lower abdominal pain

• 下腹部痛、下腹痛

WordNet

1. unrefined in character; "low comedy"
2. an air mass of lower pressure; often brings precipitation; "a low moved in over night bringing sleet and snow" (同)depression
3. a low level or position or degree; "the stock market fell to a new low"
4. used of sounds and voices; low in pitch or frequency (同)low-pitched
5. very low in volume; "a low murmur"; "the low-toned murmur of the surf" (同)low-toned
6. in a low position; near the ground; "the branches hung low"
7. less than normal in degree or intensity or amount; "low prices"; "the reservoir is low"
8. literal meanings; being at or having a relatively small elevation or upward extension; "low ceilings"; "low clouds"; "low hills"; "the sun is low"; "low furniture"; "a low bow"
9. cause emotional anguish or make miserable; "It pains me to see my children not being taught well in school" (同)anguish, hurt
10. a symptom of some physical hurt or disorder; "the patient developed severe pain and distension" (同)hurting
11. a bothersome annoying person; "that kid is a terrible pain" (同)pain in the neck, nuisance
12. a somatic sensation of acute discomfort; "as the intensity increased the sensation changed from tickle to pain" (同)pain_sensation, painful sensation
13. emotional distress; a fundamental feeling that people try to avoid; "the pain of loneliness" (同)painfulness
14. move something or somebody to a lower position; "take down the vase from the shelf" (同)take_down, let down, get_down, bring_down
15. cause to drop or sink; "The lack of rain had depressed the water level in the reservoir" (同)depress
16. set lower; "lower a rating"; "lower expectations" (同)lour
17. the act of causing something to move to a lower level (同)letting down
18. the act of causing to become less
19. the muscles of the abdomen (同)abdominal_muscle, ab
20. of or relating to or near the abdomen; "abdominal muscles"

PrepTutorEJDIC

1. (高さ・位置が)『低い』,低い所にある / (価格・数量・程度などが)『低い』,少ない / (身分・地位などが)『低い』,卑しい / (人格・行為などが)『卑しい』,下劣な,下品な / 《補語にのみ用いて》(体が)『弱った』;元気のない,憂うつな / (供給が)不十分な;(…が)乏しい《+『in』(『on』)+『名』》 / (音・声が)低い,小さい / (生物が)下等な / 『低く』,低い所に / (価格・程度などが)『安く』,低く / 低い声(調子)で;静かに / 最低点,最低水準
2. (牛の)モーという鳴き声 / (牛が)モーと鳴く
3. 〈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)
4. (lowの比較級)『もっと低い』,(価格が)もっと安い / 《名詞の前にのみ用いて》『下級の』;低い(下の)ほうの / …‘を'『下げる』,降ろす / 〈価格・程度・量・調子など〉‘を'『下げる』,小さくする,低下させる / 〈人〉‘を'品位(品格)を落とす / 低くなる,下がる,滅る
5. (…に向かって)顔をしかめる,まゆをひそめる《+『at(on, upon)』+『名』》 / 〈空模様が〉険悪になる,〈雨などが〉降りそうな / しかめっつら / 険悪な空模様
6. 低くする,低下させる;堕落させる
7. (空模様が)険悪な,荒れ模様の / しかめっつらの,(顔つきが)不機嫌な
8. (比較変化なし)腹の,腹部の

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2014/08/13 11:31:49」(JST)

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Abdominal pain

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

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

• 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

• 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 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 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

Butylscopolamine (Buscopan) is used to treat cramping abdominal pain with some success.

References

Further reading

• Boyle, J. T.; Hamel-Lambert, J. (2001). "Biopsychosocial issues in functional abdominal pain". Pediatr Ann 30 (1): 32–40. PMID 11195732. 
• Abdominal pain

UpToDate Contents

全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.

• 1. 成人における腹痛の鑑別診断 differential diagnosis of abdominal pain in adults
• 2. 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
• 3. 小児および思春期の慢性腹痛：評価のためのアプローチ chronic abdominal pain in children and adolescents approach to the evaluation
• 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. 妊娠中の女性および産後の女性における腹痛および急性腹症に対するアプローチ approach to abdominal pain and the acute abdomen in pregnant and postpartum women

English Journal

• I smell a rat: a case report and literature review of paradoxical thrombosis and hemorrhage in a patient with brodifacoum toxicity.

• Franco D, Everett G, Manoucheri M.SourceInternal Medicine Residency Program, Florida Hospital Orlando, Orlando, Florida, USA.
• Blood coagulation & fibrinolysis : an international journal in haemostasis and thrombosis.Blood Coagul Fibrinolysis.2013 Mar;24(2):202-4. doi: 10.1097/MBC.0b013e328358e959.
• Brodifacoum poisoning occurs as a result of ingestion of rodenticide compounds. It acts as a superwarfarin, inhibiting vitamin K epoxide reductase, in an irreversible fashion much like warfarin but with a much longer half-life. A 48-year-old female patient reported 4 days of mild dyspnea, dry cough,
• PMID 23358203

• Cutaneous vasculitis in ulcerative colitis mimicking Henoch-Schönlein purpura.

• de Oliveira GT, Martins SS, Deboni M, Picciarelli P, Campos LM, Jesus AA, Koda YK, Silva CA.SourcePediatric Rheumatology Unit, Children's Institute, Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil.
• Journal of Crohn's & colitis.J Crohns Colitis.2013 Mar 1;7(2):e69-73. doi: 10.1016/j.crohns.2012.05.001. Epub 2012 May 22.
• To the best of our knowledge, no cases of ulcerative colitis (UC) mimicking Henoch-Schönlein purpura (HSP) have been reported so far. During a 28-year period 5635 patients were followed up at our Pediatric Rheumatology Unit and 357 had HSP according to the European League Against Rheumatism, the Pa
• PMID 22626504

Japanese Journal

• 腰痛,腹痛,下腹痛 (特集 泌尿器科救急の実際)

• 有吉 孝一
• 救急医学 = The Japanese journal of acute medicine 36(13), 1745-1749, 2012-12
• NAID 40019528019

• 後腹膜腫瘍と鑑別が困難であった肋骨原発軟骨肉腫の1例

• 永田 雄大,白石 晃司,松山 豪泰
• 泌尿器科紀要 = Acta urologica Japonica 58(11), 605-608, 2012-11
• … A 57-year-old woman was admitted with chief complaints of pain in the right lower quadrant and weight loss. … The tumor was approached via upper abdominal midline incision and was found to be immobile. …
• NAID 40019497377

• 後腹膜腔多発性嚢胞を形成した前立腺導管腺癌の1例

• 惣田 哲次,福本 亮,林 哲也
• 泌尿器科紀要 = Acta urologica Japonica 58(10), 561-564, 2012-10
• … A 61-year-old man came to our hospital with a complaint of lower abdominal pain. … Computed tomography (CT) and magnetic resonance imaging (MRI) around his abdominal area showed large multiple cysts in the pelvis suggesting a malignant tumor. …
• NAID 40019492159

Related Links

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Related Pictures

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★リンクテーブル★

リンク元	「下腹部痛」
関連記事	「lower」「pain」「low」「abdominal」「lowering」

「下腹部痛」

　　[★]

英

lower abdominal pain

関

下腹痛。腹痛

診療エッセンシャルズ.271 改変

• 右下腹部＋左下腹部

消化器	虫垂炎、腸炎、憩室炎、炎症性腸疾患、虚血性大腸炎、ヘルニア嵌頓(内鼠径/外鼠径、閉鎖孔、大腿)、過敏性腸症候群、S状結腸捻転、腸結核
婦人科	子宮外妊娠、卵巣腫瘍茎捻転、骨盤内炎症性疾患、子宮内膜症
泌尿器	尿管結石、膀胱炎、精巣捻転

産婦人科疾患

NGY.138

急性かつ重篤な下腹痛

• 1. 子宮外妊娠
• 2. 卵巣出血
• 3. 卵巣腫瘍茎捻転

中等度の下腹痛

• 1. 鎖陰
• 2. 卵巣嚢腫破裂
• 3. 子宮内膜症
• 4. 月経困難症
• 5. 子宮筋腫
• 6. 急性付属器炎、子宮内膜炎：子宮内膜炎は子宮内操作や流産後などに起こり、ほとんどが上行性感染と考えられ、発熱や不正出血などの随伴症状を伴うことが多い。卵管に炎症が波及し付属器炎になると下腹痛も増悪し、骨盤腹膜炎を来すことがある。起因菌はクラミジアの頻度が増加している。(参考1)
• 7. 流産

産婦人科の下腹部痛の鑑別疾患

参考1

• 急性虫垂炎
• 絞扼性イレウス
• 大腸憩室炎
• 胃潰瘍穿孔
• 十二指腸潰瘍穿孔
• 腹膜炎
• 尿路結石
• 腸間膜動脈血栓症

病みえ産婦人科

引用p.212

経過	婦人科	産科	消化器/泌尿器/内分泌など
急性	骨盤腹膜炎	流産	腹部大動脈瘤破裂
	付属器炎	早産	急性虫垂炎
	子宮内膜炎	異所性妊娠	小腸閉塞
	卵巣茎捻転	常位胎盤早期剥離	汎発性腹膜炎
	卵巣出血	子宮破裂	イレウス
	卵巣腫瘍		消化管穿孔
	子宮留膿症の破裂		S状結腸軸捻転症
	排卵痛		ヘルニア
	月経モリミナ		尿管結石
	卵巣過剰刺激症候群		腎結石
			大腸憩室炎
			急性胃腸炎
			虚血性腸炎
			糖尿病性ケトアシドーシス
慢性	月経困難症		Crohn病
	子宮腺筋症		潰瘍性大腸炎
	子宮内膜症		過敏性腸症候群
	子宮筋腫		便秘症

妊娠の有無による鑑別

• 妊娠反応陽性：子宮外妊娠(妊娠5-8週)、切迫流産、進行流産、不全流産、完全流産、絨毛性疾患、(妊娠反応陰性の場合の疾患も鑑別に)
• 妊娠反応陰性：骨盤内感染症、虫垂炎、腸炎、憩室炎、卵巣腫瘍茎捻転

参考

• 1. （12）日本産婦人科医会研修プログラム；痛みの診断と治療

3）急性腹症，がん性疼痛への対応 - 日産婦誌５８巻９号

http://www.jsog.or.jp/PDF/58/5809-395.pdf

「lower」

　　[★]

• adj.

• (low比較級)より低い、下位の、下等な、低次の、低下させる、低減させる

関

decline、decrease、depression、drop、fall、inferio、inferior、inferiorly、low level、lower dimension、lower level、lower order、lowering、reduction

　 　 　 　 　

「pain」

　　[★]

• n.

• 疼痛

http://dictionary.reference.com/browse/pain

• n.

• physical suffering or distress, as due to injury, illness, etc.
• a distressing sensation in a particular part of the body
• mental or emotional suffering or torment
• pains,

• laborious or careful efforts; assiduous care
• the suffering of childbirth.

　 　 　 　 　 　

「low」

　　[★]

• adj.

• (比較級lower-最上級lowest)低い、不十分な

関

deficient、inadequate、insufficiency、insufficient、insufficiently、poorly、scanty

　 　 　 　 　 　 　 　 　 　

「abdominal」

　　[★]

• adj.

• 腹腔の、腹部の

関

abdomen、abdominal cavity、abdominis、belly、celiac、coeliac、peritoneal cavity、ventral

　 　 　

「lowering」

　　[★]

• n.

• 低下、低減

関

decline、decrease、depression、drop、fall、lower、reduction