appendicitisinfo.com
HomePatient InformationHealthcare Professional
 
 
Types of Abdominal Pain

The interactive 3-D illustration can be used to identify various disease states and the areas of the body they effect. The disease states represented often produce similar symptons to those found in cases of Appendicitis.

Using the Interactive Illustration:

  • Click on the green buttons to identify the disease states.
  • Click the magnifying glass when it appears next to the disease state to read more
  • Click and drag the green button below the illustration to rotate the 3-D model, and reveal additional disease states.
  • Use the drop down menu below to locate additional information about each disease state.
 

 

Bowel Obstruction
Return to top

The bowels can become blocked for many reasons. When the bowels become blocked, the food and fluids taken in through the mouth become trapped inside the stomach.

The symptoms and their severity depend on where in the bowels the blockage is located. Symptoms are also determined by the underlying cause, and may include:

  • nausea and vomiting
  • abdominal distress
  • swelling of the abdomen
  • loss of appetite
  • fever
  • constipation

Bowel obstruction may have many different causes. These include:

  • scar tissue in the belly, often called adhesions. This tissue can wrap around a piece of bowel. the contents of the bowel are prevented from moving normally through the intestine.
  • bowel that twists on itself or develops a bad kink.
  • fecal impaction, or hard stool that cannot pass through the bowel
  • cancer, such as colon cancer or cancer of the pancreas
  • infection of the bowel. This can be from colitis, which is an infection of the colon lining, or diverticulitis, which is an infection of small pouches that can develop in the wall of the colon.
  • lack of blood supply to the bowel, such as from a condition called ischemic colitis

Colitis
Return to top

Ulcerative colitis is a disease that causes inflammation and sores, called ulcers, in the lining of the large intestine. The inflammation usually occurs in the rectum and lower part of the colon, but it may affect the entire colon.

The inflammation makes the colon empty frequently, causing diarrhea. Ulcers form in places where the inflammation has killed the cells lining the colon; the ulcers bleed and produce pus.

Ulcerative colitis is an inflammatory bowel disease (IBD), the general name for diseases that cause inflammation in the small intestine and colon. Ulcerative colitis can be difficult to diagnose because its symptoms are similar to other intestinal disorders and to another type of IBD called Crohn's disease.

Theories about what causes ulcerative colitis abound, but none have been proven. The most popular theory is that the body's immune system reacts to a virus or a bacterium by causing ongoing inflammation in the intestinal wall.

People with ulcerative colitis have abnormalities of the immune system, but doctors do not know whether these abnormalities are a cause or a result of the disease. Ulcerative colitis is not caused by emotional distress or sensitivity to certain foods or food products, but these factors may trigger symptoms in some people.

The most common symptoms of ulcerative colitis are abdominal pain and bloody diarrhea. Patients also may experience:

  • fatigue
  • weight loss
  • loss of appetite
  • rectal bleeding
  • loss of body fluids and nutrients

Crohn’s Disease
Return to top

Crohn's disease is a chronic inflammatory disease of the intestines. It primarily causes ulcerations (breaks in the lining) of the small and large intestines, but can affect the digestive system anywhere from the mouth to the anus. It is named after the physician who described the disease in 1932. It also is called granulomatous enteritis or colitis, regional enteritis, ileitis, or terminal ileitis.

Crohn's disease is related closely to another chronic inflammatory condition that involves only the colon called ulcerative colitis. Together, Crohn's disease and ulcerative colitis are frequently referred to as inflammatory bowel disease (IBD). Ulcerative colitis and Crohn's disease have no medical cure. Once the diseases begin, they tend to fluctuate between periods of inactivity (remission) and activity (relapse). They affect approximately 500,000 to 2 million people in the United States. Men and women are equally affected. IBD most commonly begins during adolescence and early adulthood, but it also can begin during childhood and later in life.

Crohn's disease tends to be more common in relatives of patients with Crohn's disease. It also is more common among relatives of patients with ulcerative colitis.

The most common symptoms of Crohn's disease are abdominal pain, often in the lower right area, and diarrhea. Rectal bleeding, weight loss, and fever may also occur. Bleeding may be serious and persistent, leading to anemia. Children with Crohn's disease may suffer delayed development and stunted growth.

The cause of Crohn's disease is unknown. Some scientists suspect that infection by certain bacteria, such as strains of mycobacterium, may be the cause of Crohn's disease.

Activation of the immune system in the intestines appears to be important in IBD. The immune system is composed of immune cells and the proteins that these immune cells produce. Normally, these cells and proteins defend the body against harmful bacteria, viruses, fungi, and other foreign invaders. Activation of the immune system causes inflammation within the tissues where the activation occurs. (Inflammation is an important mechanism of defense used by the immune system.)

Normally, the immune system is activated only when the body is exposed to harmful invaders. In patients with IBD, however, the immune system is abnormally and chronically activated in the absence of any known invader. The continued abnormal activation of the immune system results in chronic inflammation and ulceration.


Diverticulosis
Return to top

The colon (large intestine) is a long tube-like structure that stores and then eliminates waste material. As a person ages, pressure within the colon causes bulging pockets of tissue (sacs) that push out from the colon walls. A small bulging sac pushing outward from the colon wall is called a diverticulum. More than one bulging sac is referred to as diverticula. Diverticula can occur throughout the colon but are most common near the end of the left colon called the sigmoid colon. The condition of having these diverticula in the colon is called diverticulosis.

The muscular wall of the colon grows thicker with age. Thickening of the colon wall may reflect the increasing pressures required by the colon to eliminate feces. A diet low in fiber can lead to small, hard stools which are difficult to pass. Over time, vigorous contractions in the colon push the inner intestinal lining outwards (herniates) through cracks in the muscle walls. These pouches or sacs that develop are called diverticula.

The most common symptoms of diverticular disease include abdominal cramping, constipation, diarrhea and bloating. These symptoms are related to difficulty of passing stool along the left colon narrowed by diverticular disease.

A diverticulum can become infected with bacteria and ruptures, causing diverticulitis. Fever, and pain and tenderness of the lower left abdomen are common symptoms. Constipation or diarrhea may also occur. A collection of pus can develop around the inflamed diverticulum, leading to formation of an abscess, usually in the pelvis.


Gallstones
Return to top

Gallstones form when liquid stored in the gallbladder hardens into pieces of stone-like material. The liquid, called bile, is used to help the body digest fats. Bile is made in the liver, then stored in the gallbladder until the body needs to digest fat. At that time, the gallbladder contracts and pushes the bile into a tube—called the common bile duct—that carries it to the small intestine, where it helps with digestion.

Symptoms of gallstones are often called a gallstone "attack" because they occur suddenly. A typical attack can cause:

  • steady pain in the upper abdomen that increases rapidly and lasts from 30 minutes to several hours
  • pain in the back between the shoulder blades
  • pain under the right shoulder
  • nausea or vomiting

Gallstones can block the normal flow of bile if they lodge in any of the ducts that carry bile from the liver to the small intestine. That includes the hepatic ducts, which carry bile out of the liver; the cystic duct, which takes bile to and from the gallbladder; and the common bile duct, which takes bile from the cystic and hepatic ducts to the small intestine. Bile trapped in these ducts can cause inflammation in the gallbladder, the ducts, or, rarely, the liver. Other ducts open into the common bile duct, including the pancreatic duct, which carries digestive enzymes out of the pancreas. If a gallstone blocks the opening to that duct, digestive enzymes can become trapped in the pancreas and cause an extremely painful inflammation called gallstone pancreatitis.

If any of these ducts remain blocked for a significant period of time, severe—possibly fatal—damage or infections affecting the gallbladder, liver, or pancreas can occur. Warning signs of a serious problem are fever, jaundice, and persistent pain.


Irritable Bowel Syndrome
Return to top

Irritable bowel syndrome (IBS) is a disorder that interferes with the normal functions of the large intestine (colon). It is characterized by a group of symptoms—crampy abdominal pain, bloating, constipation, and diarrhea.

One in five Americans has IBS, making it one of the most common disorders diagnosed by doctors. It occurs more often in women than in men, and it usually begins around age 20.

IBS causes a great deal of discomfort and distress, but it does not permanently harm the intestines and does not lead to intestinal bleeding or to any serious disease such as cancer. Most people can control their symptoms with diet, stress management, and medications prescribed by their physician. But for some people, IBS can be disabling. They may be unable to work, go to social events, or travel even short distances.

Symptoms cannot be traced to a single organic cause. Research suggests that people with IBS seem to have a colon that is more sensitive and reactive than usual to a variety of things, including certain foods and stress. Some evidence indicates that the immune system, which fights infection, is also involved. IBS symptoms result from the following:

  • The normal motility of the colon may not work properly. It can be spasmodic or can even stop temporarily. Spasms are sudden strong muscle contractions that come and go.
  • The lining of the colon (epithelium), which is affected by the immune and nervous systems, regulates the passage of fluids in and out of the colon. In IBS, the epithelium appears to work properly. However, fast movement of the colon's contents can overcome the absorptive capacity of the colon. The result is too much fluid in the stool. In other patients, colonic movement is too slow, too much fluid is absorbed, and constipation develops.
  • The colon responds strongly to stimuli (for example, foods or stress) that would not bother most people.

Abdominal pain or discomfort in association with bowel dysfunction is the main symptom. Symptoms may vary from person to person. Some people have constipation (hard, difficult-to-pass, or infrequent bowel movements); others have diarrhea (frequent loose stools, often with an urgent need to move the bowels); and still others experience alternating constipation and diarrhea. Some people experience bloating, which is gas building up in the intestines and causing the feeling of pressure inside the abdomen.


Kidney Stones
Return to top

Kidney stones are one of the most common disorders of the urinary tract.

The urinary tract, or system, consists of the kidneys, ureters, bladder, and urethra. The kidneys are two bean-shaped organs located below the ribs toward the middle of the back. The kidneys remove extra water and wastes from the blood, converting it to urine. They also keep a stable balance of salts and other substances in the blood. The kidneys produce hormones that help build strong bones and help form red blood cells.

Narrow tubes called ureters carry urine from the kidneys to the bladder, an oval-shaped chamber in the lower abdomen. Like a balloon, the bladder's elastic walls stretch and expand to store urine. They flatten together when urine is emptied through the urethra to outside the body.

A kidney stone is a hard mass developed from crystals that separate from the urine and build up on the inner surfaces of the kidney. Normally, urine contains chemicals that prevent or inhibit the crystals from forming. These inhibitors do not seem to work for everyone, however, so some people form stones. If the crystals remain tiny enough, they will travel through the urinary tract and pass out of the body in the urine without being noticed.

Kidney stones may contain various combinations of chemicals. The most common type of stone contains calcium in combination with either oxalate or phosphate. These chemicals are part of a person's normal diet and make up important parts of the body, such as bones and muscles.

A less common type of stone is caused by infection in the urinary tract. This type of stone is called a struvite or infection stone.

While certain foods may promote stone formation in people who are susceptible, scientists do not believe that eating any specific food causes stones to form in people who are not susceptible.

A person with a family history of kidney stones may be more likely to develop stones. Urinary tract infections, kidney disorders such as cystic kidney diseases, and certain metabolic disorders such as hyperparathyroidism are also linked to stone formation.

Kidney stones often do not cause any symptoms. Usually, the first symptom of a kidney stone is extreme pain, which occurs when a stone acutely blocks the flow of urine. The pain often begins suddenly when a stone moves in the urinary tract, causing irritation or blockage. Typically, a person feels a sharp, cramping pain in the back and side in the area of the kidney or in the lower abdomen. Sometimes nausea and vomiting occur. Later, pain may spread to the groin.

If the stone is too large to pass easily, pain continues as the muscles in the wall of the tiny ureter try to squeeze the stone along into the bladder. As a stone grows or moves, blood may appear in the urine. As the stone moves down the ureter closer to the bladder, you may feel the need to urinate more often or feel a burning sensation during urination.

If fever and chills accompany any of these symptoms, an infection may be present.


Ovarian Cyst
Return to top

An ovarian cyst is a fluid-filled sac in the ovary. On the ovary, different types of cysts can form. The most common type of ovarian cyst is called a functional cyst, which often forms during the normal menstrual cycle. Each month, a woman's ovaries grow tiny cysts that hold the eggs. When an egg is mature, the sac breaks open to release the egg, so it can travel through the fallopian tube for fertilization. Then the sac dissolves. In one type of functional cyst, called a follicular cyst, the sac doesn't break open to release the egg and may continue to grow. This type of cyst usually disappears within one to three months. A corpus luteum cyst, another type of functional cyst, forms if the sac doesn’t dissolve. Instead, the sac seals off after the egg is released. Fluid then builds up inside of it. This type of cyst usually goes away on its own after a few weeks. However, it can grow to almost four inches and may bleed or twist the ovary and cause pain.

Many women have ovarian cysts without having any symptoms. Sometimes, though, a cyst will cause these problems:

  • pressure, fullness, or pain in the abdomen
  • dull ache in the lower back and thighs
  • problems passing urine completely
  • pain during sexual intercourse
  • weight gain
  • painful menstrual periods and abnormal bleeding
  • nausea or vomiting
  • breast tenderness

Pancreatitis
Return to top

Pancreatitis is an inflammation of the pancreas. The pancreas is a large gland behind the stomach and close to the duodenum. The duodenum is the upper part of the small intestine. The pancreas secretes digestive enzymes into the small intestine through a tube called the pancreatic duct. These enzymes help digest fats, proteins, and carbohydrates in food. The pancreas also releases the hormones insulin and glucagon into the bloodstream. These hormones help the body use the glucose it takes from food for energy.

Normally, digestive enzymes do not become active until they reach the small intestine, where they begin digesting food. But if these enzymes become active inside the pancreas, they start "digesting" the pancreas itself.

Acute pancreatitis occurs suddenly and lasts for a short period of time and usually resolves. Chronic pancreatitis does not resolve itself and results in a slow destruction of the pancreas. Either form can cause serious complications. In severe cases, bleeding, tissue damage, and infection may occur. Pseudocysts, accumulations of fluid and tissue debris, may also develop. And enzymes and toxins may enter the bloodstream, injuring the heart, lungs, and kidneys, or other organs.

Acute pancreatitis is usually caused by gallstones or by drinking too much alcohol.

Acute pancreatitis usually begins with pain in the upper abdomen that may last for a few days. The pain may be severe and may become constant—just in the abdomen—or it may reach to the back and other areas. It may be sudden and intense or begin as a mild pain that gets worse when food is eaten. Someone with acute pancreatitis often looks and feels very sick. Other symptoms may include:

  • swollen and tender abdomen
  • nausea
  • vomiting
  • fever
  • rapid pulse

Severe cases may cause dehydration and low blood pressure. The heart, lungs, or kidneys may fail. If bleeding occurs in the pancreas, shock and sometimes even death follow.


Pelvic Inflammatory Disease
Return to top

Aside from AIDS, the most common and serious complication of sexually transmitted diseases (STDs) among women is pelvic inflammatory disease (PID), an infection of the upper genital tract. PID can affect the uterus, ovaries, fallopian tubes, or other related structures. Untreated, PID causes scarring and can lead to infertility, tubal pregnancy, chronic pelvic pain, and other serious consequences.

PID occurs when disease-causing organisms migrate upward from the urethra and cervix into the upper genital tract. Many different organisms can cause PID, but most cases are associated with gonorrhea and genital chlamydial infections, two very common STDs. Scientists have found that bacteria normally present in small numbers in the vagina and cervix also may play a role.

The major symptoms of PID are lower abdominal pain and abnormal vaginal discharge. Other symptoms such as fever, pain in the right upper abdomen, painful intercourse, and irregular menstrual bleeding can occur as well. PID, particularly when caused by chlamydial infection, may produce only minor symptoms or no symptoms at all, even though it can seriously damage the reproductive organs.


Urinary Tract Infections
Return to top

Urinary tract infections are a serious health problem affecting millions of people each year.

Infections of the urinary tract are common—only respiratory infections occur more often.

The urinary system consists of the kidneys, ureters, bladder, and urethra. The key elements in the system are the kidneys, a pair of purplish-brown organs located below the ribs toward the middle of the back. The kidneys remove excess liquid and wastes from the blood in the form of urine, keep a stable balance of salts and other substances in the blood, and produce a hormone that aids the formation of red blood cells. Narrow tubes called ureters carry urine from the kidneys to the bladder, a triangle-shaped chamber in the lower abdomen. Urine is stored in the bladder and emptied through the urethra.

The average adult passes about a quart and a half of urine each day. The amount of urine varies, depending on the fluids and foods a person consumes. The volume formed at night is about half that formed in the daytime.

Normal urine is sterile. It contains fluids, salts, and waste products, but it is free of bacteria, viruses, and fungi. An infection occurs when microorganisms, usually bacteria from the digestive tract, cling to the opening of the urethra and begin to multiply. Most infections arise from one type of bacteria, Escherichia coli (E. coli), which normally lives in the colon.

In most cases, bacteria first begin growing in the urethra. An infection limited to the urethra is called urethritis. From there bacteria often move on to the bladder, causing a bladder infection (cystitis). If the infection is not treated promptly, bacteria may then go up the ureters to infect the kidneys (pyelonephritis).

Not everyone with a UTI has symptoms, but most people get at least some. These may include a frequent urge to urinate and a painful, burning feeling in the area of the bladder or urethra during urination. It is not unusual to feel bad all over—tired, shaky, washed out—and to feel pain even when not urinating. Often women feel an uncomfortable pressure above the pubic bone, and some men experience a fullness in the rectum. It is common for a person with a urinary infection to complain that, despite the urge to urinate, only a small amount of urine is passed. The urine itself may look milky or cloudy, even reddish if blood is present. A fever may mean that the infection has reached the kidneys. Other symptoms of a kidney infection include pain in the back or side below the ribs, nausea, or vomiting.

In children, symptoms of a urinary infection may be overlooked or attributed to another disorder. A UTI should be considered when a child or infant seems irritable, is not eating normally, has an unexplained fever that does not go away, has incontinence or loose bowels, or is not thriving.