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Referred Pain In Abdominal Disease - Types, Causes, and Treatment

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Referred pain in abdominal diseases refers to pain that originates from pathological sites in the abdomen but is perceived in other body parts.

Medically reviewed by

Dr. Ghulam Fareed

Published At February 1, 2023
Reviewed AtJune 28, 2023

Introduction

Abdominal pain is the most common issue that interferes with daily activities. It can be mild or severe, depending on the severity of the cause. Abdominal pain can occur from one or more health conditions but can also originate from factors outside the abdominal region. The prognosis of abdominal pain depends on age, diseases, and habits. It is difficult to identify the exact cause of referred pain in abdominal disease, but one should not panic about experiencing pain as it can happen due to exertion sometimes. Abdominal pain can also result from heavy weight lifting in the gym or faulty posture. There are some tests by which a person can be diagnosed and treated by their doctors.

What Are the Types of Referred Pain in Abdominal Disease?

There are four types of abdominal pain, and they are as follows:

  • Visceral Abdominal Pain - Pain receptors are present in the organ’s muscles. The gut organs are insensitive to stimuli such as burns and cuts but are sensitive to distension and contraction, twitching, and stretching. Visceral abdominal pain is usually felt in the midline of the abdomen but can also be felt in other regions.

  • Parietal Abdominal Pain - Somatoparietal pain receptors are present in the peritoneum (a thin membrane that covers the intra-abdominal organ) of the organ. The parietal peritoneum is triggered by nerves that cause sharp, well-localized, and lateralized pain in the abdomen due to inflammation, infection, or cancer of the organ located in the stomach.

  • Referred Abdominal Pain - The pain originates from abdominal disease but is felt in other body parts like the shoulder, back, neck, or chest. This phenomenon usually occurs as the brain gets confused about locating the exact origin of pain.

  • Psychogenic Abdominal Pain - Cultural, emotional, and psychological factors affect everyone and can cause pain of varying degrees in people. In some patients, a specific causative factor may not be found, even after a thorough investigation. In such cases, psychogenic causes, such as depression, maybe a causative factor.

What Is Referred Abdominal Pain?

The pain originates from abdominal disease but is felt in other body parts like the shoulder, back, neck, or chest. For example, in gallbladder inflammation, the pain may be felt in the back or shoulder tip. Referred abdominal pain can also be defined as the pain referred to the abdomen from outside the abdomen that may be due to other than abdominal disease. For example, abdominal pain in cardiac disease, pulmonary disease, systemic disease, and central nervous system dysfunction.

Examples of referred abdominal pain -

  • Pain in the midline region of the abdomen above the navel (epigastric pain) can be a symptom of appendicitis (inflammation of the appendix).

  • Inflammation of the gallbladder can cause pain at the back or shoulder tip.

  • Myocarditis (inflammation of heart muscles) can cause abdominal pain.

  • Sharp pricking pain can occur in the epigastric region of the abdomen due to acidity.

  • Pelvic inflammatory diseases can cause lower abdominal pain in women.

  • Pulmonary diseases like pleural effusion and pneumonia can cause referred abdominal pain.

  • Systemic diseases like diabetes ketoacidosis causes referred abdominal pain. It is a condition when low sugar due to diabetes causes the body to break down fat in the body for functioning resulting in the production of acids called ketones. An excess of the ketone is called diabetic ketoacidosis.

  • Referred abdominal pain can occur due to psychogenic causes, such as depression or abdominal migraine.

  • Some infectious diseases (herpes zoster) also cause referred abdominal pain.

  • During menstruation, it is common for women to suffer from referred abdominal pain.

Referred Abdominal Pain

What Are the Causes of Referred Abdominal Pain?

Abdominal pain can result from one or more disease consequences but can also originate from outside the abdominal region. The following are the causes of referred abdominal pain:

1. Retroperitoneal (space behind the peritoneum in the abdominal cavity) -

  • Aortic aneurysm (abnormal dilation of the aortic lumen).

  • Lymphadenopathy (inflammation of the lymph nodes).

  • Malignancy (tumor or cancer).

  • An abscess (accumulation of pus).

2. Psychogenic (psychological in origin) -.

3. Locomotor Factors

  • Vertebral fracture.
  • Abdominal muscle strain.

4. Metabolic or Endocrine Disorders

  • Diabetes mellitus (increased levels of blood sugar).
  • Hypercalcemia (high level of calcium in the blood).
  • Acute intermittent porphyria (an enzyme deficiency condition related to liver disorder).

5. Drugs

  • Glucocorticoids.
  • Azathioprine.
  • Lead.

6. Hematological Disorders

  • Sickle cell disease (a condition characterized by the inability of red blood cells to carry oxygenated blood).
  • Hematolytic disorder (a condition that is characterized by the destruction of red blood cells).

7. Neurological Disorders

  • Spinal cord lesion (an abnormal change or injury in the spine).
  • Radiculopathy (pinched nerve).

How to Diagnose Referred Abdominal Pain?

Abdominal pain accounts for 50 percent of all emergency cases, requiring immediate medical intervention. The cause may be as elaborated above. Following are how abdominal pain can be examined:

Clinical Assessment - If there are signs of abdominal pain (tenderness, swelling, rigidity), the patient should be administered intravenous fluid or antibiotics. If there are no signs of abdominal pain, a note should be made of the patient's mood and emotional state, weight loss, fever, jaundice, or anemia. Suppose a thorough abdominal and rectal examination is regular, in that case, a careful investigation should be made to locate the source of the referred pain. It could generally occur due to the vertebral column, spinal cord, lungs, and cardiovascular system.

History of Patient - A pattern indicative of the history of psychiatric disturbance, repeated negative tests, or any symptoms that do not match any disease suggests the psychological origin of pain. A careful, open, and honest discussion with the patient should be held, as well as to create a case history that would reduce the need for unnecessary investigation.

Following are the investigations for referred abdominal pain:

Blood Test - The patient should have a full blood count test to examine anemia (a condition characterized by the inability of red blood cells to carry oxygenated blood) and leukocytosis (increased white blood cells in the blood).

Urea and Electrolyte Test - Indicates dehydration or other infectious diseases like pancreatic inflammation.

Urine Test - A urine test provides sufficient evidence of diabetes or renal disease nephritis.

Fecal Calprotectin - It is indicative of irritable bowel disease in the absence of rectal bleeding, weight loss, and abnormal physical finding.

X-Ray - A chest X-ray may show air under the chest, suggestive of perforation. A plain abdominal X-ray may show evidence of obstruction and also show signs of renal stones.

Ultrasound - It is useful in detecting pain in the mid-abdominal region (present in gallbladder disease). It is useful in detecting the presence of free fluid (present in intra-abdominal abscesses). It is also suggestive in chronic pancreatitis.

Computed Tomography (CT) Scan - It is indicated in patients with upper abdominal pain radiating to the back. It may provide evidence for chronic pancreatitis, pancreatic cancer, retroperitoneal collection or masses, and renal stone.

Angiography - Should be considered when pain is provoked by food in a patient with atherosclerosis (hardening of arteries), as it may indicate mesenteric ischemia (restriction of blood flow by blocked arteries). It may also indicate an aortic aneurysm.

Endoscopy - It is indicative of dyspepsia (discomfort, bloating, and nausea, which are thought to originate from the upper gastrointestinal tract).

Colonoscopy - It s indicated for patients with irregular bowel habits and rectal bleeding. Colonoscopy may be suggestive of chronic disease.

What Are the Treatment Options for Referred Abdominal Pain?

The general approach is to close perforation (if any) and treat the inflammatory condition with antibiotics, surgery, or by relieving the obstruction. The speed of recovery and the necessity for surgery depends on the organ involved and several other factors, of which the presence or absence of peritonitis is the most important. A treatment summary of some of the common causes of referred abdominal pain is as follows.

  • A range of analgesics, such as Pregabalin, particularly non-steroidal non-inflammatory drugs, are valuable. Still, the pain's severe and never-ending nature often leads to sedative use with the risk of addiction.

  • If diabetes ketoacidosis is diagnosed, then insulin infusion is recommended.

  • If a peptic ulcer is diagnosed, surgical closure of the perforation is the treatment of choice.

  • If appendicitis is diagnosed, this should be surgically treated without causing any delay.

  • Broad-spectrum antibiotics such as Ofloxacin and Metronidazole should be given if pelvic inflammatory disease is suspected.

  • Anti-depressive drugs and proper counseling of patients are the treatment of choice for a patient with abdominal pain due to psychogenic factors.

Conclusion

Abdominal pain can be the consequence of self-neglect. Therefore, it is essential to maintain a healthy diet and lifestyle. There should not be a delay in consulting a doctor, as delaying treatment increases the likelihood of adverse sequelae such as abscess formation. Therefore, hospital admission is indicated for severe symptoms. Many patients have symptoms of other diseases associated with alcohol and tobacco abuse, and they may be responsible for referred abdominal pain. A history of alcohol misuse increases the chances of chronic pancreatitis. Therefore, alcohol avoidance is crucial in halting the disease progression and reducing pain. Habits such as excessive alcohol drinking and smoking should be avoided.

Frequently Asked Questions

1.

Which Pain Is Also Known as Peritoneal Tenderness?

Pain or inflammation in the lining of the abdomen is called peritoneal tenderness. The lining of the abdomen is called the peritoneum. It can be due to a tear in the lining or a burst of the appendix. Other conditions that cause abdominal pain can include constipation, irritable bowel syndrome, allergies to some food, food poisoning, and lactose intolerance.

2.

How Is Pain in the Upper Abdomen Treated?

The management of upper abdominal pain depends on its cause. All upper abdominal pains might not be effectively managed at home. Some conditions like gas or bloating can be managed by home remedies. For general pain, painkillers might be required. Medical attention is advisable to give the appropriate treatment.

3.

When Should a Pregnant Woman Be Concerned About Abdominal Pain?

Abdominal pain in pregnancy can be false contraction pains. But when associated with spotting or bleeding, medical attention must be sought. If the cramps or the tight feeling occurs repeatedly, medical attention must be sought. Medical attention must be sought when there is an unusual vaginal discharge or abnormal lower back pain.

4.

How Can Gas Pain in Your Back Be Relieved?

An over-the-counter drug will help to reveal the pain due to gas. Applying a heat pack to the abdomen will help to relieve gas pain. Drinking plenty of water helps to relieve abdominal pain. Gentle exercises and walking will help to relieve bloating and gas issues.

5.

Does Abdominal Pain Indicate a Heart Attack?

Heartburn and abdominal pain can be a sign of a heart attack. Pressure or tightness in the chest, and aching pain in the chest that radiates to the left arm, can be noted as signs of a heart attack. Nausea, indigestion, or heartburn are the common symptoms seen.

6.

Can Shoulder Pain Be Caused by Abdominal Pain?

Yes, abdominal pain may be referred to the shoulder. The pain may be associated with a problem elsewhere in the body other than the area where the pain is felt. This is called referred pain. Abdominal pain due to gallstones, pancreatitis, ovarian cyst, etc, shows referred pain in the shoulders.

7.

What Might Cause Neck and Abdominal Pain but Show Up as Normal on an Ultrasound?

A referred pain in the neck due to an abdominal cause may not be detected in an ultrasound. However, if the cause is due to an infection in the abdomen, it might not be seen in an ultrasound. Ultrasound is also disrupted by air trapped. Hence pain due to gas might not be found in an ultrasound.

8.

Is Early Pregnancy Abdominal Pain Normal?

Abdominal pain and cramps are normal in early pregnancy. There is nothing to worry about unless abnormal pain is seen. Sharp pain that is constant or abrupt, along with nausea and vomiting, should be taken into consideration, and medical attention must be sought. If the pain is mild or goes away after some time, it is not to be worried about.

9.

How to Treat Pain in the Abdominal Nerves?

Local nerve blocks or trigger point injections are used to relieve pain that is due to a nerve in the abdomen. The site of injection is determined after the patient is asked to specify a region with the maximum pain. The pain due to the abdominal nerve is a dull aching pain radiating in the upper half of the abdomen. It may pass obliquely downward or radiate when the patient moves.

10.

Can Anxiety Cause Sharp Chest and Abdominal Pains?

Yes, stress and anxiety can also cause abdominal and chest pain. The pain caused by anxiety may be dull and nauseating. Severe cases of anxiety can cause panic attacks causing stabbing sharp pain in the chest.
Dr. Ghulam Fareed
Dr. Ghulam Fareed

Medical Gastroenterology

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