An Approach to the Patient With Chronic Undiagnosed Abdominal Pain

Abstract

Abdominal pain is a common reason for referral to a gastroenterologist. The workup of patients with chronic abdominal pain can be extremely challenging as clinicians are responsible for determining whether the patient can be observed or treated symptomatically or this abdominal pain heralds a more systemic disease. The differential is typically wide and given the innervation of the abdomen, localization of abdominal pain does not always provide clear insight into the etiology. This review attempts to help the gastroenterologist narrow down that broad differential and focus on key elements of the patient visit. We emphasize the importance of a detailed history from the patient, along with review-specific details of their history and physical examination that can clue one in about the etiology of the abdominal pain. We review the causes of diffuse abdominal pain that may not first be considered along with uncommon causes of localized abdominal pain. We also review the functional causes of abdominal pain and the importance of identifying these disorders, to avoid unnecessary testing that commonly occurs with these patients.

Identification of potential biomarkers for abdominal pain in IBS patients by bioinformatics approach

“…Abdominal pain in IBS is thought to be secondary to visceral hypersensitivity (VH), which has been described as low thresholds of stimuli perception arising from the gut [3]. Visceral hypersensitivity is characterized by two components: allodynia, a painful response to stimuli that are normally not painful and hyperalgesia, an enhanced response to a painful stimulus [4].…”

Pulsed Radiofrequency Ablation for Anterior Cutaneous Nerve Entrapment Syndrome: A Case Report

“…Localized abdominal pain with a negative Carnett's Sign can be indicative of functional dyspepsia or irritable bowel syndrome, while a positive Carnett's Sign can point to chronic abdominal wall pain. 3 Chronic abdominal wall pain, also known as Anterior Cutaneous Nerve Entrapment Syndrome (ACNES), is a cause of abdominal pain in which thoracic intercostal nerves are trapped and irritated by abdominal pressure or postoperative scar tissue formation. Anatomically, as thoracic intercostal nerves exit the spinal neuroforamina, subcostal nerves can become trapped between the internal oblique and transversus abdominis, while lateral cutaneous nerves can become trapped between subcutaneous tissue and the external oblique.…”

Are Classic Bedside Exam Findings Required to Initiate Enteral Nutrition in Critically Ill Patients: Emphasis on Bowel Sounds and Abdominal Distension

“…In ambulant patients, the focused physical examination of the gastrointestinal system traditionally includes inspection, palpation, percussion, and auscultation 6 . In critically ill patients, interpretation of the gastrointestinal tract physical examination findings is more challenging because of limited patient feedback 7 .…”

“…4 Nonetheless, in addition to comprehensive examination on admission, a daily clinician examination of the patient is considered a cornerstone of caring for those who are critically ill. 5 In ambulant patients, the focused physical examination of the gastrointestinal system traditionally includes inspection, palpation, percussion, and auscultation. 6 In critically ill patients, interpretation of the gastrointestinal tract physical examination findings is more challenging because of limited patient feedback. 7 In the intensive care unit (ICU), the gastrointestinal system examination relies on inspection and percussion to identify abdominal distension, 8 palpation for focal tenderness to identify discrete pathologies such as acalculous cholecystitis or generalized tenderness for perforated viscus, 9 and auscultation to identify the presence of sounds arising from the gastrointestinal tract (or socalled "bowel sounds").…”