Abdominal wall pain--classification, diagnosis and treatment suggestions
1DRK Krankenhaus, Neuwied, Germany. g.e.feurle@t-online.de
Background And Objective:
Abdominal pain is generally believed to be a symptom of intra-abdominal disease. When no pathological findings are evident, abdominal pain is considered functional. Abdominal pain, however, may also originate in the abdominal wall.
Methods:
Consecutive patients with unexplained abdominal pain were enrolled in a prospective observational study in a gastroenterologic clinic during a period of three years. The following criteria were tested: Can abdominal pain be elicited by physical movement? Is the source of pain localized to a circumscribed site in the abdominal wall? Can pain be provoked by digital palpation in this area and does pain increase when the abdominal muscles are tensed?
Results:
Clinical examination of 55 patients revealed small painful pits in the abdominal wall with varying intensity of pain when the abdominal muscles were contracted: in 39 patients the painful area was located in the semilunar line, in seven patients the pain originated in the linea alba between xiphoid and umbilicus, in five cases the painful spots were situated within the rectus muscle, and in four patients the pain was localized along the costal arch. Of the 39 patients with pain in the semilunar line, 16 had a BMI > 30, 12 presented with anxiety and depression, and 10 reported bloating and straining during defecation. Pain in the rectus muscle was associated with exercise. The patients with pain in the linea alba and at the costal arch suffered from obesity, anxiety or depression.
Conclusions:
These findings suggest that repeated forceful contractions of the abdominal wall muscles during exercise and straining, as well as chronic inflation of the abdominal wall by fat pads and by bloating, may cause strain and pain in the abdominal wall at sites predestined by anatomy. Symptom-specific anxiety may be a consequence of chronic unexplained abdominal pain. A novel classification of abdominal wall pain is proposed. The correct diagnosis will avoid repeated and costly investigations and relieve the patient's anxiety.
Related Concept Videos
01:28Peptic Ulcer Disease III: Clinical Manifestations and Diagnostic Studies
Few clinical manifestations differentiate gastric ulcers from duodenal ulcers. Distinctions in the location, timing, and pain relief are crucial for healthcare providers in differentiating between gastric and duodenal ulcers during clinical assessments.
01:19Abdominal Regions and Quadrants
The simpler quadrants approach, which is more commonly used in medicine, subdivides the cavity with one horizontal and one vertical line that intersects at the patient's umbilicus (navel). The four quadrants...
01:21Muscles of the Abdomen
Anterolateral Region
The anterolateral region comprises five paired muscles classified into the lateral and anterior...
01:30Acute Pancreatitis II: Clinical Manifestations and Management
01:25Assessment of the Abdomen I: Inspection and Auscultation
The abdominal examination is a cornerstone of clinical medicine, serving as a critical tool in diagnosing various gastrointestinal (GI) diseases. It involves a systematic approach that includes inspection and auscultation, each with distinct yet complementary roles in assessing the abdomen. This article will delve into these two primary methods healthcare professionals use to examine the abdomen.
Inspection of the Abdomen
The first step in any abdominal examination is inspection.
01:22Appendicitis-I: Introduction
Etiology: Appendicitis can arise from various causes, primarily rooted in the obstruction of the appendix lumen. Factors contributing to this obstruction include fecal accumulation, lymphoid hyperplasia and, in...