See also ABDOMINAL PAIN; BODY SHAPE AND CARDIO-
VASCULAR DISEASE; DYSPEPSIA; ENDOSCOPY; FALLOPIAN
TUBES; FECAL IMPACTION; FLATULENCE; WEIGHT LOSS AND
WEIGHT MANAGEMENT.
abdominal pain Discomfort in the trunk region
that can range from mild cramping to severe PAIN.
Abdominal pain requires emergency
medical attention when:- PAINis sudden, sharp, and unrelenting
- Pain radiates into the shoulder or jaw
- The abdomen is tense and tender to
the touch - There is bloody VOMITINGor DIARRHEA
Abdominal pain is one of the most common
reasons people seek medical care. Numerous
health conditions can cause abdominal pain, from
DYSPEPSIA (indigestion) and FLATULENCE (gas) to
APPENDICITISand GALLBLADDER DISEASE. Advanced or
metastatic CANCER, LIVERdisease, and HEART ATTACK
also can involve abdominal pain, among other
symptoms.
COMMON CAUSES OF ABDOMINAL PAINAPPENDICITIS cholecystitis
cholelithiasis (gallstones) CONSTIPATION
dissecting abdominal ANEURYSM DYSPEPSIA(indigestion)
ECTOPIC PREGNANCY FECAL IMPACTION
GASTROESOPHAGEAL REFLUX HEART ATTACK
DISORDER(GERD) HERNIA
ILEUS(intestinal obstruction) INTUSSUSCEPTION
NEPHROLITHIASIS(KIDNEYstones) PANCREATITIS
PELVIC INFLAMMATORY DISEASE(PID) PERITONITIS
URETHRITIS URINARY TRACT INFECTION
viral GASTROENTERITIS (UTI)
It is difficult to gauge the severity of the under-
lying cause of pain on the basis of the pain’s quali-
ties. Intestinal gas can cause immobilizing pain,
while heart attack may initially manifest as vague
discomfort. FEVER(body temperature above 100º
F) often accompanies bacterial infections, which
require treatment with ANTIBIOTIC MEDICATIONS.
Most abdominal discomfort is transitory and
benign. Abdominal discomfort requires medical
attention when pain is debilitating or continues
for longer than five days without improvement,
there is discharge from the PENISor VAGINA, or
there is accompanying VOMITINGor DIARRHEAfor
longer than three days.
See also ABDOMINAL DISTENTION.achalasia A disorder of the ESOPHAGUSin which
the lower esophageal sphincter, the ring of MUSCLE
at the entry to the STOMACH, remains constricted,
failing to allow food to pass into the stomach.
Researchers believe the cause is a reduced number
of inhibitory nerve cells, the specialized neurons
that direct involuntary muscle tissue to relax. The
resulting imbalance allows excitory NERVE cells
(neurons that direct involuntary MUSCLEtissue to
contract) to dominate. Over time the peristaltic
action of the esophagus, a structure of involuntary
muscle tissue, slows as well. Symptoms of achala-
sia include- painful or difficult swallowing
- regurgitation of swallowed food
- DYSPEPSIA(heartburn)
- PAINin the central chest and beneath the ster-
num (breastbone) after eating - unintended weight loss
BARIUM SWALLOWcan suggest the diagnosis, with
manometry (which measures the pressure within
the esophagus) providing confirmation. The gas-
troenterologist may also perform esophagogastro-
duodenoscopy (EGD), an endoscopic examination
of the upper gastrointestinal tract, to rule out can-
cers and to use balloon dilation to gently stretch
the sphincter. Some people experience relief with
medications, such as calcium channel blockers,
which block the actions of excitory neuro-
transmitters to help relax the lower esophageal
sphincter. BOTULINUM THERAPY, in which the gas-
troenterologist injects botulinum toxin into the
sphincter to paralyze it, can provide temporary
relief. The treatments of choice for short-term
relief are disruption of the lower esophageal
sphincter, in which the gastroenterologist uses
special instruments to widen the sphincter, or
esophagomyomotomy, a surgical OPERATIONto cut
a portion of the sphincter.
See also ENDOSCOPY; NERVOUS SYSTEM; NEURON; NEU-
ROTRANSMITTER; PERISTALSIS; SWALLOWING DISORDERS.achalasia 9