Abdominal Pain: Differential Diagnosis of Pain Based on Location

Introduction:

Abdominal pain is felt in any area between the chest and the pelvic region. It is a very frequently seen condition in all hospitals, and it can occur due to multiple reasons, such as food poisoning, trauma, ulcers, and irritable bowel syndrome. It can be treated as per the underlying cause. The differential diagnosis for abdominal pain is too vast and can vary according to location. These locations include the right and left hypochondriac region, epigastric region, iliac region, and umbilical region. Some of its examples are irritable bowel syndrome, Gastroesophageal reflux disease, and peptic ulcers.

What Is Abdominal Pain?

Abdominal pain is a kind of discomfort caused in any area in the belly region (between the ribs and the pelvic region). This pain could be caused because of organs other than the stomach. It is not stomach pain. The abdomen's organs are the stomach, liver, gallbladder, pancreas, small intestine, and large intestine. All these organs are part of the digestive tract. The pain in the abdominal wall, the skin, and the muscles of the outer shell is also referred to as abdominal pain. Some of the most frequent causes of abdominal pain are infection, digestive issues (indigestion, diarrhea, constipation), and menstruation.

What Is the Differential Diagnosis of Abdominal Pain Based on Location?

The differential diagnosis for abdominal pain varies as per its location. Some of them are discussed below:

Differential diagnosis for epigastric (a region in the upper central area of the abdomen) pain:

1. GERD: Pain accompanied by epigastric tenderness could be due to GERD (gastroesophageal reflux disease) and gastritis. The symptoms frequently experienced by this disease are heartburn, regurgitation, coughing, and sometimes chest pain etc.

2. Gastric Ulcers: Gastric ulcers could be the reason for pain in the epigastric region. In this condition, the pain is more with food, and even antacids do not work on this pain.

3. Pancreatitis: In the case of pancreatitis, epigastric pain is present, accompanied by nausea, vomiting, and anorexia. Pancreatitis is frequently seen to occur because of gallstones, hyperlipidemia, alcohol abuse, etc. If a patient presents with such pain, a thorough history should be taken to rule out this disease.

Differential diagnosis for right hypochondriac pain:

1. Gallbladder Diseases: In the right hypochondriac region (right kidneys, right portion of liver, gallbladder, and a few parts of small intestine), pain and tenderness could be present because of gallbladder disease like cholecystitis (redness and swelling of the gallbladder) or cholelithiasis (gallstones are deposits formed from the digestive fluids in the gallbladder). Patients dealing with these diseases can present with pain in the upper right quadrant.

2. Duodenal Ulcers: These ulcers are accompanied by pain in the right upper quadrant and right hypochondriac region. With time, this pain is reduced with food or with the help of antacids.

3. Hepatitis and other Hepatobiliary Diseases: These diseases include cirrhosis (severe scarring of the liver), hepatoma (cancer of the cells of the liver), or cholangitis (infection of the bile duct system), also occur with pain and tenderness in this region. They are primarily associated with elevated bilirubin, jaundice, and scleral icterus.

Differential diagnosis for left hypochondriac pain:

Pain in the left hypochondriac region can be caused due to GERD, gastritis, or gastric ulcers. A splenic rupture (breakage in the surface of the spleen) and cyst can also be the cause, or other diseases of splenic etiology can present with pain in this region, which frequently radiates to the back. These diseases might also involve anemia of thrombotic origin, which can lead to a finding of splenomegaly by the means of physical examination.

Differential diagnosis for umbilical pain:

1. Pain in the umbilical region might be associated with pancreatitis or peptic ulcer disease, such as gastric (inflammation of the stomach lining) and duodenal ulcers (sore formed in the duodenum lining). It might also be associated with mesenteric ischemia (a condition in which blood flow is restricted to the small intestine due to narrowed or blocked arteries) or small bowel obstruction (a blockage of the small intestines). During inspection and palpation, the umbilical hernia (a condition in which the intestine protrudes via the abdominal muscles at the belly button) should also be checked. If the hernia cannot be decreased, it will require a surgical consult.

2. Enteritis: A condition in which inflammation of the small intestine occurs. It might be caused by various etiologies (for example bacterial, viral, or autoimmune issues) and can also present with umbilical region pain. These patients frequently show nausea, vomiting, and diarrhea. It is essential to inquire about recent meals and if any of the patient's family members or friends are also sick, as the bacteria in contaminated foods is the usual cause of enteritis.

Left or right lumbar pain:

1. Sudden and flank pain in the left or right lumbar region accompanied by fever or dysuria (painful or difficult urination) can be because of nephrolithiasis (kidney stones) or pyelonephritis (kidney infection).

2. Early appendicitis (inflammation of the appendix) can also result in periumbilical pain, which later localizes to the lower right quadrant or right iliac region only.

Bilateral iliac pain:

1. Pain in the left and right iliac regions can be due to ovarian torsion (rotation of the adnexal supporting organ, either full or partial with ischemia) or ovarian cysts in females. Pain in both these areas can also be due to testicular torsion in males.

Conclusion:

Abdominal pain refers to pain occurring in the region of the ribs to the pelvic area. It can be due to infection, food poisoning, and menstruation. The differential diagnosis for abdominal pain per the region includes right or left hypochondrial pain, epigastric pain, Bilateral iliac pain, umbilical pain, etc. The pain at different locations is diagnosed differently with diseases like GERD, gastritis, cholecystitis, hernia, and appendicitis. These can be examined with proper history taking, physical examination, and identification with various radiographic techniques.