Acute GI-Related Abdominal Pain: Pathogenesis and Characteristics
Authors: Yan Yu Wayne Rosen* Reviewers: Laura Craig Danny Guo Julia Heighton Maitreyi Raman* * MD at time of publication
Peritoneal cavity
Visceral peritoneum
(innervated by autonomic nerves)
Bowel stretching, pulling, contracting
Abdominal pain type:
Diffuse, non-localized Dull, crampy, periodic Not associated with movement
Patient may writhe around, trying to get rid of the pain
Mesentery Intestinal lumen
Parietal peritoneum
(innervated by somatic nerves)
Cross-section of the GI tract
Cuts, structural damage, and inflammation in the bowel
Important Notes
• Acute abdominal pain can also result from non-
gastrointestinal causes, such as kidney stones, female reproductive tract issues, and urinary tract issues. For simplicity’s sake, only the GI-related acute abdominal pain disorders are listed here.
• The DDx of visceral abdominal pain is broad. Please consult relevant sections of the Calgary Black Book for the DDx.
• Keep in mind that visceral abdominal pain can also be caused by the “acute abdomen” diseases (if the diseases are presenting in their initial phases).
• • •
• • •
Abdominal pain type:
Sharp, well-localized
Excruciatingly painful, persistent Associated with movement of bowels
Patient often lies still to avoid abdominal vibration
Peritoneal signs
Abdominal guarding, pain with abdominal vibration (coughing, shaking, percussion, palpation)
Transition from diffuse to localized pain can indicate disease progression (e.g. from visceral to parietal peritoneal inflammation)
Note: bowel obstruction may or may not present as acute abdominal pain
Bowel Infarction
Appendicitis Diverticulitis
Acute Cholecystitis
Acute Pancreatitis
Perforated Ulcer
DDx of an “acute abdomen”:
A sudden, non-traumatic disorder of the abdomen that needs urgent diagnosis and treatment. Each topic will be further explored in their respective slides.
Legend:
Pathophysiology
Mechanism
Sign/Symptom/Lab Finding
Complications
Re-Published July 27, 2019 on www.thecalgaryguide.com