this article, we’ll explore acute abdominal pain’s many causes, symptoms, and potential treatment options including urgent care facilities like Urgent Care Brisbane. We’ll also go over the typical steps a doctor will take to provide a differential diagnosis for a patient presenting with acute abdominal pain.
Abdominal Pain in Children
Abdominal pain in children is usually mild, and is commonly caused by minor illnesses such as gastroenteritis (inflammation of the digestive system) or viral infections.
Nevertheless, it’s very important to recognize that abdominal pain may indicate a more serious medical or surgical condition in a small percentage of children. It’s absolutely critical for caregivers and medical providers to carefully evaluate children who are complaining of abdominal pain in order to differentiate between potentially life-threatening conditions and comparatively minor ones.
Acuity of Pain
Abdominal pain can be categorised into different acuity levels, including acute, subacute, and chronic pain, depending on certain criteria.
Acute Pain
Acute pain is severe pain that lasts between a few hours and a few days. It’s usually caused by some kind of infection, inflammation, vascular occlusion (blood flow restriction), or obstruction. People who are experiencing acute abdominal conditions normally notice an abrupt onset of pain that is often accompanied by additional symptoms like nausea or vomiting.
Subacute Pain
Subacute pain is a specific type of acute pain. It’s usually defined as acute pain that lasts for more than 6 weeks but less than 3 months.
Chronic Pain
Chronic pain can last for months or years. It may be episodic or intermittent, meaning it comes and goes, or progressive, meaning it worsens gradually over time. It may also remain the same for a long period of time without worsening or improving.
It’s often very challenging to determine the specific cause of chronic abdominal pain. Some of the conditions that can cause chronic abdominal pain include:
- Angina
- Celiac disease
- Endometriosis
- Gallstones
- Ovarian cysts
- Irritable bowel syndrome (IBS)
- Peptic ulcers
- Sickle cell anaemia
- Ulcerative colitis
Causes of Acute Abdominal Pain
There are many possible underlying causes of acute abdominal pain, ranging from relatively minor, non-life-threatening conditions to serious emergencies that require urgent medical attention.
Some of the most common causes of acute abdominal pain include:
Appendicitis
Appendicitis is a relatively common condition that occurs when the appendix becomes inflamed and infected. The primary symptom is severe abdominal pain that typically begins around the belly button and gradually migrates to the lower right abdomen. Appendicitis is a medical emergency that often requires surgical removal of the appendix to prevent serious and potentially life-threatening complications.
Pancreatitis
Pancreatitis is a condition characterised by inflammation of the pancreas, which is a gland located behind the stomach. There are numerous factors that can trigger pancreatitis, including gallstones, alcohol abuse, or certain medications. Pancreatitis patients normally experience severe pain in the upper abdomen and may require hospitalisation.
Intestinal Obstructions
Intestinal obstructions (also called bowel obstructions) occur when a blockage in the intestines prevents food, fluids, and gas from passing normally. A few common causes of intestinal obstructions include:
- Hernias
- Tumours
- Adhesions (scar tissue)
- Impacted faeces
Abdominal pain caused by an obstruction is typically accompanied by additional symptoms like bloating, constipation, and vomiting.
Mesenteric Ischemia
Mesenteric ischemia occurs when blood flow to the intestines is cut off, leading to tissue damage. This condition is usually caused by blood clots or narrowing of the arteries that supply blood to the intestines. Mesenteric ischemia causes severe abdominal pain and requires prompt diagnosis and intervention to prevent long-term intestinal damage.
Kidney Stones
Kidney stones are hard deposits of minerals and salts that form in the kidneys and cause excruciating pain when they eventually pass through the urinary tract. The pain typically starts in the back or side and radiates to the lower abdomen. Kidney stones can develop for a number of reasons, including chronic dehydration or too much sodium in your diet.
Kidney Infection (Pyelonephritis)
Pyelonephritis occurs when the kidneys become severely infected due to the presence of bacteria from the urinary tract. Along with frequent urination and a burning sensation, patients with Pyelonephritis generally experience acute abdominal pain, especially in their sides and lower back. Doctors often recommend treating kidney infections with antibiotics to prevent further kidney damage.
Urinary Tract Infection (UTI)
A UTI is a bacterial infection that can affect any part of the urinary system, including the bladder and urethra. UTIs are typically associated with lower abdominal pain in addition to urinary symptoms such as frequent urination or a strong urge to urinate. UTIs require prompt medical attention to prevent the infection from spreading to the kidneys.
Viral Gastroenteritis
Viral gastroenteritis (also known as the stomach flu) is an infection of the gastrointestinal tract. It normally causes the usual flu symptoms like nausea, vomiting, diarrhoea, and abdominal pain. While viral gastroenteritis is not usually a medical emergency in otherwise healthy individuals, it’s essential to stay hydrated and monitor symptoms closely to prevent complications from developing.
Ovarian Torsion
Ovarian torsion occurs when an ovary becomes twisted and its blood supply becomes compromised. This typically causes acute pelvic pain that often radiates to the lower abdomen. Prompt medical intervention is required to restore blood flow to the ovary and prevent lasting tissue damage.
Ruptured Ectopic Pregnancy
An ectopic pregnancy occurs when the fertilised egg implants outside of the uterus, often in the fallopian tube. This can cause the fallopian tube to rupture, resulting in sudden and severe abdominal pain that’s usually accompanied by vaginal bleeding. A ruptured ectopic pregnancy is a life-threatening condition that requires immediate medical attention.
Other Serious Conditions
There are numerous other serious conditions can cause acute abdominal pain, including:
- A ruptured abdominal aortic aneurysm
- Spleen or liver lacerations (usually resulting from trauma)
- Stomach or intestine perforations
- Diverticulitis (inflammation in the colon wall)
- Cholecystitis (inflammation of the gallbladder)
- Pneumonia
- Pulmonary infarction (blockage of blood supply to the lungs)
- Peritonitis (inflammation of the abdominal wall membrane)
It’s important to note that abdominal pain is sometimes referred pain — meaning it stems from a cause outside the abdomen (for example, testicular torsion). A thorough medical evaluation performed by a trained medical provider is always necessary to accurately identify the source of acute abdominal pain.
Symptoms of Acute Abdominal Pain
To understand the underlying cause of acute abdominal pain, it’s especially important to pay attention to the pain’s specific location. The location of the pain can indicate certain causes and rule out others.
Upper Abdominal Pain
Upper abdominal pain is usually associated with the stomach, liver, and pancreas. Conditions like peptic ulcer disease, gastritis, or pancreatitis typically cause upper abdominal pain.
Midabdominal Pain
Midabdominal pain (near the navel) normally indicates issues with the small intestine, upper colon, or appendix. Appendicitis, diverticulitis, or inflammatory bowel disease are examples of conditions that can cause midabdominal pain.
Lower Abdominal Pain
Lower abdominal pain is commonly caused by problems in the genitourinary tract or the lower part of the colon. Conditions like urinary tract infections, ovarian cysts, or endometriosis often lead to lower abdominal pain.
Additional Signs of Acute Abdominal Pain
Acute abdominal pain often appears alongside various other symptoms. Understanding these related symptoms is one of the best ways to determine the cause and urgency of acute abdominal pain.
In general, a person’s overall appearance can provide important clues about the type of abdominal condition they are experiencing. Unusual changes in skin colour, body temperature, or mental state typically indicate more severe cases.
Specifically, patients with acute abdominal pain may appear pale, sweaty, anxious, or in obvious distress and physical discomfort. In especially severe cases, the individual may begin to display symptoms of shock.
Tests Needed for Abdominal Pain Assessment
Appropriate diagnostic testing for acute abdominal pain varies widely based on the clinical situation and suspected cause of the abdominal pain.
Blood Testing
Blood tests can be useful if infection or risk of blood loss is suspected. Blood testing for acute abdominal pain generally involves a complete blood count.
Urine Testing
Urine testing is often conducted to look for signs of urinary tract infection or kidney stones in patients experiencing abdominal pain. A urine or serum pregnancy test may also be necessary if an ectopic pregnancy is suspected.
CT Scans
Imaging technology plays a critical role in diagnosing acute abdominal pain. Multislice helical CT scanning makes it possible for doctors to identify many (though not all) of the common causes of acute abdominal pain with relative ease.
Ultrasounds
Ultrasound technology is particularly helpful in assessing gallbladder or gynecologic disorders. It’s also the preferred method of diagnosing conditions like cholecystitis, paediatric appendicitis, ovarian torsion, and ruptured ectopic pregnancies.
Endoscopy
In certain cases, an endoscopic evaluation may be necessary to visualise and identify potential sources of pain in the gastrointestinal tract.
Managing Acute Abdominal Pain
Responsible and effective management of acute abdominal pain should include a thorough evaluation from a licensed medical professional who can perform appropriate interventions. A doctor’s physical examination will typically include palpitation (pressing gently on various areas of the belly to check for a rigid abdomen or other abnormalities), assessment of bowel sounds, and additional evaluation such as a rectal or pelvic exam as deemed necessary.
Urgent Transfer
Depending on what the doctor finds during their examination, further consultation with a specialist or surgeon may be required. In cases where the patient is determined to be critically unwell, urgent transfer to a hospital emergency department is usually the best course of action.
Discharge with Follow up Plan
If hospitalisation or surgical intervention is not necessary, treatment options may include pain management and supportive care. Historically, many doctors have been reluctant to administer pain relievers to patients with severe abdominal pain due to concerns that it might mask important symptoms. However, it’s now understood among medical professionals that pain relievers in certain doses are perfectly appropriate as long as the patient’s condition is stable.
Abdominal Pain Management at Urgent Care Brisbane
Urgent Care Brisbane is staffed with experienced emergency doctors who specialise in treating urgent conditions such as those that cause acute abdominal pain. Our step-by-step approach to abdominal pain care includes a thorough evaluation of your symptoms and medical history and appropriate on-site diagnostic testing.
Urgent Care Brisbane offers comprehensive services including on-site radiology for initial imaging, closed reduction capabilities, casting options, and timely follow-up consultations to ensure optimal patient care. For all non-life threatening emergencies, you can walk in 7 days per week between the hours of 10 a.m. to 9 p.m. and be seen by a medical professional right away.
