If you have abdominal pain, many are in a hurry to drink a No-Shpa or Phthalazole tablet, believing that they have a problem with the digestive system. However, the stomach can hurt due to a dozen reasons that are completely unrelated to either the stomach or intestines. This phenomenon even has a medical term - abdominal syndrome. What it is? The name comes from the Latin "abdomen", which translates as "stomach". That is, everything that is connected with this area of the human body is abdominal. For example, the stomach, intestines, bladder, spleen, kidneys are abdominal organs, and gastritis, pancreatitis, cholecystitis, colitis and other gastrointestinal problems are abdominal diseases. By analogy, abdominal syndrome is all the trouble in the abdomen (severity, pain, tingling, cramping and other bad feelings). With such complaints of the patient, the task of the doctor is to correctly differentiate the symptoms so as not to make a mistake with the diagnosis. Let's see how this is done in practice and what features of pain exist for each disease.
Human abdomen
To make it easier to deal with the question: "Abdominal syndrome - what is it?" and to understand where it comes from, you need to clearly understand how our stomach is structured, what organs it contains, how they interact with each other. On the anatomical pictures you can see a schematic tube of the esophagus, baggy stomach, snake-wriggling intestines, a liver under the ribs on the right, a spleen on the left, a bladder with ureters stretching from the kidneys at the very bottom. That’s all, it seems. In reality, our abdominal cavity has a more complex structure. Conventionally, it is divided into three segments. The boundary of the upper is, on the one hand, a domed muscle called the diaphragm. Above it is the chest cavity with the lungs. On the other hand, the upper segment is separated from the middle by the so-called mesentery of the colon. This is a two-layer fold, with the help of which all the organs of the digestive tract are attached to the posterior plane of the abdomen. In the upper segment there are three departments - the liver, pancreas and omental. The middle segment extends from the mesentery to the beginning of the pelvis. It is in this part of the abdomen that the umbilical zone is located. And, finally, the lower segment is the area of the small pelvis in which the organs of the genitourinary and reproductive systems have found their place.
Any disorders (inflammation, infection, mechanical and chemical influences, pathologies of formation and development) in the activity of each organ located in the above three segments cause abdominal syndrome. In addition, in the peritoneum there are blood and lymph vessels and
nerve nodes. Among them, the most famous are the aorta and the solar plexus. The slightest problem with them also provokes abdominal pain.
To summarize: abdominal syndrome can be caused by any known disease of the gastrointestinal tract and urogenital system, problems with blood vessels and nerve plexuses of the peritoneum, chemical effects (poisoning, drugs), mechanical compression (squeezing) by neighboring organs of everything that is located in the peritoneum.
Acute pain
Differential diagnosis of abdominal pain syndrome, as a rule, begins with determining the location and nature of the pain. The most life-threatening and difficult to tolerate by man is certainly acute pain. It occurs suddenly, abruptly, often without any apparent causes that provoked it, manifested by seizures lasting from several minutes to an hour.
Acute pain can be accompanied by vomiting, diarrhea, fever, chills, cold sweat, loss of consciousness. Most often, they have an exact localization (right, left, bottom, top), which helps to establish a preliminary diagnosis.
The diseases that cause this abdominal syndrome are:
1. Inflammatory processes in the peritoneum - acute and recurring appendicitis, Meckel diverticulitis, peritonitis, acute cholecystitis or pancreatitis.
2. Intestinal obstruction or infringement of a hernia.
3. Perforation (perforation, hole) of the peritoneal organs, which occurs with a stomach ulcer and / or duodenal ulcer and diverticulum. This also includes tears of the liver, aorta, spleen, ovary, and tumor.
In cases with perforation, as well as with appendicitis and peritonitis, the patient’s life is 100% dependent on the correct diagnosis and urgent surgery.
Additional research:
- blood test (makes it possible to assess the activity of the inflammatory process, determine the blood group);
- X-ray (shows the presence or absence of perforation, obstruction, hernia);
- Ultrasound
- if there is a suspicion of bleeding in the digestive tract, do esophagogastroduodenoscopy.
Chronic pain
They grow gradually and last for many months. The sensations at the same time are as if dull, pulling, aching, often "spilled" along the entire periphery of the peritoneum, without a certain localization. Chronic pain can subside and come back again, for example, after any meal. In almost all cases, such an abdominal syndrome indicates chronic diseases of the abdominal organs. It can be:
1) gastritis (pain in the upper segment, nausea, heaviness in the stomach, belching, heartburn, problems with bowel movements);
2) an ulcer of the stomach and / or duodenum in the early stages (pains “under the spoon” on an empty stomach, at night or after a short time after eating, heartburn, sour belching, bloating, flatulence, nausea);
3) urolithiasis (pain in the side or lower abdomen, blood and / or sand in the urine, pain during urination, nausea, vomiting);
4) chronic cholecystitis (pain in the upper segment on the right, general weakness, bitterness in the mouth, low temperature, persistent nausea, vomiting - sometimes with bile, belching);
5) chronic cholangitis (pain in the liver, fatigue, yellowness of the skin, low temperature, with an acute form, pain can be given in the heart and under the shoulder blade);
6) oncology of the digestive tract in the initial stage.
Relapsing pain in children
Relapses are pains that recur over a period of time. They can be observed in children of any age and in adults.
In newborns, intestinal colic becomes a frequent cause of pain in the tummy (it can be determined by sharp piercing crying, restless behavior, bloating, refusal to eat, arching of the back, chaotic rapid movements of the leg-legs, regurgitation). An important sign of intestinal colic is that when they are eliminated, the baby becomes calm, smiles, eats well. Cope with the disease helps heat, massage the tummy, dill water. With the growing up of the baby, all these troubles go away by themselves.
A much more serious problem is abdominal syndrome with somatic pathology in children. “Soma” in Greek means “body”. That is, the concept of "somatic pathology" means any disease of the organs of the body and any of their congenital or acquired defects. In newborns, most often observed:
1) infectious diseases of the gastrointestinal tract (temperature up to critical points, refusal of food, lethargy, diarrhea, regurgitation, vomiting of a fountain, crying, in some cases, discoloration of the skin);
2) pathology of the digestive tract (hernia, cyst, and others).
The diagnosis in this case is complicated by the fact that the baby is not able to show where it hurts and explain his feelings. Differential diagnosis of abdominal pain in newborns is carried out using additional examinations, such as:
- coprogram;
- Ultrasound
- blood analysis;
- esophagogastroduodenoscopy;
- X-ray with barium of the abdominal cavity;
- daily pH meter.
Relapsing pain in adults
In older children (mainly of school age) and in adults, there are so many causes of recurring abdominal pain that they are divided into five categories:
- infectious;
- inflammatory (without infection);
- functional;
- anatomical (associated with a particular organ);
- microbiological (cause various parasites that settle in the digestive tract).
What is infectious and inflammatory pain is more or less clear. And what do functional mean? If they are indicated in the diagnosis, how is the term "abdominal syndrome in children" to be understood? What it is? The concept of functional pain can be explained as follows: patients are disturbed by abdominal discomfort for no apparent reason and without diseases of the peritoneal organs. Some adults even believe that the child is lying about his pains, as long as he does not find any violations. However, such a phenomenon exists in medicine, and it is observed, as a rule, in children over 8 years old. The cause of functional pain can be:
1) abdominal migraine (abdominal pain turns into a headache, accompanied by vomiting, nausea, refusal to eat);
2) functional dyspepsia (a completely healthy child develops pain in the upper segment of the abdomen and disappears after defecation);
3) intestinal irritation.
Another controversial diagnosis is "SARS with abdominal syndrome" in children. The treatment in this case has some specifics, as the babies have symptoms of both colds and intestinal infections. Doctors often make such a diagnosis for children who have the slightest signs of acute respiratory viral infections (for example, runny nose), and confirmation of gastrointestinal diseases is not found. The frequency of such cases, as well as the epidemic nature of the disease deserve more detailed coverage.
ARI with abdominal syndrome
This pathology is more often observed in preschool children and primary school students. In adults, it is extremely rare. In medicine, acute respiratory infections and acute respiratory viral infections are classified as a single type of ailment, since respiratory diseases (respiratory diseases) are most often caused by viruses, and they automatically become RVI. The easiest way to "pick them up" in children's groups - school, kindergarten, nursery. In addition to the well-known respiratory flu, the so-called "stomach flu", or rotavirus, is also a great danger. It is also diagnosed as SARS with abdominal syndrome. In children, the symptoms of this disease appear 1-5 days after infection. The clinical picture is as follows:
- complaints of abdominal pain;
- vomiting
- nausea;
- temperature;
- diarrhea;
- runny nose;
- cough;
- red throat;
- it is painful to swallow;
- lethargy, weakness.
As can be seen from the list, there are symptoms of both colds and intestinal infections. In rare cases, a child may actually have a common cold plus a gastrointestinal disease, which doctors must clearly distinguish. Diagnosing rotavirus infection is extremely difficult. It includes enzyme immunoassay, electron microscopy, diffuse precipitation, and the conduct of many reactions. Often, pediatricians are diagnosed without such complex analyzes, only by the clinical manifestation of the disease and on the basis of anamnesis. With rotavirus infection, although there are symptoms of a cold, it is not the ENT organs that are infected, but the gastrointestinal tract, mainly the large intestine. The source of infection is a sick person. Rotaviruses enter the body of the new owner with food, through dirty hands, household items (such as toys) that the patient used.
Treatment of acute respiratory viral infections with abdominal syndrome should be based on the diagnosis. So, if the abdominal pain in a child is caused by pathological products of the vital activity of respiratory viruses, the main disease is treated, plus rehydration of the body by taking sorbents. In case of confirmation of rotavirus infection, it makes no sense to prescribe antibiotics to the child, since they do not have an effect on the pathogen. Treatment consists in taking activated charcoal, sorbents, following a diet, drinking plenty of water. If the child has diarrhea, probiotics are prescribed. Prevention of this disease is vaccination.
Paroxysmal pain without bowel disease
To make it easier to determine what caused the abdominal syndrome, pain is divided into categories according to the place in the abdomen, where they are felt most strongly.
Paroxysmal pain without symptoms of dyspepsia occurs in the middle segment (mesogastric) and lower (hypogastric). Possible reasons:
- worm infection;
- Payr's syndrome;
- pyelonephritis;
- hydronephrosis;
- problems with the genitals;
- intestinal obstruction (incomplete);
- stenosis (compression) of the celiac trunk;
- IBS.
If the patient has just such an abdominal syndrome, treatment is prescribed on the basis of additional examinations:
- extended blood count;
- sowing feces on eggs of worms and intestinal infections;
- Analysis of urine;
- Ultrasound of the digestive tract;
- irrigography (irrigoscopy with barium radiation method);
- dopplerography of the abdominal vessels.
Abdominal pain with intestinal dysfunction
All five categories of recurrent pain can occur in the lower and middle segments of the peritoneum with bowel problems. The reasons why such an abdominal syndrome occurs are many. Here are just a few of them:
- helminthiasis;
- allergy to any products;
- ulcerative colitis is nonspecific (diarrhea is additionally observed, and the stool may be with pus or blood, flatulence, loss of appetite, general weakness, dizziness, weight loss);
- celiac disease (more commonly observed in young children during the period when they began to feed them with baby mixtures on cereals);
- infectious diseases (salmonellosis, campylobacteriosis);
- pathologies in the colon, for example, dolichosigma (elongated sigmoid colon), while prolonged constipation is added to the pain;
- disaccharidase deficiency;
- hemorrhagic vasculitis.
The last disease appears when they become inflamed and, as a result, the blood vessels in the intestines swell, and thrombosis occurs. The reasons are a violation in the processes of blood circulation and a shift in hemostasis. This condition is also known as hemorrhagic abdominal syndrome. It differentiates in three degrees of activity:
I (mild) - the symptoms are mild, determined by ESR in the blood.
II (moderate) - mild pain in the peritoneum is observed, the temperature rises, weakness and headache appear.
III (severe) - fever, severe headaches and abdominal pains, weakness, nausea, vomiting with blood, urine and feces with impurities of blood, bleeding in the stomach and intestines, perforation may occur.
If there are pains in the middle and lower parts of the peritoneum with a suspicion of any problems with the intestines, the diagnosis includes:
- extended blood count (biochemical and general);
- coprogram;
- fibrocolonoscopy;
- irrigography;
- sowing feces;
- blood test for antibodies;
- hydrogen test;
- Endoscopy and biopsy of the tissue of the small intestine;
- immunological tests;
- sugar curve.
Pain in the upper segment of the peritoneum (epigastrium)
Most often, abdominal syndrome in the upper segment of the peritoneum is a consequence of food intake and can occur in two forms:
- dyspepsia, that is, with an upset stomach ("hungry pains" that occur after eating);
- dyskinetic (bursting pains, a feeling of overeating, regardless of the amount of food taken, belching, vomiting, nausea).
The causes of such conditions can be gastroduodenitis, hypersecretion of hydrochloric acid in the stomach, infections, worms, diseases of the pancreas and / or biliary tract, impaired gastroduodenal motility. In addition, Dunbar syndrome (pathology of the celiac trunk of the aorta when squeezing it with a diaphragm) can provoke pain in the epigastrium. This ailment is congenital, hereditary (often) or acquired when a person grows neurofibrotic tissue.
The celiac trunk (a large short branch of the peritoneal aorta) during compression is pressed down to the aorta, greatly narrowed at its mouth. This causes abdominal ischemic syndrome, the diagnosis of which is carried out using a contrast x-ray (angiography). The celiac trunk, together with other blood vessels of the abdominal cavity, supplies blood to all organs of the gastrointestinal tract. When squeezing, blood delivery, and therefore the supply of organs with necessary substances, does not occur in full, which leads to their oxygen starvation (hypoxia) and ischemia. Symptoms of this disease are similar to those observed with gastritis, duodenitis, and gastric ulcer.
If the intestines experience a deficiency of blood supply, ischemic colitis and enteritis develop. If insufficient blood enters the liver, hepatitis develops, and the pancreas responds to interruptions in the blood supply to pancreatitis.
In order not to make a mistake with the diagnosis, additional examinations of patients with suspected abdominal ischemic syndrome should be carried out. Endovascular diagnosis is an advanced method in which blood vessels are examined by inserting a catheter with X-ray properties into them. That is, the method will allow you to see the problems in the vessels without surgical intervention. Endovascular diagnosis is used for any diseases of the vessels of the abdominal cavity. If there is evidence, endovascular surgery is also performed. It is possible to suspect abdominal ischemic syndrome according to such complaints of the patient:
- persistent abdominal pain, especially after eating, when performing any physical work or emotional stress;
- feelings of fullness and heaviness in the upper segment of the peritoneum;
- belching;
- heartburn;
- a feeling of bitterness in the oral cavity;
- diarrhea or, conversely, constipation;
- frequent headaches;
- dyspnea;
- throbbing in the abdomen;
- weight loss;
- general fatigue and weakness.
Only an external examination of the patient, as well as standard diagnostic methods (blood, urine, ultrasound tests) are not critical in detecting this disease.
Vertebral Abdominal Syndrome
This type of pathology is one of the most difficult to detect. It consists in the fact that patients have obvious signs of gastrointestinal problems (abdominal pain, vomiting, belching, heartburn, diarrhea or constipation), but they are caused by diseases of the spine or other parts of the musculoskeletal system. Often, doctors do not immediately correctly determine the cause, so they carry out treatment that does not bring results. So, according to statistics, about 40% of patients with osteochondrosis of the thoracic region are treated for diseases of the intestine and stomach that do not exist in them. An even sadder picture with diseases of the spine. Pain in such cases is most often aching, dull, completely unrelated to eating, and if patients have constipation or diarrhea, they are not treated by classical methods. The following diseases can cause vertebral abdominal syndrome:
- spondylosis;
- scoliosis;
- spinal tuberculosis;
- syndromes associated with tumor changes in the spinal column;
- visceral syndromes (Gutzeit).
The saddest thing is that patients who complain of abdominal pain and do not have pathologies with the gastrointestinal tract are often perceived as simulants. To find out the cause of unexplained abdominal pains, it is necessary to use additional diagnostic methods, such as spondylography, X-ray, MRI, X-ray tomography, echospondylography and others.