One of the most common and most challenging symptoms resulting in medical evaluation is abdominal pain.
The range of potential causes is quite broad and is the subject of many texts designed to educate medical providers. Yet, certain aspects of abdominal pain merit consideration by the general public in an effort to improve recognition and treatment of disease.
For starters, new abdominal pain that is severe should always lead to medical evaluation. Similarly, pain accompanied by a prolonged high fever, severe vomiting, blood in vomit or stool or blaccolored stool (which may indicate internal gastrointestinal bleeding) may represent a medical emergency. An urgent medical assessment is warranted to determine the source of the pain.
Pain location can sometimes give a clue as to the cause. For instance, right-side upper abdominal pain may be attributable to gallbladder problems, ranging from gallstones to an infected gallbladder. Appendicitis, on the other hand, most commonly produces pain in the right lower abdomen. Both conditions commonly require surgery.
Less serious causes of short-term abdominal pain include viral gastroenteritis and dyspepsia. Gastroenteritis is a condition most commonly caused by a viral agent known as Norwalk virus. This typically produces sudden onset of nausea, vomiting and frequent watery diarrhea often associated with abdominal cramping. Duration is usually less than two to three days. Treatment is often geared toward control of symptoms, and the most important issue is maintaining adequate hydration.
Dyspepsia is discomfort in the central upper abdomen or lower chest, sometimes referred to as indigestion. It is sometimes associated with nausea, heartburn or a bloated sensation. It is sometimes associated with heartburn and may follow a large meal. It may also occur when lying down soon after a meal. Severe or prolonged dyspepsia symptoms should prompt a medical evaluation to exclude other causes.
Chronic abdominal pain lasting for more than a few weeks may be the result of benign or serious causes. Prolonged, severe or recurrent abdominal pain always merits medical evaluation to determine the source. Causes vary based on characteristics, including gender, age and risk factors. Chronic abdominal pain associated with weight loss may indicate a serious cause.
Two common and important causes of chronic abdominal pain are irritable bowel syndrome and celiac disease. These conditions can share similar symptoms, but it is essential to distinguish the two. Symptoms may include diarrhea, constipation, abdominal bloating and pain. While irritable bowel syndrome is troublesome, it is not dangerous.
However, celiac disease, resulting from sensitivity to gluten in the diet, is actually a multisystem disease with potentially significant complications ranging from anemia to cancer. Symptoms often persist for years before diagnosis, which can have significant health consequences.
Dr. Matthew A. Clark is a board-certified physician practicing at the Ute Mountain Ute Health Center in Towaoc.