About 1/3 of all adults are said to have ever experienced abdominal pain.
In the case of patients over 65 years of age, 63% are hospitalized when they consult with abdominal pain, almost 30% end up in surgery, with a mortality of 10%.
In addition to this scenario, 30% of patients who consult for abdominal pain never discover the cause. A figure that raises some alarm but puts us in perspective about how difficult it is to assess abdominal pain.
Over 1,000 different causes have been identified, and they can be caused by problems within or outside the abdomen itself.
Causes of abdominal pain
The abdominal pain may be classified in different ways:
· Acute or chronic, when the pain is 12 weeks or less, respectively.
· Surgical or medical, depending on the cause of resolution by surgery or by pathologies of non-surgical medical treatment, respectively.
· Anatomical location: separating the abdomen by nine quadrants, in order to facilitate the identification of pain, but does NOT necessarily mean that the cause of the pain is directly related to the area that is reported sensitive by the patient.
· Upper or lower pain, left or right can be located by dividing the abdominal region in half, as the case may be.
· Causes can also be identified according to the mechanism of pain.
According to the mechanism of abdominal pain on the left side, we have:
Pain of abdominal origin
· Inflammation of the abdominal wall.
· Bacterial contamination (eg, pelvic inflammatory disease, perforated diverticulum).
· Chemical irritation (eg, perforated ulcer).
· Mechanical obstruction of the hollow intestines.
· Small and large bowel obstruction.
· Biliary tract obstruction (right side).
· Urinary tract obstruction.
· Vascular diseases.
· Intestinal embolism or thrombosis.
· Rupture of vessels.
· Compression or torsion occlusion.
· Sickle cell anemia
· Changes in the abdominal wall (hernias).
· Mesenteric torsion / stretch.
· Muscle trauma / infections.
· Distension of visceral surfaces (eg, kidney / liver capsule).
Referred extra-abdominal pain
· Chest (eg, pneumonia, coronary occlusion).
· Spinal column (eg radiculitis due to arthritis, Herpes zoster).
· Genitalia (for example, testicular torsion).
· Metabolic causes.
Exogenous causes
· Lead poisoning and other substances.
Endogenous causes
· Uremia
· Diabetic cetoacidosis
· Neurogenic causes
Organic causes
· Herpes infection
Functional causes
· Hematologic causes
· Acute leukemia
· Anemias: hemolytic and sickle cell
Differential diagnosis of abdominal pain on the left side:
The situation of abdominal pain in children is a little more difficult, although the causes are usually less severe and with lower morbidity and mortality than in other age groups.
It is necessary to mention the differences of the causes between newborns, children and adolescents.
Newly born:
· Colic of the newborn.
· Stomach flu.
· Constipation.
· Hernias, Intestinal Intussusception or Volvulus.
· Urinary infections
Children:
· Stomach flu.
· Appendicitis (right side, exceptionally left side can hurt).
· Constipation.
· Urinary infections.
· Mesenteric lymphadenitis (viral).
Teenagers:
· Stomach flu.
· Constipation.
· Dysmenorrhea, menstrual pain.
· Pelvic inflammatory disease (F).
· Testicular torsion.
· Inflammatory bowel disease
Elderly:
The first cause is those originating in the large intestine:
· Colon diverticulosis.
· Diverticulitis
· Intestinal perforations.
Vascular causes must be taken into account:
· Arterial aneurysms.
· Intestinal ischemia.
In case of chronic pain:
· Cancer and tumors.
Extraintestinal causes must be considered:
· Pneumonia
· Myocardial infarctions.
· Urinary infections.
· Referred spinal pain.
The causes of abdominal pain on the left side are very varied and as we mentioned above, 30% remain undiscovered, the important thing is to always recognize certain alarm symptoms:
Warning signs to consult a specialist:
· Symptoms continue despite completing a course of medication treatment - either prescription or over-the-counter.
· Vomiting
· Non-voluntary weight loss.
· Change in pain pattern.
· Pain that interferes with daily activities.
Warning signs to consult emergencies:
· Pain accompanied by fever.
· Pain with inability to urinate, defecate or pass gas.
· Severe pain, fainting, inability to move.
· Chest pain accompanied by pain that radiates to the neck, jaw, arms, with shortness of breath, weakness, irregular pulse or sweating.
· Ongoing nausea, vomiting, or diarrhea.
· Severe pain
· Vomiting of blood or black stools.
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