STUDY OF THE CAUSES OF PAIN

IN UPPER ABDOMEN

Submitted by –Kanika Munjal

Batch- 2020
Roll No - 206053060

Supervised by – Dr Akhil Gupta

(Head Of Department)
Department Of Surgery
Muzaffarnagar medical
college and hospital .
 Introduction

Abdominal Pain is the most common of all abdominal symptoms and may be
due to inflammatory, infective, obstructive, neoplastic or ischaemic pathology.
It is essential to establish the site, nature and radiation of the pain, the rapidity
of onset, and associated or relieving features.[1]
Abdominal pain also known as stomach ache , is a symptom associated with both
non - serious medical issues . Since the abdomen contains most of the body’s organs
it can be a indicator of a wide variety of diseases.[2]
Localised pain is limited to one area of the abdomen. This type of pain is often
caused by problems in a particular organ. The most common cause of localized
pain is stomach ulcers. There are many different causes of abdominal pain which
can cause pricky pain or diffuse pain in the body.[3]

Causes
1. Biliary colic: It will result in colicky pain in the right upper quadrant of the abdomen which
radiates to the angle of the scapula and is associated with food intake (which results in
cholecystokinin release and gallbladder contraction).
2. Acute pancreatitis: It often has an abrupt onset of severe epigastric pain radiating to the back
which may be similar to pain emanating from peptic ulcer perforation or leaking aortic aneurysm.
3. Indigestion: Epigastric pain after eating is one of the defining features of indigestion, particularly
with a burning quality. That quality is usually related to stomach acid during digestion. It may be
accompanied by gastroesophageal reflux disease (GERD) and heartburn.
4. Peptic ulcer disease: Erosion by stomach acid or by a common bacterial infection can cause ulcers
(sores) in your stomach and duodenum. A stomach ulcer typically causes a burning, gnawing and
penetrating type of stomach pain.
5. Gallstones: A gallstone that's gotten stuck somewhere in your biliary tract is
common cause of gallbladder pain and inflammation, and also pancreas
inflammation.
6. Cardiac and lung problems.[4]

The type of abdominal pain can vary greatly. It can be a sharp, dull, stabbing, cramp like, twisting
or be brief which come and go with waves. It can also make you throw vomit or make anyone want
to stay still and restless. It is acute if present for less than a day and chronic if it persists for more
than 2 weeks. Abdominal pain that comes and goes in waves is called colic which comes from
contraction of hollow organs such as bowel, the gallbladder or the urinary tract.

Abdominal pain is one of the common symptom a person experiences in day to day life. It may be
due to an underlying serious medical condition or may just be acute with a minor issue. Abdominal
pain is mostly experienced in chest till pelvic regions and is associated with both serious and non
serious issues.
 Aims and objectives

Aim

To study causes of pain in upper abdomen.

Objectives

1. Develop a differential diagnosis of patient presenting with abdominal pain.

2. Recognise features, characteristic of abdominal pain caused by peritonitis, obstruction of
hollow viscera ,vascular disturbances and originating from the abdominal wall.
3. Identify common causes of abdominal pain that localise to quadrants of abdomen.
4. List indications for urgent surgical management in a patient presenting with abdominal pain.
5. Identify useful laboratory tests and imaging for patients presenting for abdominal pain.
 Material and method

1. Study design - Hospital based observational study.

2. Study place - Department of surgery, Muzaffarnagar Medical College and
Hospital.
3. Study population - Patients presenting with complaints of abdominal pain to surgery OPD
and emergency.
4. Duration of study- 15 days
5. Sample size – 20 patients will be selected from the OPD of surgery
department.
6. Sampling technique – Purposive sampling.
7. Inclusion criteria - All patients with abdominal pain.
8. Exclusion criteria – Patients not giving consent.
9. Study procedure:
. Inspection: It is examination of abdomen for any external clues about the problem.
Bruises, scars and other marks on the skin can help suggest potential problems.
. Auscultation: It is listening to different areas of abdomen with stethoscope. The sound
intestine makes or don’t make can help rule out different problems in or out.
. Percussion: It is tapping on different areas of the abdomen. This process can help to
determine organ without an x-ray or imaging studies.
. Palpation: it is pressing gently on different areas of abdomen to see if they are painful or
tender. This process narrows down the area of concern to help with diagnosis.

10. Statistical Analysis - Appropriate statistical tests will be used.

11. Ethical clearance - Will be taken by institutional committee.
12. Conflict Of Interest - Nil
 Review of literature

1. By William C Lloyd III, MD, FACS Tim Jewell (2013) upper abdominal pain is commonly
due to peptic ulcer disease, and worsening of the symptoms may herald a complication such as
perforation or penetration. The differential diagnosis of upper abdominal symptoms with
ulceration in the stomach or duodenum includes infections and infiltrative diseases. [6]

2. According to Willow Banks , Alana Biggers, (2017) right upper quadrant pain may be seen in
biliary colic, acute cholestasis, acute cholangitis, acute hepatitis, and liver abscess. Left upper
quadrant pain may be caused by disorders of the spleen such as splenomegaly or splenic abscess
or infarction.A number of parasitic worms may cause nonspecific gastrointestinal symptoms
including epigastric pain. Abdominal pain is a common symptom in several infectious diseases,
most notably malaria.[7]

3. By the review of Anika Vindoo , Christian Keunecke, Tobias Biroga (2018) there is a
high prevalence of patients of abdominal pain. The review identified a comparably high
rate of acute underlying diseases in need of further investigation of therapy. At the same
time the underlying cause of the complaints often remains and explained. Further
symptom, evaluating studies are necessary for support tools.[8]

4. In the review of Sarah L.Cartwright , Mark P.Knudson (2020) abdominal pain is a

common presentation in the outpatient setting and is challenging to diagnose abdominal pain
is presenting complaint in 1.5% of office based visits and 5% of emergency department
visits, therefore, a thorough and logical approach to the diagnosis of abdominal pain is
necessary.[9]

5. According to Sherman R, Hurst JW(2022) pain in the abdomen is the single most important
symptom of an acute abdominal pathologic process. It is a symptom that brings the patient to
his physician and the symptom that deserve the atmosphere in his evaluation.[10]
References

1. "Bailey & Love's Short Practice of Surgery "- Hamilton Bailey, Christopher J. K.
Bulstrode, Robert John McNeill Love, P. Ronan O’Connell. (5): 50:417.
2. Woodwell DA, Cherry DK. National Ambulatory Medical Care: 2002 summary. 2004(346):1-44.
3. Gus M. Garmel "An Introduction to Clinical Emergency Medicine " pp.2007;65:101-52.
4. Naik RD, Meyers MH, Vaezi MF. Treatment of refractory gastroesophageal reflux
disease. Gastroenterol Hepatol. 2020; 16:196–205.
5. Pichetshote N, Pimentel M. An approach to the patient with chronic undiagnosed abdominal
pain. Am J Gastroenterol. 2019; 114:726–32.
6. William C Lloyd III, MD, FACS Tim Jewell : " Abdominal pain an emergency"— Updated on
July 13, 2013; 142:484-489.
7. Willow Banks , Alana Biggers, MD, MPH : " Study of abdomen" 2017;270(13):1563-8.
8. Anika Vindoo , Christian Keunecke, Tobias Biroga: “Study of symptoms of abdominal pain ” by
31:517-529; 1 July 2018.
9. Sarah L.Cartwright , Mark P.Knudson: “ Evaluation of acute abdominal pain in adults” by
77(7):971-978.2020
10. Sherman R, Hurst JW: “Acute Abdominal Pain ”3(86):123-130.2022