Abdominal pain largely indicates our daily habits, lifestyle, eating habits, and mental condition. Most of the abdominal pain depends on our food habits and mental health. Our brain is the primary driver of our body, like the abdomen and stomach. If you are stressed or overthinking, your brain fails to deliver the proper digestion signal and others.
On the other hand, our food habits primarily affect our abdomen and create abdominal pain frequently. Our stomach has several kinds of rules for working correctly. So if you break the rules, you must feel the pain, which is stomach or abdominal pain. I explain the abdominal pain causes, types, identification, and prevention guidelines. Let’s start our abdominal class!
How do abdominal and stomachs work?
The role of the stomach is to break down the food you eat. The stomach will primarily break down the protein and extract the minerals when carbohydrates hit the stomach. The amylase enzymes have already worked on them in your mouth, and the belly kills bacteria and viruses from getting into your system.
- The stomach must be very acidic regarding pH levels to break down your food and kill off any potential bacteria. It needs to be in the range of one to three. If your stomach acid is higher than this, it won’t trigger the liver to release bile. Now boiling is the thing that will help you break down these fats and extract the fat-soluble vitamins.
- It also helps you absorb fatty acids; the liver produces bile. The bile is thought in the gallbladder, which is responsible for fat metabolism in the body. So if your stomach isn’t acidic enough, the liver won’t release enough oil, and you can become deficient embalm.
- This is one of the primary mechanisms that will trigger bloating symptoms, but we will get to this shortly then we have the pancreas. The pancreas’ role in the body is to produce enzymes, which are proteins that will help you break down your food.
- So you have specific enzymes to break down carbs, fats, and proteins, so the stomach, liver, and gallbladder all work together to break down the food before it is sent to these small intestines, where the gut microbiome further breaks it down. All other different types of microbes in your gut, so reiterate.
If your stomach isn’t specific enough, the liver won’t release enough bile, and your pancreas won’t release sufficient quantities of digestive enzymes. So then you’re going to have a lot of undigested food hitting your small intestines, and in this scenario, you will be getting a lot of bloating constipation, in my suggestion.
What causes abdominal pain?
Stomach pain is pretty broad and can originate from many different causes. One main reason is the stomach, where the organ is blocked and backed up. Also, it doesn’t move like open and close.
Sometimes the nerves get pinched and can also leave you in a cramped feeling. That’s no fun; sometimes, even the spine is compressed and can give you those symptoms. Whatever the reason, it’s not fun.
When we look at our abdomen, many structures or organs are associated predominantly with the digestive system. If we broke up the abdominal cavity into nine regions, we could locate particular structures or organs within each area.
For example, at the top right, you’ll have the liver and the gallbladder; right at the very top, you will have the stomach and pancreas. Then the top left, you go to the stomach, pancreas, and spleen.
- Right in the middle, you will have most of the small intestines. A little bit of the transverse portion of the colon. Then towards the bottom right, you will have where these small intestines turn to the large intestines. So this includes the appendix.
- Then right in the middle and towards the right, you will have a sending colon, transverse colon, and descending colon towards the left. Then it turns into the sigmoid colon. This is basically how it broke up into these nine regions.
Appendix pain: How these structures manifest their pain depends on their embryological development. You can see the appendix while sitting down in the bottom right area. It tends to present itself when you first get appendicitis or appendix-related pain.
Visceral pain: As though it’s coming from the umbilical region. Why because of its embryological development being the midgut in the central area. So that is called visceral pain.
Colicky pain: The other thing is some of these structures are hollow. Some of them are solid. Now, these hollow structures will be filled with liquids and gases. They need to be moving around. They move around because the muscles surrounding these tubes contract and often relax. The pain associated with hollow organs in the abdomen is called colic.
It’s a colicky pain, and it’s intermittent. It’s coming and going, and it’s because the muscles are surrounding something that’s eliciting pain. Also, it could be some obstruction. It could be a mass, but now this can even happen in the kidneys. When the ureters of the kidneys surround a stone, it causes this colicky pain again. It could happen in the intestines if there’s an obstruction.
- Pain can be elicited if blood accumulates or the mass puts some pressure on and again when this visceral pain presents. It’s often quite diffused and hard to localize as I said, you would often say it’s the upper abdomen, mid or lower abdomen.
- When appendicitis starts to manifest, you can feel it as though. It’s the bottom right area. This is usually the inflammation that is spread to the wrapping of the entire digestive organs. So this wrapping is called the peritoneum. Once that starts to get irritated in particular areas, you can more specifically localize where this pain is coming from is called somatic pain.
- You have the visceral pain from the organs relatively diffuse intermittently, and then you’ll have the bodily pain, which is the inflammation of the peritoneum. The more direct wrapping is more localized, and then the third is referred to as pain, which is where. So referred pains are difficult where a specific pain comes from a particular structure. But your brain interprets results coming from somewhere else.
For example, a myocardial infarction is a heart attack of the heart’s lower part, like heartburn, as though it’s coming from the epigastric region. Sometimes you can get hip pain, and it manifests. It’s coming from areas within the lower abdomen. Sometimes diaphragmatic issues can present as though. It’s coming from the shoulder.
So this is all referred pain because of different structures up into the spinal cord at the same level. When it goes to the brain, it has difficulty knowing which structure came from what pain a signal came from what particular structure. So this is abdominal pain.
Some common bad habits for stomach pain are given below:
- Dehydration or lack of drinking water.
- Poor sleeping habits are trauma in itself.
- Overthinking and irregular food habits.
- Too much eating and junk food.
- Lack of exercise and laziness.
Types of abdominal pain
There are three types of pain. They are:
- Somatic pain.
- Visceral pain.
1. Somatic pain: Somatic pain has a somatic nerve that innervates the organ appropriately. When it gets hurt, the organ tells the nerve I’ve injured that the pain is pinpoint. You can easily localize it when you get a laceration or burn. Somatic nerves innervate your skin.
2. Neuropathic pain: Neuropathic pain is when the person is innervated and has no problem, but the nerve is damaged. So the nerve is telling the brain that there’s pain even though there’s nothing wrong. This is usually in the way of tingling or burning. Think of diabetic neuropathy or radiculopathy.
3. Visceral pain: The visceral organs don’t have somatic nerves. So when the visceral organs get injured, they hijack the somatic nerves. So when an organ in the abdomen feels, the patient will experience pain on the skin or abdominal wall above the embryologic organ origin. You must remember the embryologic source.
Visceral organs, especially the hollow ones, experience pain when they become:
There are three types of Visceral pain. They are:
1. Obstructive: Obstructive abdominal pain is colicky. You have a low two-bit obstructed peristaltic wave coming. It hurts more as the peristaltic wave passes by the obstruction. The pain is alleviated, thus colicky, because there is no inflammation.
It’s only an obstruction. You have no fever and no leukocytosis. When that pain comes, it’s not because of contact with the perineum. The patient is going to attempt to find a position of comfort. They’ll be restless, but they’ll find no comfort in moving.
2. Inflammatory: This real pain is when that colicky pain becomes constant, and there is inflammation. You’ll see a low-grade fever and an elevation in the white blood cell. This pain will also be restless, but they’ll find no position of comfort using the cholelithiasis and never lettuce. Pyelonephritis solid organs can also become inflamed, which is why pancreatitis hurts.
3. Perforation: It can rupture if the inflammation goes on long enough or has a different diagnosis. But a hollow viscus perforation causes the contents of whatever was in the tube to spill into the abdomen. The peritoneum does not like being touched by anything but the organs, stool, air, and blood.
It doesn’t matter if the peritoneal wall feels pain and the peritoneal wall has somatic innervation. When anything touches it, it hurts, and perforations present sick as there will be a high fever and leukocytosis.
Abdominal pain is not all created equal. There are different ways that patients will explain pain, and it all has to go back to embryology. So it all has to go back to how the organ is developed.
There are two common types of pain signs. They are:
1. Parietal pain: Parietal pain is due to stretching or irritation of the parietal peritoneum. So that’s the lining of the parietal purge of the peritoneal cavity. This pain is generally sharper. So it’s more like a sharp or stabbing pain than the referred pain.
2. Referred pain: Referred pain is felt at a site far from the diseased organ. The classic thing is gall bladder pain felt in the right shoulder when we think about referred pain. So pain may radiate to the right shoulder when someone has cholecystitis or potentially biliary colic.
How to examine abdominal pain?
Before examining the abdominal pain, you need to follow 5 steps. You should follow these step by step to identify the abdominal pain correctly. Here are the 5 steps:
Step 1: The physical exam is vital signs. Sometimes it can be comfortable that one may be overlooked a little bit, but having an accurate temperature, blood pressure reading, pulse oximeter, heart rate, and respiratory rate. All will benefit you in this situation, and you want to ensure you’re paying attention to all those vital signs.
Step 2: When someone comes in with respiratory distress, there’s a lot of information looking at them. If they’re laying still, that could potentially indicate that they have peritoneal signs that moving around might make their pain a little bit worse. Restless, which might support renal colic or a kidney stone diagnosis. Classically those are very restless.
Some people also aren’t very good at remembering what procedures. They’ve had it on their abdomen. They say no, and then you look at their belly, and there are many scars. Suppose you see surgical scars or look in the medical record to try and figure out what happened.
Surgical scars are becoming harder and harder to notice, especially with more and more people getting laparoscopic surgery. Those laparoscopic surgical scars are minimal and are often tried to do in less noticeable areas. So one classic place is around the umbilicus, which can be harder to pick up on.
Step 3: Listen historically. Everyone’s taught to listen before they palpate. So we’ll go ahead and go with that for now, you want to listen for two minutes, and you’re listening for bowel sounds.
If you don’t hear any bowel sounds after two minutes, the patient does not have bowel sounds. So make sure you listen for that appropriate period and hear if the bowel sounds are overactive, underactive, not present, or potentially in the normal range.
Step 4: It is palpation. You want to start in the area away from the pain. So if the pain is on the right side in the lower abdomen, go ahead and start on the left upper abdomen and then work your way around that area. You’re going to want to palpate lightly and then go ahead and push a little more deeply, depending on the exam you’re getting for the patient.
Step 5: When you’re palpating, you also want to go ahead and assess for rebound tenderness. So rebound tenderness is pain that occurs when you let go. You push down on the abdomen, and when you release your hand, I tell people to try and focus.
Does it hurt more when I push down, or does it hurt more when I let go rebound? Tenderness is that you can sometimes shake the bed. This was a tip that I learned when I was a medical student.
There are some additional examiners and signs that you want to think about doing.
Murphy’s sign is taking a closer look at the gallbladder or indicating. If there’s a disease in the gallbladder for cholecystitis and what you do in that situation, you feel in the right upper quadrant.
When you’re palpating deeply in the right upper quadrant, the patient stops inspiring, which indicates that the pain is so severe or intense or localized to that area that the patient will stop encouraging.
This can be done during a physical exam or an ultrasound exam. So when doing the ultrasound for the patient, you can see if they have an optimistic Murphy’s.
Palpate aorta: The other thing you can do, generally done in the abdomen’s center, is to palpate the aorta. You want to think about a triple-a in older patients.
So as patients are older, this disease process generally does start to develop. You want to go ahead and feel in the center of the belly and see for those patients. If you feel any enormous palpable mess, anyone’s skinny younger people and you may be able to feel their aorta. Because they’re generally slim and more youthful, and you can feel it in the center of their abdomen.
Psoas, Obturator, and Raphson sign: Those are indicative of appendicitis. The other things to focus on are our agenda urinary exams. The testicular exam and the pelvic exam. The testicular exam is essential for the patient. He or their concern may not be able to report to you whether they’re having testicular pain accurately.
In the pelvic exam, I always tell women who come to the IDI with abdominal pain that they’re tricky because they have their intestines and the normal stuff in their belly.
You also have your reproductive organs, the uterus and the ovaries. Those are sometimes a source of pain. So doing the public exam for all women with a uterus and ovaries is key when presenting abdominal pain.
You don’t want to miss a pelvic infection or some ovarian mass presenting in that way. You also want to look for extra-abdominal findings, which means the herpes zoster rash was discussed.
It means listening to the patient’s lungs and seeing if there’s any concern for pneumonia, looking at the respiratory rate, and seeing if the respiratory rate is elevated might make you support diabetic ketoacidosis.
How to know if abdominal pain is serious?
When they develop abdominal pain, the first thing to do is characterize the pain type. There are 3 things that you should look for the doctor.
1. Number one is what type of pain is it? Is it a dull, achy pain that is constant? Or is it more of a sharp stabbing pain that comes and goes?
2. Number two is you should realize where the pain is arising from. Is it in the upper part of the abdomen, the lower part of the abdomen, the abdomen’s right side, or the left side? Because the abdomen has multiple different organs, and as such, any organ can cause abdominal pain.
So if you recognize the pain location, you can identify the origin and give you information if you need medical attention.
3. Number three is to know if the pain is associated with other symptoms. Abdominal pain is typically associated with other nonspecific symptoms like nausea, vomiting, diarrhea, and constipation, and if you feel bloated, you might have little indigestion.
So if any of these symptoms are associated with it, you must consider it.
Prevention of abdominal pain
Your regular habit and food habit is the key to preventing abdominal pain. Here is some advice that will help you to relieve it.
- Firstly, you can take one or two tablespoons of apple cider vinegar before each meal to increase your stomach acidity. This will help improve the amount of bile and pancreatic enzymes released. Taking apple cider vinegar and increasing your stomach acid will trigger the swing too close if it’s a stomach issue. It will help alleviate your GERD and reflux-type symptoms.
- Now what you can also take after each meal is a bottle supplement because you can find that when you start increasing the stomach acid with apple cider vinegar, it takes a while for the liver and gallbladder to stop motoring. Especially if you’ve had digestive issues for a1, taking a supplement can help the gallbladder until it can stand on its own two feet. Finally, you can take a digestive enzyme supplement before each meal, which will boost your body to help further break down your food.
- You must drink lots of water throughout the day to help with this overall process. Don’t drink water too much that you feel uneasy. Drink water after 1-2 hours and avoid drinking before and after meals for at least 30 minutes.
- You have to exercise daily and keep your health running. When you run or move, your abdomen or stomach also gets the energy to move fast. When it moves fast, it breaks down the food quickly and does good digestion.
- Avoid junk food or street food. Eat homemade food. If you eat fatty food, exercise to burn it properly because the stomach can not burn it quickly.
I have already written an article to stop stomach pain naturally. Please read it and make your stomach healthy.
Frequently ask question
What is SIBO?
You’d have very minimal bacteria if you have an overpopulation of harmful bacteria in your guts or even good bacteria that migrates into your small intestines and area. Then, the food starts fermenting in your school intestines instead of correctly absorbing. This food fermentation is caused by small intestinal bacterial overgrowth or SIBO.
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Dickerson, Lori M.; Mazyck. “Premenstrual Syndrome.” American Family Physician.
National Institute of Allergy and Infectious Diseases. “Food Allergy An Overview.”
Levitt MD, Furne J, Aeolus MR. “Evaluation of an extremely flatulent patient: case report and proposed diagnostic and therapeutic approach.”
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