Abdominal Pain: Possible Causes

WHY DOES MY BELLY HURT?

Abdominal pain is a very common complaint in a gastrointestinal (GI) office. Many causes of pain are minor and self-limited, like occasional abdominal cramping after eating or from a viral illness. However, for abdominal pain that progressively worsens over the course of a day or more, or for pain that is recurrent, you should seek medical attention to determine the cause. To help us narrow down possible causes, you will be asked to characterize the pain – location, duration, severity, factors that make it worse or better, and associated symptoms. Below are common GI causes of pain for particular locations of the abdomen. This is not an inclusive list.

UPPER ABDOMEN:

Right upper quadrant (RUQ):

• Gallbladder disorders: This includes gallbladder inflammation, gallstones, and a dysfunctional gallbladder. Gallbladder pain can be intense and radiate to the right shoulder, chest, back and mid-upper abdomen. It usually occurs after eating, particularly foods that are fatty. The pain can last several hours before it subsides, but often will recur after other meals. Sometimes the pain occurs at night and is not necessarily related to meals. Associated symptoms may include fever, nausea, vomiting and jaundice.
• Liver disorders: Acute hepatitis is a condition that can cause the liver to become inflamed and swollen. This causes stretching of the outer lining, or capsule, resulting in pain. This can occur from viral illnesses like Hepatitis A or Mono, from drinking alcohol, or from taking certain drugs or medications. Usually the pain is accompanied by fatigue, nausea, vomiting, and loss of appetite. Other symptoms may include jaundice and dark urine.

Epigastrium (mid upper abdomen):

• Gastritis: This means inflammation of the lining of the stomach. This can occur for many reasons, including acid, alcohol, NSAIDs (Aleve, Advil, Goody’s, BC powders), and infection. Associated symptoms may include heartburn, nausea, and aching or burning pain.
• Peptic ulcer disease: Ulcers form in the stomach, sometimes as the result of medications or bacteria called H. pylori. Pain from ulcers is often relieved temporarily by eating.
• Gastroparesis: This is a functional disorder of the stomach in which it empties slower than normal. Symptoms include nausea, vomiting, feeling full quickly when eating, and bloating. Common causes of gastroparesis include diabetes, post-infection and post-surgery, but many cases are idiopathic, meaning the cause is not known.
• Pancreatitis: This is inflammation of the pancreas, and when acute, presents with rather sudden onset of intense and progressively worsening pain. Symptoms include nausea, vomiting, and fatigue. The pain often radiates into the back. Common causes of pancreatitis include alcohol, gallstones causing obstructions, and high triglycerides. People with recurrent episodes of acute pancreatitis may develop chronic pancreatitis.

Left upper quadrant (LUQ):

• Pancreatitis: see above
• Spleen disorders: The spleen is not an organ of the GI system, but it is connected to the liver through blood vessels. If there is a disorder of the liver, like cirrhosis, the spleen may become enlarged and painful.

LOWER ABDOMEN:

Right lower quadrant (RLQ):

• Appendicitis: This is inflammation and swelling of the appendix, a small structure attached to the beginning of the colon. Pain tends to start around the belly button and then migrate into the RLQ. It usually does not come and go, but rather progressively worsens, and may be accompanied by nausea, vomiting and fever.
• Colitis: This refers to inflammation of the colon. While this condition can really present as pain anywhere in the abdomen, depending on the location of the problem, the lower abdomen is the more common location. Pain can vary from dull and aching to sharp and stabbing, and it can come and go. Various things cause colitis, such as infections, chronic bowel disease, and ischemia (poor blood flow). Associated symptoms may include diarrhea, rectal bleeding, fever, nausea and vomiting.

Left lower quadrant (LLQ):

• Diverticulitis: Diverticula are pockets that form in the muscle wall of the colon. They are a common anatomical defect. If one of these pockets becomes inflamed and/or infected, that is called diverticulitis. The most common location for pain is the LLQ, though diverticula can occur anywhere in the colon. The pain tends to progressively worsen, rather than come and go. Associated symptoms may include fever, nausea and vomiting.
• Colitis: see above

It is important to note that not all abdominal pain stems from the GI tract. For example, urinary tract infections, kidney stones, ovarian cysts, and muscle aches can cause abdominal pain as well. If you aren’t sure whether you need to see a gastroenterologist for your pain, ask your primary care physician for guidance, as you may need to see another type of specialist depending on your particular symptoms.