CHRONIC ABDOMINAL PAIN
(Donavon & Yim)
1. CHRONIC (EROSIVE) GASTRITIS - mild epigastric discomfort (aching, gnawing, burning) often associated with nausea, dyspepsia, and positive occult blood
2. PEPTIC ULCER DISEASE (PUD)
DUODENAL ULCER - epigastric pain (gnawing, aching, burning) occurring 1-3 hrs after meal, often relieved with food and antacids (pain / food / relief pattern), 1/3 of patients awaken at night with pain - pain almost always episodic lasting several days to weeks then subsiding for weeks to months
GASTRIC ULCER - pain < after food (pain / food / pain / relief pattern), positive occult blood, bloating, nausea, XSive eructations, epigastric tenderness, wrinkling of brow above root of nose
+ HELICOBACTER PYLORI serum Ab test (strongly associated with antral gastritis and duodenal ulcers; to a lesser degree in gastric ulcers)
3. BILIARY TRACT DZ (CHOLELITHIASIS, CHOLECYSTITIS OR CHOLEDOCHOLITHIASIS) - epigastric and or RUQ pain and discomfort, steady or cramp-like, comes on quickly, plateaus and resolves over a half hour to several hours, pain often refers to right subscapular area, pain < after meals (esp. fatty), postprandial fullness, belching, flatulence,fatty food intolerance
4. IRRITABLE BOWEL SYNDROME (IBS) - abdominal pain, dull aching discomfort in LQ's to sharp, knife-like hypogastric pain associated with changing frequency and/or consistency of stools, pain often related to meals
Disturbed Defecation - (2 or more of the following) altered stool frequency, altered stool form, altered stool passage (straining, urgency, feeling of incomplete evacuation), passage of mucous, abdominal distention
Costarella: lower abdominal cramping/ pain; aggravated by course/ raw foods; relieved by defecation/flatus; abdominal tenderness; alternating diarrhea/constipation; small stools with visible mucus; dyspepsia, nausea, abdomen distention; aggravated by stress, anxiety, emotional lability
5. INFLAMMATORY BOWEL DZ (IBD)
ULCERATIVE COLITIS - blood in stool and diarrhea most prominent sxs (frequent bouts of bloody diarrhea) crampy lower abdominal pain often relieved by defecation, low grade fever, leukocytosis, incrd
ESR, hypoalbuminemia, signs of dehydration, in 95% of patients there is rectal involvement with rectal abscess
Extraintestinal Manifestations:
*Joints (arthritis, sacroileitis, ankylosing spondylitis, peripheral arthropathy),
*Eyes (iritis),
*Liver (pericholangitis, sclerosing cholangitis, fatty liver infiltration, hepatic abscess, bile duct CA),
1 chronic active hepatitis,
*Skin (erythema nodosum, ulcerations of extremities, necrotizing cutaneous vasculitis)
*Blood (Fe/B12/ and hemolytic anemias, thrombocytosis, hypoprothrombinemia)
CROHN'S DISEASE - abdominal pain - steady periumbilicular < eating (ileal infiltration), to crampy lower abdominal (often RLQ) discomfort (colonic involvement), chronic diarrhea (moderate daily # of watery to loose stools suggest ileal dz - while incontinence, urgency or rectal bleeding suggests colonic involvement), weight loss, anorexia, recurrent fevers, growth failure, in younger patients, fistula formation (tracts between bowel and skin, bladder, vagina, or other bowel segments with purulent drainage and abscesses), signs of malnutrition and nutrient deficiency, palpable abdominal mass, perianal abscesses, fissures and/or fistulas
Extraintestinal Manifestations:
*Same as UC with arthritides, and iritis being mostly in women,
*UTIs and oxalate stone formation

*Recurrent aphthous ulcers
6. CHRONIC PANCREATITIS - severe, intractable abdominal pain (can be episodic with relapsing pancreatitis), referring to back and > sitting up and < food and ETOH, anorexia, weight loss, S&SXS of malabsorption, DM, jaundice, pancreatic calcification seen on abdominal x-rays or CT scan, demonstration of pseudocysts on CT or US, amylase incrs only in acute attacks
7. CHRONIC RECURRENT DIVERTICULITIS - see acute abdominal pain for diverticulitis
8. COLON CANCER (second most common CA) - abdominal pain in association with rectal bleeding or positive occult blood and change in bowel habits, Fe deficiency anemia, weight loss, possible palpable abdominal mass
Costarella: right colon lesion will not obstruct as early due to liquid stool; left colon lesions will have more signs of obstructive symptoms much earlier than on the right; most colon cancers are descending and sigmoid; pain is produced by obstruction; sharp, crampy due to distention and vigorous muscular contraction; screening test is hemoccult test
9. PANCREATIC CANCER (fourth most common CA) - clinical manifestations are insidious
Cardinal SXS - epigastric pain (persistent, dull, non-colicky) and may radiate to back and weight loss
Other SXS - N&V, anorexia, often aversion to meat, obstructive jaundice(eventually obstructs pancreatic duct into duodenum and obstructs biliary tract), hypercalcemia, upper GI bleeding, sudden onset of DM without obesity or family Hx; similar pain of chronic pancreatis and these individuals tend to develop pancreatic cancer (Costarella)
10. GASTRIC CARCINOMA - epigastric pain (variable - like PUD or most commonly dull and achy < with meals, associated with anorexia and satiety, weight loss, V, dysphagia, anemia, hematemesis, weakness, fatigue, SOB, positive occult blood
MISCELLANEOUS:
T.B. PERITONITIS
LEAD POISONING
PORPHYRIA
CONNECTIVE TISSUE DZS
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