When you should pay attention to stomach pain
Pain unnerves us. Obviously it hurts - a little or a lot. And we want
to know why. Some types of pain frighten us, like chest pain. Other
types are more common and we tend to put off looking into their causes,
at least until we are very uncomfortable. Abdominal pain often falls
into that latter category.
There are several organs and conditions that can cause abdominal
pain, from the acutely dangerous appendicitis, to the subtle condition
of dysbiosis and leaking gut. So how can you identify the source of your
pain can be categorised according to the location of the organs inside.
Pretend you are looking right into the abdomen. You'll see the following
organs located like this:
Right upper: liver, gall bladder and colon
Middle upper: lower oesophagus,
stomach and pancreas
Left upper: spleen and colon
Right lower: appendix, ovary, ureter
Middle lower: urinary bladder and
Left lower: ovary, ureter and colon
Diseases causing abdominal pain
Now consider the common,
rather urgent, conditions of these organs.
Liver: viral hepatitis A, B or C and advanced alcoholic liver disease
can cause right upper abdominal pain along with nausea, lack of appetite
and often fever.
Gall bladder: gall stones stuck in the cystic duct (cholelithiasis)
cause inflammation of the gallbladder (cholecystitis) with right upper
abdominal pain and nausea. Ascending cholangitis is much more rear,
which will cause fever and is a medical emergency.
Lower oesophagus: acid reflux, Barrett's oesophagus, and achalasia
(spasm of the lower oesophagus) all cause heartburn symptoms in the
middle upper abdomen similar to gastritis or stomach ulcers.
Stomach: gastritis, stomach ulcer, and dyspepsia cause a constant
middle upper abdomen pain often with nausea, lasting several minutes to
hours and can mimic a heart attack.
Pancreas: pancreatitis pain feels like oesophageal or stomach acid
pain of the middle upper abdomen, but worse. It nearly always comes with
nausea, vomiting, and fever, leading to serious dehydration.
Spleen: an enlarged spleen may cause left upper abdominal pain that
is worse when you take in a deep breath.
Appendix: appendicitis causes right lower abdominal pain eventually,
but often begins in the middle or even left abdomen. This pain is
constant or may be in waves (coinciding with peristalsis, the rhythmic
movement of the intestinal tract), along with nausea and often fevers.
Pain will usually increase steadily and if it is not diagnosed (CT scan)
and treated (appendectomy) urgently, it can quite often rupture, which
is a life-threatening true medical emergency.
Ovary: ovarian cyst pain is also a constant aching like appendicitis
and does not come in waves with peristalsis. Nausea is much less common.
Right or left lower abdominal pain comes on slower and is treated with
pain reliever until it naturally resolves or ruptures.
Ureter: a stone in either the right or left ureter (ureterolithiasis)
will cause flank or lower abdominal pain on the affected side. This pain
comes on rather quickly and is described as deep aching or sharp pain
lasting until the stone passes (minutes to days).
Bladder: urinary tract infection almost always causes urinary pain or
urgency of the urethra. This often is associated with bladder pain
(cystitis), which is located in the middle lower abdomen.
Uterus: infection of the female uterus (endometritis), painful
overgrowth of oestrogen-sensitive tissue (endometriosis), or any
pregnancy-related problem can cause middle lower abdominal pain. This
pain comes on slowly, is deep and constant, and may come with a fever.
No urinary pain is expected with this.
The small and large intestines can cause urgent pains in almost any
location of your abdomen. Left lower abdominal cramping pain that comes
in waves, associated with fever and diarrhoea fits with diverticulitis,
treated effectively with antibiotics.
Rare but seriously emergent conditions include bowel that gets kinked
into a knot (volvulus), folded inside out (intussusception), obstructed,
severely dilated (toxic megacolon) or perforated (unless there is known
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