Kembara Xtra - Symptoms and Signs - Generalized Abdominal Pain

Kembara Xtra - Symptoms and Signs - Generalized Abdominal Pain 

The majority of stomach pain is localized, such as discomfort brought on by a kidney or biliary stone, an acute appendicitis, or a peptic ulcer. 
However, there are a number of causes of nonspecific abdominal discomfort, with peritonitis and intestinal obstructions being the most prevalent.
Among the causes to take into account are:
1. Generalized peritonitis
2.Tuberculous peritonitis
3. intestinal blockage
4. (Rare) Lead colic
5. Rare gastric crises
6. Abdominal Angina
7. Functional stomach pain
8. Common medical conditions:
Malaria, porphyria, diabetic ketoacidosis, blood dyscrasias, Henoch's purpura, sickle-cell anemia, and hypercalcemia are only a few examples.

Generalized Peritonitis 
Peritonitis must result from a lesion that provides a historical clue that points to the underlying disease. Because of this, a patient with established peritonitis may provide a history of onset that suggests acute appendicitis or salpingitis as the cause of genesis.
When peritonitis develops suddenly, a hollow viscus may have been acutely perforated.
The severity and scope of the peritonitis determine the early symptoms. In contrast to the restlessness of a patient with stomach colic, pain is always intense and typically causes the patient to lie still.
Shoulder-tip pain may accompany an extensive peritonitis that affects the abdominal portion of the diaphragm. Early on in the course of the disease, vomiting frequently happens. Clearly unwell, the patient frequently has a high temperature. The temperature may be normal if the peritoneal exudate is not initially purulent. A nice saying about the two common causes of this condition is that peritonitis caused by appendicitis frequently has a temperature exceeding 38 °C (100 °F), whereas peritonitis caused by a perforation of a peptic ulcer rarely does. 
The pulse is frequently elevated and tends to get stronger every hour.
Tenderness is visible on examination of the abdomen; it may be confined to the affected area or diffuse if the peritoneal cavity is heavily implicated. There is noticeable guarding, which can again be localized or generalized, as well as rebound soreness. On auscultation, the abdomen is silent, however occasionally the transmitted sounds of the heartbeat and breathing may be heard. The pelvic peritoneum is painful in the recto region.
As the illness worsens, the abdomen swells, free fluid may be seen, and the pulse weakens and becomes more fast. Now that vomiting is easy and frequent, the patient exhibits the Hippocratic facies, which includes sunk-in eyes, pale, clammy skin, sweating, and cyanosis of the extremities. However, the patient is still aware and intellectually attentive.
Free subdiaphragmatic gas may be visible on an abdominal X-ray taken with the abdomen in the upright position in cases of peritonitis caused by hollow viscus perforation (such as a perforated peptic ulcer), but its absence does not rule out the diagnosis.
The primary differential diagnoses are colics from ureteric or biliary stones, intestinal blockage, or both.

Important differential diagnoses include intraperitoneal hemorrhage, severe pancreatitis, dissection or leakage of an aortic aneurysm, or basal pneumonia.

Tuberculous Peritonitis 

This illness is now rare in Great Britain. The patient is typically an immigrant from a developing nation when it is seen in the UK. In most cases, there is a heaviness rather than a sharp ache. Slowly developing symptoms include abdominal distension, fluid in the peritoneal cavity, and frequently the development of a puckered, thickened omentum that lies transversely across the middle of the abdomen as a tumor.

Intestinal obstruction
This is a typical reason for widespread stomach pain.
There is no periodic rhythm in peritonitis, whereas blockage is characterized by waves of pain punctuated by intervals of total respite or only a dull discomfort.
The sufferer of intestinal blockage is restless and rolls around during colic spasms, in contrast to patients with peritonitis who prefer to remain perfectly still. Progressive abdominal distension, complete constipation, progressive vomiting (which turns faeculent), and the presence of noisy bowel noises on auscultation are the usual companion symptoms. On the upright film of an abdominal X-ray, several fluid levels are typically seen, along with dilated loops of gas-filled bowel that are noticeable on the supine radiograph.

No matter how long ago the abdominal surgery was conducted, the presence of a scar (or scars) strongly suggests that postoperative adhesions or bands are what are causing the obstruction. To detect a strangulated external hernia, the hernial orifices at the inguinal, femoral, and umbilical regions must be carefully examined.
Unexpectedly, the patient can be completely unaware of its existence. The author once encountered a renowned anesthetist who diagnosed his own acute intestinal blockage accurately but failed to recognize that his inguinal hernia was strangulated.

Lead Colic

Extremely severe episodes of generalized stomach pain may be brought on by lead colic. Anorexia, constipation, and a generalized abdominal discomfort may have been present beforehand. The severe pain typically originates in the lower abdomen and spreads to both groins; it may also occasionally be accompanied by wrist drop (caused by peripheral neuritis), lead encephalopathy, or both. If oral sepsis is present, lead sulphide may precipitate and leave a blue "lead line" on the gums. Normocytic hypochromic anemia with stippling of the red cells (punctuate basophilia) is a common occurrence. The initial hint to the diagnosis may come from asking the patient about their job.

Gastric Crises 
Although uncommon, gastric crises in neurosyphilis can result in generalized abdominal pain. Argyll Robertson pupils, optic atrophy, ptosis, loss of deep feeling (lack of pain on testicular compression or compressing the Achilles tendon), and loss of ankle and knee jerks are further signs of tabes dorsalis in the patient. It is really painful and lasts for several hours or even days. Along with abdominal rigidity, there could also be concomitant vomiting.
The only sign of tabes may be the visceral crisis. Of all, just because a patient has tabes dorsalis does not automatically suggest that their stomach pain is a sign of a gastric emergency. In a patient who had all the traditional symptoms of well-documented tabes dorsalis, the author successfully treated a perforated duodenal ulcer.

Abdominal Angina 
The superior mesenteric artery's gradual atheromatous constriction causes abdominal angina in aged people. Following meals, colicky attacks of central stomach pain occur, and these are followed by diarrhea. Attacks of this kind frequently precede complete occlusion with intestinal infarction.
A number of vasculopathies, including systemic lupus erythematosus (SLE) and polyarteritis nodosa, can cause vessels to the small or large intestine to become blocked, which can lead to generalized abdominal pain, gangrene, perforation, and general peritonitis.

Functional Abdominal Pain 
One of the most challenging cases is the patient (more frequently a female than a male) who exhibits severe, persistent, widespread abdominal pain but has negative results from all clinical, laboratory, and radiographic investigations. Investigation will frequently turn up signs of depression or the presence of a trigger that causes worry.
In other instances, the abdomen is covered in scars from prior laparotomies during which different organs were repositioned, unnecessary viscera were removed, and actual or fictitious adhesions were separated. Some of these patients turn out to be drug addicts, while others are outright hysterics or desire the safety of the hospital setting. In yet other patients, however, the underlying cause is still unknown.This is a sort of what the late Dr. Richard Asher named "Munchausen's syndrome."


Abdominal Pain in General Diseases 
Numerous undiagnosed medical disorders might cause acute abdominal pain. Malignant malaria, familial Mediterranean fever, cholera, uncontrolled diabetes with ketosis, porphyria, and any of the blood dyscrasias are among the conditions that can cause sudden, severe pain; the best examples are Henoch's purpura in children and the abdominal colic of acute sickle-cell crisis (see p. 54). In cases of hyperparathyroidism with hypercalcaemia, stomach discomfort episodes may happen.