Stomach pain? not necessarily! Experts teach you to distinguish between abdominal pain

Outpatients often encounter patients covering their stomachs saying that they have stomach pains, asking for appetizers, and finally being diagnosed with other problems. We found that whenever there is epigastric pain, patients will call stomach pain, but in fact, epigastric pain is not necessarily stomach pain.

There are three types of abdominal pain

Abdominal pain is divided into three types according to the mechanism of occurrence: visceral pain, somatic pain, and referred pain.

1. Visceral pain

Pain caused by internal organ disorders is called visceral pain and can be induced by mechanical pulling, ischemia, and inflammatory stimulation. Visceral pain is characterized by vague localization, because the distribution of the nerves that feel pain in the internal organs is much more sparse than in the body, and the afferent pathways of visceral sensations are relatively scattered.

2. Somatic pain

Skin pain caused by lesions of the peritoneal wall and abdominal wall is called somatic pain. It is characterized by accurate localization, a degree of continuous and intense, and can have local muscle tension. Pain can be worsened by coughing and changes in position.

3. Referred pain

Pain that involves visceral pain on the surface of the body is called referred pain. It is characterized by clear localization, severe pain, tenderness, abdominal muscle tension and hyperesthesia. The location of referred pain is closely related to the distribution of nerves and the relationship between abdominal organs. The organs of the upper abdomen that sense the surface of the body, such as the stomach, liver, gallbladder, etc., we can infer the diseased organs by the position of the body surface.

Abdominal pain in a disease may involve multiple mechanisms at the same time, such as acute appendicitis, early pain in the periumbilical or epigastric region, which is visceral pain. As the disease progresses, referral pain appears, and the pain shifts to the right lower quadrant. When inflammation progresses further and spreads to the peritoneal wall, somatic pain occurs to a severe degree, which can be accompanied by tenderness, rebound pain, and abdominal muscle tension.

Stomach pain is not necessarily a stomach disease

Since stomach pain is not necessarily stomach pain, which diseases may appear epigastric pain? Here are just a few of the more common, critical causes of epigastric pain.

1. Acute myocardial infarction

A small number of patients with acute myocardial infarction may present only with acute pain in the epigastric region, accompanied by nausea, vomiting, and even epigastric tenderness and abdominal muscle tension. In recent years, there has been a trend towards a younger age of onset. Acute abdominal pain of unknown etiology over the age of 40, especially in patients with a history of hypertension, atherosclerosis, or angina attacks, should be highly vigilant for the possibility of acute myocardial infarction.

This pain tends to occur suddenly and intensely, and exertion and agitation can induce or worsen the pain. Some patients may develop arrhythmias or even shock. Since it takes time for the ECG and the heart damage markers to change, patients with stomach pain should not wonder why doctors repeatedly ask for an ECG.

2. Abdominal aortic aneurysm

Abdominal aortic aneurysms are often syphilitic (cardiovascular lesions caused by treponemal treponema invasion) in middle-aged people, while arteriosclerotic in the elderly can cause severe abdominal pain. Patients may have a pulsatile mass in the middle and upper quadrants, and compressions can induce abdominal pain. A roller-like murmur can be heard through a stethoscope, and a diagnosis can be definitively made by Doppler ultrasound, CT, MRI, or abdominal aortiography.

3. Diabetic ketoacidosis or lactic acidosis

Abdominal pain caused by diabetic ketoacidosis or lactic acidosis is more common in adolescent patients, and abdominal pain is paroxysmal and quite intense, with bloating, nausea, vomiting, etc. The cause of abdominal pain is mainly acidosis accompanied by severe water and electrolyte disorders such as sodium loss, chlorine loss, and water loss, resulting in muscle spasms. Sometimes it may be accompanied by fever, elevated white blood cells, abdominal tenderness, and abdominal muscle tension. Patients generally have a period of polydipsia and polyuria before the onset of the disease, often manifested as vomiting first, abdominal pain afterwards, and the test shows a decrease in pH, a significant increase in blood glucose, positive urine glucose, positive urine ketone body, and symptoms can completely disappear within a few hours after active treatment.

True stomach pain is usually closely related to eating. For example, pain occurs after or before meals, after eating certain foods or overeating, overeating, etc. In addition, stomach pain is often accompanied by symptoms such as hiccups, flatulence, nausea, vomiting, and diarrhea. After taking drugs to treat stomach disease, the symptoms of stomach pain are significantly relieved, which also indicates that it is stomach pain caused by stomach disease.

In short, stomach pain occurs from time to time, when symptoms appear, especially when symptoms recur or continue to be alleviated, we must seek medical treatment in time so as not to delay the timing of treatment.

Text: Department of Gastroenterology, Beijing Tsinghua Changgeng Hospital, Tsinghua University, Xie Shan, Jiang Xuan

Source: Healthy China