Flank pain due to renal hemorrhage, calculi, or urinary tract infection is the most common symptom reported by patients.([1])

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
be located at the sides of something or somebody
a subfigure consisting of a side of something
the side between ribs and hipbone
the side of military or naval formation; "they attacked the enemys right flank" (同)wing
a cut from the fleshy part of an animals side between the ribs and the leg
open pastry filled with fruit or custard

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)
(人・動物の)横腹;わき腹の[筋]肉 / (建物・山・道路などの)わき,横側,側面 / (軍隊の編隊・配置,要塞の)右翼(または左翼) / …‘の'側面に置く(並べる)
フラン(果物・チーズ入りパイ)
《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

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/07/15 18:19:46」(JST)

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Abdominal pain or stomach pain is a common symptom associated with both temporary, non-serious disorders and more serious conditions.

Common causes include gastroenteritis and irritable bowel syndrome. In a third of cases the exact cause is unclear. About 10% of people have a more serious underlying condition such as appendicitis or diverticulitis.^[1] Determining the cause can be difficult, because many diseases can cause this symptom.

Differential diagnosis

The most frequent cause of abdominal pain is gastroenteritis (13%), irritable bowel syndrome (8%), urinary tract problems (5%), inflammation of the stomach (5%) and constipation (5%). About 30% of cases the cause is not determined. About 10% of cases have a more serious cause including gallbladder or pancreas problems (4%), diverticulitis (3%), appendicitis (2%) and cancer (1%).^[1] More common in those who are older, mesenteric ischemia and abdominal aortic aneurysms are other serious causes.^[2]

A more extensive list includes the following:

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

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

Location^[3]

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, colitis 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 be 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

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 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 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

Butylscopolamine (Buscopan) is used to treat cramping abdominal pain with some success.^[4]

Epidemiology

Abdominal pain is the reason about 3% of adults see their family physician.^[1] Rates of emergency department visits in the United States for abdominal pain increased 18% from 2006 through 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%.^[5]

References

^ ^a ^b ^c Viniol, A; Keunecke, C; Biroga, T; Stadje, R; Dornieden, K; Bösner, S; Donner-Banzhoff, N; Haasenritter, J; Becker, A (October 2014). "Studies of the symptom abdominal pain--a systematic review and meta-analysis.". Family practice 31 (5): 517–29. doi:10.1093/fampra/cmu036. PMID 24987023.
^ 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/preaccept-3303381914150346. PMID 25635203.
^ 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.
^ 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.

UpToDate Contents

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English Journal

Paediatric percutaneous nephrolithotomy: Single-centre 10-year experience.

Bhageria A, Nayak B, Seth A, Dogra PN, Kumar R.SourceDepartment of Urology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India.
Journal of pediatric urology.J Pediatr Urol.2013 Aug;9(4):472-5. doi: 10.1016/j.jpurol.2013.02.004. Epub 2013 Mar 13.
INTRODUCTION: Percutaneous nephrolithotomy (PCNL) is a standard management option for complex and large renal calculi. In children, there is some concern over potential perioperative complications. We reviewed our 10 years of experience of PCNL in children and present our data.MATERIAL AND METHODS:
PMID 23498666

Ureteroileal strictures after urinary diversion with an ileal segment-is there a place for endourological treatment at all?

Schöndorf D, Meierhans-Ruf S, Kiss B, Giannarini G, Thalmann GN, Studer UE, Roth B.SourceDepartment of Urology, University of Bern, Bern, Switzerland.
The Journal of urology.J Urol.2013 Aug;190(2):585-90. doi: 10.1016/j.juro.2013.02.039. Epub 2013 Feb 20.
PURPOSE: We compared the long-term results of minimally invasive endourological intervention and open surgical revision in patients with a nonmalignant ureteroileal stricture.MATERIALS AND METHODS: We retrospectively evaluated the records of 74 patients (85 renal units) treated for unilateral or bil
PMID 23454401

Abdominal pain localization is associated with non-diarrheic Rome III functional gastrointestinal disorders.

Bouchoucha M, Fysekidis M, Devroede G, Raynaud JJ, Bejou B, Benamouzig R.SourceService de Physiologie, Université René Descartes, Paris V, Paris, France; Service de Gastrœntérologie, Hôpital Avicenne, Bobigny, France.
Neurogastroenterology and motility : the official journal of the European Gastrointestinal Motility Society.Neurogastroenterol Motil.2013 Aug;25(8):686-93. doi: 10.1111/nmo.12149. Epub 2013 May 27.
BACKGROUND: Abdominal pain is common in patients with functional bowel disorders (FBDs). The aim of this study was to characterize the predominant sites of abdominal pain associated with FBD subtypes, as defined by the Rome III criteria.METHODS: A total of 584 consecutive patients attending FBD cons
PMID 23710967

Japanese Journal

Pararenal Lymphatic Cyst Infection Caused by Helicobacter cinaedi

, , , , , , , , , ,
Internal Medicine 54(11), 1437-1440, 2015
… A 43-year-old man was referred to our hospital for an acute-onset fever and left flank pain. …
NAID 130005072934

Von Hippel-Lindau病腎癌におけるラジオ波焼灼術の検討

波越朋也,島本力,辛島尚 [他],亀井麻依子,福原秀雄,深田聡,佐竹宏文,蘆田真吾,山崎一郎,鎌田雅行,井上啓史,山西伴明,小川恭弘,伊藤悟志,執印太郎
泌尿器科紀要 = Acta urologica Japonica 60(9), 415-420, 2014-09
… While minimal flank pain, nausea, perinephritic hematoma and lumbago were observed, there was no major complication during or after the procedure. …
NAID 120005477663

画像診断困難な転移を有する腎孟腫瘍の2例

篠原雅岳,細川幸成,飯田孝太 [他],武長真保,伊丹祥隆,林美樹,藤本清秀
泌尿器科紀要 = Acta urologica Japonica 60(5), 231-235, 2014-05
… Case 1 : A 60-year-old man presented with right flank pain. …
NAID 120005439521

Related Pictures

★リンクテーブル★

国試過去問	「109F025」
リンク元	「側腹部痛」「側腹痛」
関連記事	「pain」「flank」「flanking」「pai」

「109F025」

Abdominal pain
	Abdominal pain can be characterized by the region it affects.
Specialty	General surgery
ICD-10	R10
ICD-9	789.0
MedlinePlus	003120

　　[★]

44歳の男性。航空会社の職員に付き添われて空港内の診療所を受診した。持参した英文紹介状の一部を示す。
This patient is a 44-year-old man with a complaint of right flank pain＊. The pain suddenly occurred while he was on the airplane. It was colicky and radiated to the right inguinal region. Neither nausea nor diarrhea was associated. He had appendectomy when he was 8 years old.
Urinalysis results: Protein(-), Sugar(-), Occult blood(2+)
＊flank pain: lateral abdominal pain
出張のため近隣国へ向かう飛行機内で上記の症状を認めたため、到着直後に現地の空港内の診療所を受診し鎮痛薬を投与された。疼痛は我慢できる程度になり、予定を変更して次の便で日本に帰国した。現在、紹介状に書かれた症状は我慢できる程度に続いており、新たに生じた症状はない。意識は清明。身長 165cm、体重 68kg。体温 37.1℃。脈拍 76/分、整。血圧 136/76mmHg。
この患者にみられる可能性の高い身体診察所見はどれか。