Abdominal pain syndromes may have diffuse, non-specific abdominal or variable presentations of pain:
— Obstruction – Severe, acute diffuse abdominal pain can be caused by either partial or complete obstruction of the intestines. Intestinal obstruction should be considered when the patient complains of pain, vomiting, and obstipation. Physical findings include abdominal distention, tenderness to palpation, high-pitched or absent bowel sounds, and a tympanic abdomen. The most common etiologies in adults being postoperative adhesions, malignancy related (eg, from colorectal cancer), and complicated hernias. Other less common etiologies include Crohn disease, gallstones, volvulus, and intussusception.
— Perforation of gastrointestinal tract – Can present acutely or in an indolent manner. Sudden, severe chest or abdominal pain following instrumentation or surgery is very concerning for perforation.
— Mesenteric ischemia – Acute mesenteric ischemia presents with the acute and severe onset of diffuse and persistent abdominal pain, often described as pain out of proportion to examination.
— Inflammatory bowel disease (IBD) – IBD is comprised of two major disorders: ulcerative colitis and Crohn’s disease.
— Ulcerative colitis (UC) – Usually present with diarrhea which may be associated with blood. Bowel movements are frequent and small in volume as a result of rectal inflammation. Associated symptoms include colicky abdominal pain, urgency, tenesmus, and incontinence.
— Crohn’s disease (CD) – Fatigue, prolonged diarrhea with abdominal pain, weight loss, and fever, with or without gross bleeding, are the hallmarks of CD.
— Spontaneous bacterial peritonitis (SBP) – Most often occurs in cirrhotics with advanced liver disease with ascites. Patients present with fever, abdominal pain, and/or altered mental status.
— Malignancy – Gastrointestinal malignancies may be associated with abdominal discomfort. For example; colorectal cancer, gastric cancer, pancreatic cancer.
— Celiac disease – Patients with celiac disease may complain of abdominal pain in addition to diarrhea with bulky, foul-smelling, floating stools due to steatorrhea and flatulence.
— Ketoacidosis – Patients with ketoacidosis (eg, from diabetes or alcohol) may have diffuse abdominal pain as well as nausea and vomiting.
— Adrenal insufficiency – Patients with adrenal insufficiency may have diffuse abdominal pain as well as nausea and vomiting. Patients with adrenal crisis may present with shock and hypotension.
— Irritable bowel syndrome (IBS) – Present with chronic abdominal pain and altered bowel habits.
— Constipation – Constipation may be associated with abdominal pain. Diseases associated with constipation include neurologic and metabolic disorders, obstructing lesions of the gastrointestinal tract, including colorectal cancer, endocrine disorders such as diabetes mellitus, and psychiatric disorders such as anorexia nervosa.
— Diverticulosis – Uncomplicated diverticulosis is often asymptomatic and an incidental finding on colonoscopy or sigmoidoscopy. However, these patients may have symptoms of abdominal pain and constipation.
— Lactose intolerance – Symptoms of lactose intolerance include abdominal pain, bloating, flatulence, and diarrhea. The abdominal pain may be cramping in nature and is often localized to the periumbilical area or lower quadrants.