WordNet

cause emotional anguish or make miserable; "It pains me to see my children not being taught well in school" (同)anguish, hurt
a symptom of some physical hurt or disorder; "the patient developed severe pain and distension" (同)hurting
a bothersome annoying person; "that kid is a terrible pain" (同)pain in the neck, nuisance
a somatic sensation of acute discomfort; "as the intensity increased the sensation changed from tickle to pain" (同)pain_sensation, painful sensation
emotional distress; a fundamental feeling that people try to avoid; "the pain of loneliness" (同)painfulness
of or relating to the anterior walls of the abdomen; "epigastric artery"
lying on or over the stomach

PrepTutorEJDIC

〈C〉〈U〉(肉体のある部分の)『苦痛』,『痛み』 / 〈U〉(精神的な)『苦痛』,心痛 / 《複数形で》骨折り,苦労,努力 / 〈C〉不快感,いやな感じ;うんざりさせるもの,やっかい者 / (肉体的・精神的に)…‘に'苦痛を与える(受動態にできない)
《補語にのみ用いて》腹を立てて / 《補語にのみ用いて》(心が)鐘ついて / 不愉快な,気まずい
とうちゃん(papa)

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2013/11/21 19:58:51」(JST)

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Abdominal pain (or stomach ache) is a common symptom associated with transient disorders or serious disease. Diagnosing the cause of abdominal pain can be difficult, because many diseases can cause this symptom. Most frequently the cause is benign and/or self-limiting, but more serious causes may require urgent intervention.

Differential diagnosis[edit]

Gastrointestinal
- GI tract
  - Inflammatory: gastroenteritis, appendicitis, gastritis, esophagitis, diverticulitis, Crohn's disease, ulcerative colitis, microscopic colitis
  - Obstruction: hernia, intussusception, volvulus, post-surgical adhesions, tumours, superior mesenteric artery syndrome, severe constipation, hemorrhoids
  - Vascular: embolism, thrombosis, hemorrhage, sickle cell disease, abdominal angina, blood vessel compression (such as celiac artery compression syndrome), Postural orthostatic tachycardia syndrome
  - digestive: peptic ulcer, lactose intolerance, coeliac disease, food allergies
- Glands
  - Bile system
    - Inflammatory: cholecystitis, cholangitis
    - Obstruction: cholelithiasis, tumours
  - Liver
    - Inflammatory: hepatitis, liver abscess
  - Pancreatic
    - Inflammatory: pancreatitis
Renal and urological
- Inflammation: pyelonephritis, bladder infection
- Obstruction: kidney stones, urolithiasis, Urinary retention, tumours
- 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: ruptured ectopic pregnancy, threatened abortion
Abdominal wall
- muscle strain or trauma
- muscular infection
- neurogenic pain: herpes zoster, radiculitis in Lyme disease, abdominal cutaneous nerve entrapment syndrome (ACNES), tabes dorsalis
Referred pain
- from the thorax: pneumonia, pulmonary embolism, ischemic heart disease, pericarditis
- from the spine: radiculitis
- from the genitals: testicular torsion
Metabolic disturbance
- uremia, diabetic ketoacidosis, porphyria, C1-esterase inhibitor deficiency, adrenal insufficiency, lead poisoning, black widow spider bite, narcotic withdrawal
Blood vessels
- aortic dissection, abdominal aortic aneurysm
Immune system
- sarcoidosis
- vasculitis
- familial Mediterranean fever
Idiopathic
- irritable bowel syndrome (affecting up to 20% of the population, IBS is the most common cause of recurrent, intermittent abdominal pain)

Acute abdominal pain[edit]

Acute abdomen can be defined as severe, persistent abdominal pain of sudden onset that is likely to require surgical intervention to treat its cause. The pain may frequently be associated with nausea and vomiting, abdominal distention, fever and signs of shock. One of the most common conditions associated with acute abdominal pain is acute appendicitis.

Selected causes of acute abdomen

Traumatic : blunt or perforating trauma to the stomach, bowel, spleen, liver, or kidney
Inflammatory :
- Infections such as appendicitis, cholecystitis, pancreatitis, pyelonephritis, pelvic inflammatory disease, hepatitis, mesenteric adenitis, or a subdiaphragmatic abscess
- Perforation of a peptic ulcer, a diverticulum, or the caecum
- Complications of inflammatory bowel disease such as Crohn's disease or ulcerative colitis
Mechanical :
- Small bowel obstruction secondary to adhesions caused by previous surgeries, intussusception, hernias, benign or malignant neoplasms
- Large bowel obstruction caused by colorectal cancer, inflammatory bowel disease, volvulus, fecal impaction or hernia
Vascular : occlusive intestinal ischemia, usually caused by thromboembolism of the superior mesenteric artery

By location[edit]

Location^[1]

Upper middle abdominal pain
- Stomach (gastritis, stomach ulcer, stomach cancer)
- Pancreas pain (pancreatitis or pancreatic cancer, can radiate to the left side of the waist, back, and even shoulder)
- Duodenal ulcer, diverticulitis
- Appendicitis (starts here, after several times moves to lower right abdomen)
Upper right abdominal pain
- Liver (caused by hepatomegaly due to fatty liver, hepatitis, or caused by liver cancer, abscess)
- Gallbladder and biliary tract (gallstones, inflammation, roundworms)
- Colon pain (below the area of liver - bowel obstruction, functional disorders, gas accumulation, spasm, inflammation, colon cancer)
Upper left abdominal pain
- Spleen pain (splenomegaly)
- Pancreas
- Colon pain (below the area of spleen - bowel obstruction, functional disorders, gas accumulation, spasm, inflammation, colon cancer)
Middle abdominal pain (pain in the area around belly button)
- Appendicitis (starts here)
- Small intestine pain (inflammation, intestinal spasm, functional disorders)
Lower abdominal pain (diarrhea and dysentery)
Lower right abdominal pain
- Cecum (intussusception, bowel obstruction)
- Appendix point (Appendicitis location)
Lower left abdominal pain
- Sigmoid colon (polyp), sigmoid volvulus, obstruction or gas accumulation)
Pelvic pain
- bladder (cystitis, may secondary to diverticulum and bladder stone, bladder cancer)
- pain in women (uterus, ovaries, fallopian tubes)
Right lumbago and back pain
- liver pain (hepatomegaly)
- right kidney pain (its location below the area of liver pain)
Left lumbago and back pain
- less in spleen pain
- left kidney pain
Low back pain
- kidney pain (kidney stone, kidney cancer, hydronephrosis)
- Ureteral stone pain

Diagnostic approach[edit]

When a physician assesses a patient to determine the etiology and subsequent treatment for abdominal pain the patient's history of the presenting complaint and physical examination should derive a diagnosis in over 90% of cases.

It is important also for a physician to remember that abdominal pain can be caused by problems outside the abdomen, especially heart attacks and pneumonias which can occasionally present as abdominal pain.

Investigations that would aid diagnosis include

Blood tests including full blood count, electrolytes, urea, creatinine, liver function tests, pregnancy test, amylase and lipase.
Urinalysis
Imaging including erect chest X-ray and plain films of the abdomen
An electrocardiograph to rule out a heart attack which can occasionally present as abdominal pain

If diagnosis remains unclear after history, examination and basic investigations as above then more advanced investigations may reveal a diagnosis. These as such would include

Computed Tomography of the abdomen/pelvis
Abdominal or pelvic ultrasound
Endoscopy and colonoscopy (not used for diagnosing acute pain)

Management[edit]

Butylscopolamine (Buscopan) is used to treat cramping abdominal pain with some success.^[2]

References[edit]

^ Richard F.LeBlond. Diagnostics. US: McGraw-Hill Companies, Inc. ISBN 0-07-140923-8.
^ Tytgat GN (2007). "Hyoscine butylbromide: a review of its use in the treatment of abdominal cramping and pain". Drugs 67 (9): 1343–57. doi:10.2165/00003495-200767090-00007. PMID 17547475.

UpToDate Contents

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1. 成人における腹痛に対する診断的アプローチ diagnostic approach to abdominal pain in adults
2. 成人における腹痛の鑑別診断 differential diagnosis of abdominal pain in adults
3. 消化不良成人患者へのアプローチ approach to the adult with dyspepsia
4. 小児および思春期における急性腹症の原因 causes of acute abdominal pain in children and adolescents
5. 消化性潰瘍：臨床症状および診断 peptic ulcer disease clinical manifestations and diagnosis

English Journal

Prevalence and risk factors of functional dyspepsia: a nationwide multicenter prospective study in Korea.

Kim SE, Park HK, Kim N, Joo YE, Baik GH, Shin JE, Seo GS, Kim GH, Kim HU, Kim HY, Kim SM, Seo JH, Park EH, Cho SI.Author information *Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam †Department of Internal Medicine, Chonnam National University Medical School, Gwangju ‡Department of Internal Medicine, Hallym University College of Medicine, Chuncheon §Department of Internal Medicine, Dankook University College of Medicine, Cheonan ∥Department of Internal Medicine, Wonkwang University College of Medicine, Iksan ¶Department of Internal Medicine, Pusan National University School of Medicine, Busan #Department of Internal Medicine, Jeju National University School of Medicine, Jeju **School of Public Health and Institute of Health and Environment, Seoul National University, Seoul, South Korea.AbstractGOALS: To evaluate the prevalence of functional dyspepsia (FD) and its risk factors.
Journal of clinical gastroenterology.J Clin Gastroenterol.2014 Feb;48(2):e12-8. doi: 10.1097/MCG.0b013e31828f4bc9.
GOALS: To evaluate the prevalence of functional dyspepsia (FD) and its risk factors.BACKGROUND: FD is a common disorder, but its negative influences greatly affect the quality of life. The predictive factors of FD are still ambiguous.STUDY: A total of 3399 participants underwent screening gastroscop
PMID 23632355

The Rome III Criteria for the Diagnosis of Functional Dyspepsia in Secondary Care are not Superior to Previous Definitions.

Ford AC1, Bercik P2, Morgan DG3, Bolino C2, Pintos-Sanchez MI2, Moayyedi P2.Author information 1Leeds Gastroenterology Institute, St. James's University Hospital, Leeds, UK; Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK. Electronic address: alexf12399@yahoo.com.2Farncombe Family Digestive Health Research Institute, Gastroenterology Division, McMaster University, Health Sciences Center, Hamilton, Ontario, Canada.3Gastroenterology Department, St. Joseph's Healthcare, Hamilton, Ontario, Canada.AbstractBACKGROUND & AIMS: Although the Rome III criteria for functional dyspepsia were defined 7 years ago, they have yet to be validated in a rigorous study. We addressed this issue in a secondary-care population.
Gastroenterology.Gastroenterology.2014 Jan 10. pii: S0016-5085(14)00027-4. doi: 10.1053/j.gastro.2014.01.014. [Epub ahead of print]
BACKGROUND & AIMS: Although the Rome III criteria for functional dyspepsia were defined 7 years ago, they have yet to be validated in a rigorous study. We addressed this issue in a secondary-care population.METHODS: We analyzed complete symptom, upper gastrointestinal (GI) endoscopy, and histolo
PMID 24417817

Esophageal actinomycosis in a patient with end-stage renal disease.

Nagaraju SP, Kirpalani DA, Bhabhe AS, Prasad R, Shah H, Kirpalani AL.Author information Department of Nephrology, Kasturba Medical College, Manipal University, Manipal, India.AbstractActinomycosis of esophagus is uncommon. Herpes simplex virus, cytomegalovirus, candidiasis, tuberculosis, and other fungal infections are the commonly reported infections in both immunocompromised and immunocompetent patients. We report a case of esophageal actinomycosis in an end-stage renal disease patient. A 28-year-old lady, known case of systemic lupus erythematosus, hepatitis B virus infection with end-stage renal disease on regular maintenance hemodialysis since 5 years presented with history of epigastric pain and odynophagia for 1 week. Her upper gastrointestinal endoscopic examination revealed extensive necrotic areas with membrane in the esophagus. Histopathology revealed actinomycotic colonies and bacterial clumps. She was treated with intravenous penicillin followed by oral ampicillin for 6 months. She showed marked clinical improvement, and repeat endoscopy showed healing of ulceration and no evidence of actinomycosis.
Hemodialysis international. International Symposium on Home Hemodialysis.Hemodial Int.2014 Jan 7. doi: 10.1111/hdi.12124. [Epub ahead of print]
Actinomycosis of esophagus is uncommon. Herpes simplex virus, cytomegalovirus, candidiasis, tuberculosis, and other fungal infections are the commonly reported infections in both immunocompromised and immunocompetent patients. We report a case of esophageal actinomycosis in an end-stage renal diseas
PMID 24393413

Japanese Journal

Management of Concomitant Large Aortic Aneurysm and Severe Stenosis of Aortic Arc

Ren Shiyan,Sun Guang,Yang Yuguang,Liu Peng
Annals of Thoracic and Cardiovascular Surgery, 2013
… A 59-year-old woman with a 7-day history of headache, dizziness and chest pain, and a 5-year history of hypertension admitted and was diagnosed with transverse aortic aneurysm with sever aortic stenosis, the huge saccular aneurysm was located behind the transverse aortic arc. … A collateral pathway between internal mammary artery and inferior epigastric artery via the superior epigastric artery was found on3-dimensional reconstruction before surgery. …
NAID 130003377837

経過観察中にBall valve syndromeを呈した胃Inflammatory fibroid polypの1例

塩入利一,小林洋明,武田良祝,石橋至,河原正樹,岡輝明
日本消化器内視鏡学会雑誌 55(8), 2214-2219, 2013
症例は85歳の男性，胃粘膜下腫瘍の経過観察中に腹痛および嘔吐が出現し，当院救急外来を受診．上部消化管内視鏡検査・上部消化管造影検査・腹部CT検査等から，胃粘膜下腫瘍によるBall valve syndromeと診断し，胃局所切除術を行った．腫瘍は病理組織学的検査により，胃Inflammatory fibroid polypと診断された．本症例は経過観察中にBall valve syndromeを呈 …
NAID 130003375348

Clinical Classification of Subgroups According to the Rome III Criteria Cannot be Used to Distinguish the Associated Respective Pathophysiology in Japanese Patients with Functional Dyspepsia

Ochi Masahiro,Tominaga Kazunari,Tanaka Fumio,Tanigawa Tetsuya,Yamagami Hirokazu,Watanabe Kenji,Watanabe Toshio,Fujiwara Yasuhiro,Arakawa Tetsuo
Internal Medicine 52(12), 1289-1293, 2013
… Objective Patients who meet the Rome III criteria for functional dyspepsia (FD) are generally classified into the following two subgroups, those with postprandial distress syndrome (PDS) and those with epigastric pain syndrome (EPS), in order to treat the dyspeptic symptoms caused by the respective pathophysiological conditions. …
NAID 130003365673