Abdominal pain: causes, mechanism, principles of treatment. Abdominal pain syndrome: diagnosis, treatment

The localization of pain guides the clinician to the topography of a possible pathological process. The epigastric region includes three sections: the right and left hypochondrium, the epigastrium proper. Pain in the right hypochondrium more often indicates diseases of the gallbladder, bile ducts, head of the pancreas, duodenum, hepatic angle of the colon, right kidney, abnormally high located appendix. Hepatomegaly manifests itself less intensively. In the left hypochondrium, pain syndrome is fixed in case of lesions of the stomach, pancreas, spleen, left kidney, left half of the large intestine, left lobe of the liver. The epigastrium is directly connected with the cardial esophagus, stomach, duodenum, diaphragm, pancreas, hernia of the abdominal wall, dissecting aneurysm of the abdominal aorta. Mesogastrium in its central umbilical region reflects the state of the small intestine, abdominal aorta, hernial changes in the abdominal wall, omentum, mesentery, lymph nodes and blood vessels. The right iliac region is traditionally associated with changes in the appendix, the cecum, the terminal small intestine with the Bauguine valve, the right kidney, the ureter, and the right ovary. Left iliac region - left half of the large intestine, left kidney, ureter, left ovary. Only the suprapubic region narrows the list of possible lesions to the genitourinary system and inguinal hernias. Widespread (diffuse) pains over the entire surface of the abdominal cavity are characteristic of diffuse peritonitis, intestinal obstruction, damage to the vessels of the abdominal cavity, ruptures of parenchymal organs, capillary toxicosis, ascites.
Pathogenetically, there are 3 types of abdominal pain.
True visceral pain is provoked by a change in pressure in the organs when they are stretched (both parenchymal and hollow organs) or a sharp contraction of the muscles of hollow organs, a change in blood supply.
From a clinical point of view, true visceral pain includes three types of sensations: spastic, distension, and vascular pain. Spasmodic pains are characterized by paroxysmal, pronounced intensity, clear localization. They have a clear irradiation (refers to the second type of abdominal pain, but we have no right not to mention this when describing the clinical characteristics of pain), which is associated with anatomical proximity in the spinal and thalamic centers of the afferent pathways of innervation of the affected organ and the area in which the pain radiates. Examples can be the conduction of pain in case of damage to the biliary system “up and to the right” of the right shoulder blade, shoulder, right arm, in case of damage to the pancreas - pain of a “girdle” nature, etc. Often, spastic pains are called "colic", although the term "colic" in Greek ("colicos") means only "pain in the large intestine." In practice, the use of combinations of biliary colic, renal colic, gastric colic, intestinal colic occurs constantly. Activation of nociceptors (pain receptors) can be carried out by various stimulants: high and low temperatures, strong mechanical effects, release of biologically active substances (bradykinin, histamine, serotonin, prostaglandins) at the site of inflammation or damage. The latter either lower the threshold of sensitivity to other stimuli, or directly activate pain receptors. The spastic mechanism of pain suggests a positive effect when taking antispasmodics. Concomitant phenomena may be vomiting, often without relief, fever of reflex origin and local muscle tension of the anterior abdominal wall.
The occurrence of visceral pain can be due to both organic and functional disorders. However, in any case, they are the result of a violation in the first place of the motor function of the gastrointestinal tract. The motor function of the gastrointestinal tract has mechanisms of regulation from the side of external and internal innervation. External innervation is carried out through the autonomic nervous system (sympathetic and parasympathetic). The submucosal and muscular plexus of the gastrointestinal tract are united by the concept of internal innervation. The presence of intramural neurons in the Auerbach (muscular) plexus allows for autonomous control of the motor activity of the gastrointestinal tract even when the autonomic nervous system is turned off.
The contractility of the gastrointestinal tract is determined by the activity of smooth muscle cells, which is directly dependent on the ionic composition, where calcium ions, which cause contraction of the muscle fiber, play the leading role. The opening of calcium channels for the entry of Ca2+ ions into the cell correlates with an increase in the concentration of sodium ions in the cell, which characterizes the beginning of the depolarization phase. Intramural mediators play a significant role in the regulation of transport ion flows and directly the motility of the gastrointestinal tract. Thus, the binding of acetylcholine to M receptors stimulates the opening of sodium channels.
Serotonin activates several subtypes of receptors, which causes diametrically opposite effects: connection with 5-MT-3 receptors promotes relaxation, with 5-MT-4 - contraction of the muscle fiber.
New mediators currently include: substance P, enkephalins, vasoactive interstitial polypeptide, somatostatin.
Substance P (isolated as a separate group from the tachykinin group), by binding directly to the corresponding myocyte receptors, increases their motor function due to direct activation and due to the release of acetylcholine.
Enkephalins modulate the activity of intramural neurons operating at the level of the Auerbach (muscular) plexus. Enkephalinergic receptors are widely distributed in the gastrointestinal tract and are localized in the gastrointestinal effector cells of smooth muscle fibers.
Endorphins also play a certain role in the regulation of gastrointestinal motility: when they are associated with m and D-opioid receptors of myocytes, stimulation occurs, when associated with k-receptors, the motor activity of the digestive tract is slowed down.
Somatostatin can both stimulate and inhibit intramural neurons, resulting in similar motor changes.
The direct effect of the motilin polypeptide on the stimulating receptors of muscle cells has been proven, which increases the tone of the lower esophageal sphincter, accelerates gastric emptying and enhances the contractile activity of the large intestine.
Vasoactive intestinal peptide (VIP) (the predominant area of secretion is the submucosal and muscular plexus in the large intestine) is able to relax the muscles of the lower esophageal sphincter, the muscles of the fundus of the stomach, and the large intestine.
The functional disorders of the gastrointestinal tract are based on an imbalance of neurotransmitters and regulatory peptides (motilin, serotonin, cholecystokinin, endorphins, enkephalins, VIP), and a change in motor activity is considered the leading component of pathogenesis. Functional disorders (FD) - a set of symptom complexes on the part of the digestive system, the occurrence of which cannot be explained by organic causes - inflammation, destruction, etc. Due to the high prevalence of this pathology, methodological recommendations ("Rome III criteria") were developed on the pathogenesis, diagnosis and treatment of the presented nosological form. Table 1 shows the classification of the RF of the digestive system.
Analysis of the above states proves that the basis of the pathogenesis of functional disorders is a change in motor activity in combination with violations of the central, peripheral and humoral regulation of the digestive tract, hyperalgesia of the digestive organs.
The distension nature of pain occurs when the volume of internal organs (both hollow and parenchymal) changes and the tension of their ligamentous apparatus. Complaints are described by patients as low-intensity, gradually emerging, long-term, without a clear localization and irradiation of pain; taking antispasmodics does not have a positive effect, sometimes giving the opposite effect. The syndrome of flatulence, gastrointestinal dyspepsia with secretory insufficiency, hepatomegaly, splenomegaly are manifested by the above clinical complaints. In violation of the blood supply to the abdominal organs (arterial embolism, mesenteric thrombosis, atherosclerosis of the abdominal aorta and its branches - "abdominal toad") pain occurs suddenly, diffuse, usually intense, gradually increasing.
The next category of pain is parietal pain. Mechanism: irritation of the cerebrospinal nerve endings of the parietal peritoneum or root of the mesentery, as well as perforation of the wall of hollow organs. The pathogenesis of peritonitis may be of inflammatory origin (appendicitis, cholecystitis are considered as the result of perforation). Depending on the etiology, the onset of peritoneal pain is transformed from gradual to acute sudden, with pain syndrome continuously increasing in intensity up to unbearable pain. Mandatory companion are symptoms of inflammation, intoxication, probably the presence of acute vascular insufficiency.
Reflex (radiating, reflected) pain. The description of pain is associated with the names of G.A. Zakhar-i-na and Geda, who first proved the relationship between internal organs and areas of increased skin sensitivity, which occurs as a result of the interaction of visceral fibers and somatic dermatomes in the dorsal horns of the spinal cord. For example, visceral afferentation from the liver capsule, spleen capsule, and pericardium travels from the C3-5 nerve segments (dermatomes) to the central nervous system via the phrenic nerve. Afferent from the gallbladder and small intestine passes through the solar plexus, the main celiac trunk and enters the spinal cord at the level of T6-T9. The appendix, colon and pelvic organs correspond to the T6-T9 level through the mesenteric plexus and small branches of the celiac trunk. The level of T11-L1 is connected through the lower branches of the celiac nerve with the sigmoid colon, rectum, renal pelvis and capsule, ureter and testicles. The rectum, sigmoid colon, and bladder enter the spinal cord at the S2-S4 level. In addition to zones of increased skin sensitivity (Zakharyin-Ged zones), pains are detected in deeper tissues. For example, pain caused by intestinal distension at the initial stage is perceived as visceral, but as it progresses, it radiates to the back.
Pain syndrome treatment. Domestic medicine is characterized by etiological and pathogenetic approaches in the treatment of any disease. Treatment carried out in connection with only one of the stated complaints cannot be taken as a basis, especially since there are quite a few reasons for its occurrence, firstly, and secondly, the pain syndrome itself is diverse in its development mechanisms. However, the humane desire to alleviate the suffering of the patient gives us the right, with a correct assessment of all the collected complaints and the status of the patient, to offer approaches to the treatment of pain in the abdomen. The most common mechanism for this is smooth muscle spasm. Based on the reasons for its occurrence, drugs are used that affect different parts of the reflex chain (Table 2).
Of the drugs presented in the table, myotropic antispasmodics have found the most widespread use. The mechanism of their action is reduced to the accumulation of cAMP in the cell and a decrease in the concentration of calcium ions, which inhibits the binding of actin to myosin. These effects can be achieved by inhibition of phosphodiesterase or activation of adenylate cyclase, or blockade of adenosine receptors, or a combination of these effects. Due to the selectivity of the pharmacological effects of myotropic antispasmodics, there are no undesirable systemic effects inherent in cholinomimetics. However, the antispastic effect of this group of drugs is not powerful enough and fast. Myotropic antispasmodics are prescribed mainly for functional diseases of the gastrointestinal tract (non-ulcer dyspepsia, irritable bowel syndrome), as well as for secondary spasms caused by an organic disease.
Of the non-selective myotropic antispasmodics, papaverine and drotaverine are currently the most studied, but the latter is more preferable in the choice of a clinician. Drotaverine (Spazmonet) is highly selective in action. The selectivity of its action on smooth myocytes of the gastrointestinal tract is 5 times higher than papaverine. The frequency of undesirable side effects, including those from the cardiovascular system (arterial hypotension, tachycardia), when taking the drug is much lower. Spazmonet does not penetrate the central nervous system, does not affect the autonomic nervous system.
A significant advantage of drotaverine, in contrast to anticholinergics, is the safety of use.
Spazmonet is ideal for long-term use in order to provide a long-term spasmolytic effect. In gastroenterology, the indications are: spastic biliary dyskinesia, relief of pain in gastric and duodenal ulcers, pylorospasm, irritable bowel syndrome, nephrolithiasis.
Spazmonet reduces blood viscosity, platelet aggregation and prevents thrombosis. This property may be useful in the treatment of patients with intestinal ischemia.
However, in chronic pathologies such as IBS or biliary disorders, oral administration of these agents at therapeutic doses is often not enough, and it becomes necessary to increase their dose or parenteral administration. In order to enhance the therapeutic effect, drugs with a higher dosage of the active substance are produced. An example is the tablet form of Spazmonet-forte (KRKA). 80 mg of drotaverine in 1 tablet allows you to get a more pronounced antispasmodic effect with a decrease in the frequency of administration, as well as a decrease in the number of dosage forms taken.
Although drotaverine and papaverine are usually well tolerated, in high doses or when administered intravenously, they can cause dizziness, decreased myocardial excitability, and impaired intraventricular conduction.
Despite the fact that monotherapy of abdominal pain syndrome is not a complete treatment for both functional and organic lesions of the gastrointestinal tract, however, it can serve as one of the directions in the complex treatment of the patient.

Literature
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2. Grigoriev P.Ya., Yakovenko A.V. Clinical gastroenterology. M.: Medical Information Agency, 2001. S. 704.
3. Grossman M. Gastrointestinal hormones and pathology of the digestive system: .- M .: Medicine, 1981. - 272 p.
4. Ivashkin V.T., Komarova F.I., Rapoport S.I. A short guide to gastroenterology. - M.: OOO M-Vesti, 2001.
5. Ivashkin V.T. Metabolic organization of stomach functions. - L .: Nauka, 1981.
6. Menshikov V.V. Gastrointestinal hormones: a scientific review. Moscow, 1978.
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Abdominal syndrome (AS) is a complex of symptoms of a number of diseases of the digestive system. Acute abdominal pain is the main clinical manifestation of the disease. It is caused by involuntary convulsive contraction of the muscles of the digestive tract, overstretching of the biliary ducts, bloating of the intestines, or inflammation of the peritoneum.

Abdominal syndrome refers to an urgent pathology called "acute abdomen". It is caused by diseases and injuries of the digestive tract. The etiological factors of abdominal pain are diverse, which is connected with the presence in the abdominal cavity of many organs, the pain receptors of which respond to various stimuli. Patients experience severe pain in the abdomen, which is acute, dull, pulling, cramping or girdle. The causes of AS, which is manifested by a sharp and intense pain in the abdomen, can also be diseases of the nervous system, heart and blood vessels, bronchopulmonary tree.

The disease is observed mainly in children. They are most often diagnosed with ARVI with AS. Abdominal pain is usually accompanied by catarrhal symptoms, intoxication manifestations, leukocytosis and other indicators of a viral infection in the blood. If these signs occur, you should immediately contact a specialist, whose task is to establish the correct diagnosis and alleviate the patient's condition.

Etiology

The causes of abdominal pain syndrome are inflammatory pathologies of internal organs, which are conventionally divided into two large groups - intra-abdominal and extra-abdominal.

The first group includes pathologies of organs located in the abdominal cavity:

Diseases of the hepatobiliary zone - cholecystitis, cholelithiasis, hepatitis;
Inflammation of the spleen and lymph nodes - lymphadenitis, spleen infarction;
Pathologies of the stomach and intestines - diverticulitis, colitis, appendicitis, gastric ulcer, gastroenteritis, tumors, IBS, Crohn's disease;
Diseases of the pancreas - pancreatitis;
Inflammation of the peritoneum - peritonitis, as well as thrombosis of the mesenteric vessels.

With inflammation, obstruction and ischemia of the internal organs, pain occurs, and the normal functioning of the whole organism is disrupted. The pain is localized in different parts of the abdominal cavity.

Extra-abdominal diseases of the internal organs are manifested by abdominal pain, the source of which is outside the abdominal cavity:

Diseases of the bronchopulmonary system - pneumonia, pleurisy;
Pathology of the cardiovascular system - ischemic heart disease, vasculitis, periarteritis;
Diseases of the esophagus - diverticulosis;
Diseases of the genital organs - endometriosis;
Inflammation of the kidneys, bladder and urinary ducts - pyelonephritis, paranephritis;
Pathology of the nervous system - meningitis, trauma and brain tumors, neuralgia;
Infectious diseases - influenza, measles, scarlet fever, syphilitic infection;
Metabolic disorders - diabetes mellitus;
Systemic diseases - rheumatism;
Injuries and ailments of the spine.

These diseases are manifested by pseudo-abdominal syndrome. Radiating pain in the abdomen reflexively occur in diseases of the heart, pleural cavity, urinary system, central nervous system. At the same time, clinical manifestations of the main pathological process are added to dyspeptic phenomena - fever during infectious processes, cardialgia during coronary heart disease, joint pain during rheumatism.

Factors that provoke the appearance of unpleasant symptoms:

Passive lifestyle;
Stress;
Improper nutrition;
Taking antibiotics or NSAIDs;
Intestinal diseases and more.

Children constitute a special category of the population, which is most at risk of suffering from AS. This is due to the ability of the child's body to respond in a special way to any damaging factor. Abdominal colic is observed in almost every newborn baby. Night pains often require urgent hospitalization of the child. They cause acute appendicitis or intestinal obstruction. Recently, ARVI with abdominal syndrome has been very common. In such cases, the disease is treated conservatively, after visiting a doctor and making the correct diagnosis. In patients, hyperemia and sore throat, runny nose, cough and fever are combined with nausea, vomiting and abdominal pain.

Symptoms

Pain is the only clinically significant symptom of acute abdominal syndrome. In order to diagnose a pathology that manifests itself with these signs, it is necessary to know certain distinctive characteristics of pain in certain diseases.

In acute coronary insufficiency, renal or biliary colic, a protruding, very intense and burning pain in the abdomen occurs. The pain is pronounced, strong, its intensity directly depends on the extent of the lesion. It does not go away on its own, has an undulating course and subsides after injection of painkillers. After some time, the pain returns.
Intestinal obstruction, acute inflammation of the pancreas and thrombosis of the mesenteric vessels are characterized by the rapid development of the most severe pain, which remains at its peak for a long time.
With diverticulitis, acute cholecystitis and appendicitis, the attack develops slowly and lasts for hours.

The pain that occurs with abdominal syndrome is divided by origin into 2 large groups - functional and organic. The first is due to spasm of the smooth muscles of the internal organs, the second - inflammation of the mucous membrane, incarceration of the hernia, obstruction, perforation of hollow organs or rupture of parenchymal organs.

By severity and nature, abdominal pain is divided into acute, short - rapidly increasing and chronic - gradually progressive.

In addition to pain of varying intensity and severity, AS is manifested by vomiting, dryness of the tongue, tension in the muscles of the anterior abdominal wall, leukocytosis, dizziness, flatulence, hyperthermia, chills, discoloration of stools, and intestinal paresis.

Emergency hospitalization is required for patients who experience the following symptoms of "acute abdomen":

Severe asthenia of the body,
Bleeding or subcutaneous hematomas,
indomitable vomiting,
Bloating and lack of peristalsis,
Tension of the muscles of the anterior abdominal wall,
Rapid heart rate and drop in blood pressure
High body temperature,
Pain during bowel movements
Intensive increase in the volume of the abdomen,
Rapid increase in pain
Fainting during bowel movements
Uterine bleeding.

Abdominal syndrome is usually diagnosed in children and young adults. They complain of abdominal pain that worsens with exercise. With unbearable pain, they lose their appetite, vomiting occurs, and weight loss occurs. Often, pain is preceded by discomfort and heaviness in the epigastrium, heartburn, vomiting, diarrhea. Any pain in the abdomen is a reason to see a doctor. Acute abdominal pain usually requires urgent surgery and is often life threatening.

In newborns, abdominal pain is usually associated with intestinal colic. This is the most banal reason that does not pose a danger to the life of the child. More serious reasons include: lactose deficiency, allergies, dysbacteriosis, gastric reflux. Babies become restless and capricious, often cry, refuse to eat. They constantly move their legs and press them to the chest. A rash appears on the skin, the stool becomes liquid and plentiful. There is a weight deficit.

Specialists separately consider ischemic abdominal syndrome. It develops when the blood supply to the digestive organs is disturbed due to damage to the abdominal cavity by internal constriction or external pressure. The pain gradually increases and reaches an extreme degree of severity. Necrotic processes in the gastrointestinal tract are caused by a lack of oxygen and the accumulation of decay products. Pressing, aching, paroxysmal pain in the abdomen is combined with bowel dysfunction and progressive weight loss.

compartment syndrome- a complication of traumatic injury to the abdominal cavity or a postoperative condition associated with an increase in intra-abdominal pressure. This dangerous disease is manifested by abdominal pain of varying strength and localization. To determine intra-abdominal hypertension, it is necessary to measure the pressure in the bladder. Treatment of the syndrome is surgical. Patients undergo decompression, which reduces intra-abdominal pressure. Otherwise, irreversible changes in the functioning of internal organs can lead to death.

Diagnostic measures

Diagnosis of AS is to determine the nature of the pain, its localization and intensity. In addition to the patient's complaints, history, examination, and physical examination, the results of additional methods are required to make a diagnosis.

Laboratory research:

Hemogram - leukocytosis and other signs of inflammation,
Urinalysis reveals pyelonephritis, inflammation of the urogenital tract, urolithiasis,
Liver tests for lipase and amylase - for suspected pancreatitis, cholecystitis, cirrhosis.

Instrumental Methods:

Ultrasound examination of internal organs,
tomographic study,
radiographic examination,
Fibroesophagogastroduodenoscopy,
videocolonoscopy,
sigmoidoscopy,
capsule endoscopy.

In children, the diagnosis of abdominal syndrome is complicated by the fact that they cannot describe specifically their feelings, the nature and localization of pain, its irradiation and accompanying symptoms. With any ailment, babies often indicate abdominal pain. Diagnosis of abdominal syndrome in adults and children is to identify the disease that has become its root cause. Doctors advise their patients not to take antispasmodics and painkillers when abdominal pain occurs. These drugs do not cure the disease, but only eliminate the symptom, blurring the overall picture of the pathology and making it even more difficult to diagnose, which can lead to serious consequences.

Healing process

Treatment of the syndrome of abdominal pain is carried out in a hospital. It depends on the causes that provoked discomfort in the abdomen and is aimed at eliminating the pain syndrome. If the cause of the pathology is not established, general strengthening and symptomatic therapy is carried out. An integrated treatment approach allows you to get rid of the pathology caused by non-dangerous causes, even at home. In more serious cases, specialist advice is required.

Patients are prescribed:

Diet therapy consists in the exclusion of coarse and gas-forming foods, fried, spicy, fatty foods, alcoholic beverages, strong tea and coffee. Patients are shown gentle nutrition in small portions every 3 hours. Preference should be given to lean soups, dietary meat and fish, stewed vegetables, and some cereals. Compliance with the drinking regime is a mandatory recommendation of the attending physician.

Traditional medicine normalizes the functioning of the digestive and nervous systems. Decoctions of chamomile and mint have an antispasmodic effect on the intestines, dill water eliminates flatulence, infusion of valerian root helps to calm down.

A healthy lifestyle helps reduce the risk of developing abdominal syndrome. Short-term abdominal pain lasting one or two minutes does not require special medical attention.

When symptoms of an "acute abdomen" appear, patients are urgently hospitalized by ambulance in the surgical department of the hospital. Surgery is also performed to restore blood circulation in the abdominal branches of the aorta.

Prevention and prognosis

Special preventive measures for the disease have not yet been developed. Proper nutrition, maintaining a healthy lifestyle, physical culture are standard methods that allow each person to feel satisfactory and get sick less. To prevent the occurrence of abdominal pain, it is necessary to treat the underlying disease that caused AS in time.

The prognosis of the pathology is relatively favorable. Timely diagnosis and adequate treatment can quickly get rid of abdominal pain and other symptoms.

Abdominal pain is a dangerous manifestation of diseases of the abdominal organs, in which the destruction of cells and tissues is caused by many factors. Timely diagnosis and competent treatment of AS can eliminate abdominal pain and normalize the functioning of the affected organs.

Video: acute abdomen in the program "Consilium"

abdominal pain- this is acute or chronic pain in the abdomen, which occurs periodically (paroxysmal) or is observed constantly. The abdomen is bounded from above by the costal arches, and from below by the pubic articulation, so any discomfort in this section is regarded as a syndrome of abdominal pain.

Abdominal pain is not an independent disease, but only a sign of any pathology of the abdominal cavity.

According to the mechanism of the appearance of pain can be:

Visceral (come from a hollow or parenchymal organ). They are most common and are associated with mechanical damage, excessive stretching, inflammation or circulatory disorders of the internal organs. Occur in both organic and functional states. Accompanied by symptoms of dysfunction (for example, nausea, vomiting, stool retention, bloating, fever), vegetative manifestations (feeling of fear, palpitations, dizziness, sweating, pallor).
Parietal or somatic. Occur due to irritation of the peritoneum. In some cases, the involvement of the sheets of the peritoneum in the inflammatory process occurs after the internal organ. At the same time, the pain syndrome intensifies, becomes more distinct (localized), acute.
Irradiating. Reflected pain sensations occur in the areas of skin sensitivity, which are innervated by the same section of the spinal cord as the affected organ.
Psychogenic pains appear when there is a malfunction of the central mechanisms for controlling pain sensitivity. At the same time, no organic pathologies were observed in the abdominal cavity. Most often, such pains are constant, prolonged, not acute, do not lead to sleep disturbance, and are accompanied by depression. These symptoms are usually not accompanied by disruption of the digestive tract: constipation, diarrhea, muscle tension in the abdominal wall.

According to the duration and nature of the pain is divided into:

Acute. Observed with vascular or other pathologies in the abdominal cavity (perforation of a stomach ulcer, thrombosis of the mesenteric vessels, rupture of the spleen, intestinal intussusception, bleeding, etc.).
Paroxysmal (periodic). Appears at regular intervals, lasting from a few seconds to several hours. Characteristic for, biliary dyskinesia.
Permanent (chronic). The patient is disturbed almost constantly, often of moderate intensity, dull. They are observed with inflammation of the pancreas, chronic hepatitis, prolonged constipation associated with intestinal overflow and the development of partial intestinal obstruction.

By localization:

Epigastric pain (in the area of the solar plexus under the xiphoid process).
Right hypochondrium (diseases of the liver, gallbladder).
Left hypochondrium (inflammation of the pancreas).
The umbilical region (mesogastrium) is a duodenal ulcer.
Right or left iliac region (sigmoid, caecum, ovaries).

For reasons:

Intra-abdominal: stretching, spasm, inflammation, perforation of a hollow organ, circulatory disorders, blockage of the duct, neoplasm in the abdominal cavity, and more.
Extra-abdominal (cause not in the abdomen): myocardial infarction, pneumonia, pleurisy, osteochondrosis, anemia, hormonal or endocrine disorders. At its core, most of these pains are reflected.

Causes of abdominal pain

The cause of any pain in the abdomen can be diseases of the internal organs or functional disorders that do not have an organic pathology.

Non-pathological causes

Violation of the diet: lack of fluid, excess of spicy, salty, carbohydrates, gas-producing foods, eating expired dishes or eating in large quantities.
Taking medications that affect the mucosa and motility of the gastrointestinal tract (non-steroidal anti-inflammatory drugs, vitamins, analgesics, prokinetics).
Menstruation. Periodic pain in women is associated with temporary ischemia of the endometrium and spasm of the myometrium during menstruation.
Abdominal pain in children. Up to a year (intestinal distention) due to the immaturity of the digestive system. At 1-3 years old, pain in the abdomen can be psychological in nature (this is how the child attracts the attention of adults) or occur due to errors in eating.
Pain sometimes occurs in predisposed persons with a pronounced temperament, emotionally unbalanced, subject to the influence of external factors. They appear after excitement, conflicts, shocks, experiences. Pass on their own.
Pain during pregnancy can occur due to sprains, divergence of the pubic joint, articular surfaces, skin tension.

Pathological causes

Associated directly with the disease (trauma) of the organs or vessels of the abdominal cavity. There are a large number of pathologies of the gastrointestinal tract, they can be conditionally divided into the following subgroups:

Pain associated with inflammation of the organ (gastritis, pancreatitis, cholecystitis, esophagitis, colitis, endometritis, and others).
Pain caused by ischemia (acute thrombosis of the mesenteric vessels, gastrointestinal bleeding, kidney or spleen infarction, ovarian apoplexy).
Obstruction of a duct or hollow organ (stone in the ureter, common bile duct, intestinal obstruction, stenosis of the esophagus, pylorus).
Pain due to a violation of the integrity of the organ or tissues (ulcerative, erosive defect, rupture of the organ as a result of trauma, necrosis).
Oncological pains are considered the most severe, at the last stage they are chronic.

Dangerous symptoms for which you need to see a doctor

Increased pain in the abdomen with the appearance of dizziness, tachycardia, fainting, severe weakness, a sharp decrease in blood pressure, the appearance of blood in the vomit or feces. Similar signs can be with.
Pain with fever, chills, vomiting or diarrhea indicate (viral, bacterial).
Prolonged pain of any intensity against the background of a noticeable weight loss, anemia. Such symptoms are found in malignant tumors.
Acute unbearable pains in the abdomen, a forced posture with knees reduced, retention of stool and gases speaks in favor. In this case, any delay is life-threatening.
Tension of the muscles of the abdominal wall () is a sign of local or widespread peritonitis.
An increase in the volume of the abdomen (as a rule, it occurs over time and indicates the accumulation of free fluid - ascites).

The addition of the following symptoms may indicate a formidable pathology that is dangerous to life and health.

Diagnosis of the causes of abdominal pain

It is not always possible to identify the source of pain and determine the exact cause only according to the patient's complaints and examination data. In some cases (especially with chronic pain), you have to resort to additional laboratory and instrumental diagnostic methods:

General analysis of blood and urine, blood biochemistry with the determination of enzymes, hormones, microelement levels.
Ultrasound examination of the organs of the abdominal cavity, small pelvis gives the doctor a lot of information about their condition, shape, size, pathological inclusions, neoplasms.
with or without contrast, allows you to identify foreign bodies of hollow organs, volumetric formations, impaired blood flow, intestinal obstruction, the presence of fluid or gas in the abdominal cavity.
CT or MRI is performed if the previous diagnostic methods were ineffective, as well as to clarify the prevalence of the pathological process, its nature, and to identify tumor metastases.

Treatment

Therapy for inflammatory diseases

It is aimed at eliminating inflammation in the organ, suppressing infection (if any), reducing pain and swelling, improving blood circulation and restoring the function of damaged tissues. For this apply:

if necessary, the course inside or parenterally.
(No-shpa, Duspatalin, Buskopan).
(Analgin, Sedalgin, Ketorol). It can not be used with an unclear diagnosis, suspicion of surgical pathology, so as not to blur the clinical picture of the disease.
, hepatoprotectors, uroseptics to improve the functioning of organs.
Non-steroidal anti-inflammatory drugs (NSAIDs) - Movalis, Voltaren, Ibuprofen.
Herbs, homeopathy.
A diet aimed at reducing the load on the organ and relieving irritation (exclude hot, cold, spicy, sweet, fatty, carbonated drinks, caffeine).

Therapy of vascular pathologies of the gastrointestinal tract

Depending on the severity of vascular accidents in the abdominal cavity, the intensity of the pain syndrome, the degree of damage to the organ, the following are used:

Surgical treatment (stopping bleeding, suturing vessels, suturing a mucosal defect, resection of a necrotic part of an organ or complete removal, and so on).
Restoration of blood circulation (antiplatelet agents and anticoagulants for kidney and spleen infarction; hemostatic drugs for ulcer bleeding).
Replenishment of the volume of lost blood (saline solutions, plasma).
Narcotic painkillers (Promedol, Omnopon).

Therapy of obstructive diseases and traumatic injuries

Basically, in this case, one has to resort to an operative method to eliminate the problem: removal of the gallbladder in case of gallstone colic, removal of a stone from the ureter or kidney, balloon dilatation of the esophagus, release of intestinal loops during volvulus, closure of tears. After the operation, antibiotics, gemodez, saline solutions, painkillers and NSAIDs, physiotherapy are indicated.

Cancer Therapy

The golden rule of cancer treatment is the radical removal of the tumor in the abdominal cavity, if possible. After the indications, radiation, chemotherapy, courses of immunomodulators, or just observation are possible. In advanced cases, palliative treatment is prescribed to improve the quality of life: adequate pain relief, restoration of organ functions, elimination or reduction of unpleasant symptoms.

Serious pathology of the abdominal cavity can begin with harmless, at first glance, abdominal pain. Therefore, any discomfort in the abdomen should be treated with due attention.

Abdominal syndrome, abdominal distension refers to swelling of the abdomen. Stretching can be caused by either air (gas) or fluid collection. The accumulated substance causes external expansion of the stomach and waist beyond normal proportions. Although it is not a disease, it is a symptom or indicator of other diseases such as cirrhosis, heart failure, anemia, fluid overload.

Causes of abdominal bloating are usually gas, irritable bowel syndrome (IBS), and constipation. Other causes may be fibroids, ascites, intra-abdominal bleeding. Less common causes are cysts, tumors, neoplasms.

Abdominal distension (accumulation of gas, fluid) has many underlying causes. This condition is usually caused by overeating or swallowing excess air (aerophagia). Irritable bowel syndrome (IBS), constipation, dyspepsia, diabetes also cause this disease.

It occurs due to mechanical and non-mechanical intestinal obstruction. Mechanical obstruction of the intestine can be caused by tumors or neoplasms, hematomas, foreign bodies. Non-mechanical obstacles are caused by thrombosis, pancreatitis, ulcers, biliary peritonitis.

Abdominal syndrome due to fluid collection is usually associated with ascites caused by cirrhosis or congestive heart failure. In this case, the individual has swelling of the legs and ankles. Many women experience it before and during their period.

Symptoms

Symptoms of abdominal syndrome usually include belching, nausea, vomiting, diarrhea, fever, abdominal pain, shortness of breath, weakness, and a feeling of bloating. People who suffer from abdominal distension describe it as a "bloated feeling". They experience a feeling of fullness, abdominal pressure, pain, cramps . Bloating usually occurs due to the accumulation of gas in the stomach, small intestine, and large intestine.

Diagnostics

A thorough clinical evaluation is necessary to determine the cause of abdominal distension. It usually begins with a history and physical examination. Physical examination is performed with percussion of the abdominal cavity. The clinician asks the patient about pre-existing diseases or other complications, about his diet, existing allergies, medications taken.

Laboratory tests such as a complete blood count, liver function tests (LFTs), urinalysis, and kidney function tests are done.

For further research, visualization is used:

ultrasound,
barium x-rays,
colonoscopy,
endoscopy.

Treatment

It is individual, depends on the underlying cause. Age and the presence of other coexisting diseases determine the treatment plan. Sometimes changes in diet and lifestyle can help overcome this condition. Clinicians advise low-fat diets.

Individuals with lactose intolerance are advised to avoid dairy products. Excess dietary fiber also causes bloating, so a low fiber diet is recommended. Recommended exercise, avoiding lying on the back during sleep.

Enzymes and probiotics are prescribed. Prescription medications include antibiotics (usually intestinal), low dose antidepressants, antispasmodics, low dose laxatives.

In medicine, it is customary to refer to a complex of symptoms, the main criterion for which is abdominal pain. It should be noted right away that it often does not have a direct connection with any surgical pathology, but is caused either by diseases of the organs located in the abdominal cavity, or problems with the patient's nervous system, the state of his lungs and heart. The inflammatory process in the peritoneum, caused by exposure to toxic substances, and its stretching by the diseased organ can also provoke the named pain.

In what cases does abdominal syndrome develop?

Abdominal pain syndrome has a rather complicated classification. Conventionally, it can be correlated with the diseases against which it manifests itself.

These can be diseases of the digestive system - hepatitis, cirrhosis of the liver, stenosis of the pylorus of the duodenum, etc.
These abdominal pains can also accompany pathologies of the chest organs - pneumonia, myocardial infarction, esophageal diverticulosis, etc.
The manifestation of abdominal syndrome was also observed in infectious or viral diseases - syphilis, herpes zoster, etc.

In a special group of pathological conditions that form the development of the described pathology, it is necessary to include diseases caused by metabolic or immune system disorders - diabetes mellitus, rheumatism and porphyria.

How pain manifests itself with various factors

Abdominal pain syndrome is also distinguished depending on the type of pain. It is this symptom that often helps specialists to make the correct diagnosis and establish the cause of the disease. This is done with the help of a thorough examination of the patient, a biochemical blood test, ultrasound results, as well as x-rays of the chest and abdominal organs.

There are spastic pains that arise and disappear suddenly, bearing the character of a pain attack. They often radiate to the back, under the shoulder blade, to the lower back or lower extremities and are accompanied by nausea, vomiting, forced positioning, etc. As a rule, they are provoked by inflammatory processes in the abdominal cavity, poisoning or disruption of the gastrointestinal tract.
If the syndrome is caused by stretching of hollow organs, then the pain becomes aching and pulling.
And with structural changes or damage to organs, peritoneal pain appears. In medicine, they are considered the most dangerous and are united by the common name "acute abdomen". Such pain appears suddenly, it is diffuse, accompanied by general malaise and severe vomiting. When you change position, move or cough - it gets worse.
occur with pneumonia, heart attack, pleurisy, etc. During such attacks, pain caused by a disease of an organ located outside the abdominal cavity is reflected in the stomach. They usually join it and against the background of which the described syndrome develops - fever (if it is an infection), or in the joints (with coronary heart disease or rheumatism), etc.
And not associated with a disease of the internal organs. They are neurotic and are most often caused by stress, shock and depression of the patient.

I would like to emphasize that any pain in the abdomen should be the reason for going to the doctor, because the abdominal syndrome, as you have seen, can be a sign of a condition that requires urgent surgery and threatens the life of the patient.

Features of the manifestation of chronic abdominal pain

The syndrome of abdominal pain can be manifested by short-lived and rapidly developing attacks, and can also be of a protracted chronic nature.

In the latter case, the pain, as a rule, increases gradually and recurs within a few weeks and even months. And it should be said that the chronic form of the syndrome is mainly formed depending on psychological factors, and not on the degree of damaging effects. That is, this pathology to some extent ceases to reflect the degree of the underlying disease and begins to develop according to its own laws.

Researchers believe that chronic abdominal syndrome is often provoked by a state of latent depression. Such patients, as a rule, complain of a combination of different localizations of pain sensations - for example, they can have a headache, back, stomach, etc. at the same time. Therefore, they often characterize their condition as follows: "My whole body hurts."

True, not all chronic abdominal pain is caused by mental disorders - they can also appear against the background of oncological diseases, joint diseases, coronary heart disease. But in this case, the syndrome has a clear limited localization.

Manifestations of abdominal syndrome that require urgent hospitalization

As mentioned earlier, acute abdominal syndrome in some cases may be a sign of serious dysfunction of some organs in the abdominal cavity or outside it. Therefore, in order not to expose yourself to possible danger when abdominal pain occurs, you should know in which cases it requires urgent medical attention.

if, along with pain, severe weakness, dizziness and a state of apathy appear;
multiple subcutaneous hematomas appear on the body;
the patient is tormented by repeated vomiting;
abdominal muscles tense;
along with pain, tachycardia occurs and blood pressure decreases;
the patient is worried about fever, the origin of which is unclear;
the volume of the abdomen increases greatly, accompanied by severe pain;
gases do not depart, and there are no peristaltic noises;
women have profuse discharge or bleeding.

Each of these signs (and even more so their combination) requires a mandatory consultation of a specialist, as it may be a manifestation of a life-threatening condition.

Abdominal pain syndrome in children

According to the development of abdominal syndrome, children represent a special risk group. This is due to the ability of the child's body to overreact to any damaging factors.

So, at an early age, the named syndrome may be provoked by excessive gas formation, causing intestinal colic in a baby. And occasionally, intussusception (a type of obstruction) of the intestine, requiring immediate hospitalization, or congenital anomalies of the abdominal organs can also act as a cause.

Abdominal syndrome in schoolchildren is most often a sign of chronic gastroduodenitis or pancreatic dysfunction. Often, the syndrome develops against the background of acute or chronic pathology of the kidneys or bladder. In adolescent girls, it can manifest itself during the formation of the menstrual cycle. By the way, in this case, the appearance of pain may be a sign of the presence of ovarian cysts.

Difficulties in diagnosing abdominal syndrome in children

Abdominal syndrome in children causes certain difficulties in diagnosing the pathology that caused the onset of pain. This is due to the fact that the child most often is not able to accurately characterize his feelings, their localization, strength and the presence of irradiation.

By the way, pediatricians say that babies quite often describe any malaise and discomfort as pain in the abdomen. Doctors encounter this description even in cases where the child is clearly experiencing dizziness, pain in the ears, head, or nausea.

Ways to deal with abdominal syndrome in children, as well as in adults, directly depend on the underlying disease that caused it, therefore, experts strongly recommend that parents do not make independent decisions and do not try to stop the pain in the baby’s abdomen without the help of a specialist with antispasmodics or painkillers drugs. The fact is that such actions can blur the picture of what is happening with the child, make even more difficult an already difficult diagnosis, and thereby cause serious consequences.

So, if your child complains of abdominal pain and other signs of abdominal syndrome, you should immediately consult a doctor. In this case, it is better to play it safe!

The manifestation of the syndrome in ARVI

Often, pediatricians also observe SARS with abdominal syndrome. In children, this is also associated with the peculiarity of the body's reaction to damaging factors.

In such cases, the usual symptoms of a viral infection - redness of the throat, runny nose, cough, weakness and fever - in a small patient may be accompanied by vomiting and abdominal pain. But these manifestations can turn out to be both a feature of the reaction of the child's body to an infection, and, for example, a sign of a chronic pathology of the abdominal organs that has worsened against the background of SARS.

Therefore, the diagnosis of "SARS with abdominal syndrome" in medical circles is considered inaccurate and streamlined. He does not give a specific explanation of what is happening in the patient's body at the moment, and a patient with manifestations of the symptoms of the mentioned syndrome requires a mandatory additional examination to exclude surgical causes of abdominal pain.

How is abdominal syndrome treated?

Due to the fact that the described condition is not a separate disease, but only a complex of symptoms, it is necessary to deal with the abdominal syndrome by eliminating, first of all, the cause that caused the disease. A significant role in this is also played by the elimination of motor disorders in the gastrointestinal tract and the normalization of pain perception in the patient.

To eliminate the discomfort that appeared against the background of problems with the gastrointestinal tract, as a rule, myotropic antispasmodics are prescribed. The most popular among them is the drug "Drotaverine", which has a high selective effect and does not have a negative effect on the nervous and cardiovascular systems. This remedy has not only an antispasmodic effect, but also helps to reduce blood viscosity, which allows it to be used not only for biliary dyskinesia, peptic ulcer of the stomach or duodenum, but also for coronary bowel disease.

No less effective are drugs related to muscarinic receptor blockers (they create conditions for muscle relaxation and relieving spasms) or selective and non-selective anticholinergics (Gastrocepin, Platifillin, Metacin, etc.).

What is abdominal ischemic syndrome

From the various abdominal pains described above in medicine, it is customary to distinguish the syndrome of abdominal chronic ischemia. It is a developing for a long time insufficiency of blood supply to various parts of the abdominal aorta as a result of:

severe cardiovascular disorders;
arteritis;
vasculitis;
anomalies in the development and compression of blood vessels;
as well as the appearance of cicatricial stenosis after injuries and operations.

Such a state is fraught with the death (necrosis) of sections of vessels or organs into which oxygen is not supplied sufficiently and decay products are not removed.

Interestingly, abdominal ischemic syndrome is most often found in men over 45 years of age. And it is manifested, as a rule, by a triad of signs - pressing, aching, often paroxysmal pain in the abdomen, intestinal dysfunction, as well as progressive weight loss.

How to deal with abdominal ischemic syndrome

The pain usually appears about half an hour to an hour after eating and can last up to four hours. Sometimes it radiates to the back or to the left side of the chest and is accompanied by flatulence, belching, nausea, vomiting, regardless of the quality of the food taken.

It can be provoked not only by food, but also by physical exertion or brisk walking, and pain is stopped at rest on its own, however, sometimes for this you need to additionally take nitroglycerin or (in case of increased intensity) analgesics.

With the diagnosis of "abdominal ischemic syndrome", treatment, as in other cases, is directed to the underlying disease. The patient is prescribed anticoagulants that improve the blood circulation process, and in the case of intestinal dysbacteriosis - means that improve its microflora.

Patients are usually recommended fractional meals in small portions with the exception of gross and in severe cases of the disease, they may be shown surgery to restore blood circulation in the abdominal branches of the aorta.

compartment syndrome

If the patient has increased intra-abdominal pressure as a result of complications caused by trauma or surgery, then this condition is diagnosed as abdominal compartment syndrome. It is quite dangerous and is also accompanied by pain in the abdomen of varying strength and localization, which depend both on the height of the patient's pain threshold and on his general condition.

By the way, there are no specific symptoms that speak of intra-abdominal hypertension, therefore, a physical method of examining the abdomen or studying the general clinical picture of the disease is not enough to make the above diagnosis. The most accurate way to determine hypertension in this case, according to experts, is to measure the pressure in the bladder, which can serve as a starting point for the appointment of urgent adequate treatment.

As already mentioned, compartment syndrome is a dangerous condition. Without special treatment, it can lead not only to serious violations of the functions of the abdominal organs, but even to death. As a rule, the most effective way to combat the mentioned abdominal syndrome is surgical intervention - the so-called decompression, as a result of which the level of intra-abdominal pressure decreases and blood circulation in the abdominal region is restored.