Causes of abdominal pain. Abdominal syndrome

Respiratory infections are considered the most common diseases. Every person has encountered them in one form or another. But sometimes the disease is accompanied by atypical symptoms, which makes diagnosis difficult. Someone has probably already heard about such a condition as ARVI with abdominal syndrome, and for many this diagnosis will be news. Parents are especially worried when they hear something like this from a pediatrician examining a child. In any case, you will have to understand its origin, characteristic features and diagnostic criteria.

In fact, the diagnosis of a viral infection with abdominal syndrome is only valid at the initial stage of medical care. It suffers from inaccuracy and vagueness, requires further verification, and sometimes turns out to be completely different from what was initially thought. Therefore, it is extremely important to determine what exactly caused the disturbances in the body.

The origin of respiratory and abdominal symptoms varies. Abdominal problems usually arise due to inflammation of the abdominal lymph nodes (mesadenitis). Sometimes the wall of hollow organs is also involved in the process. The neuro-reflex origin of abdominal syndrome cannot be ruled out, as a result of severe intoxication. The range of pathogens that can cause this condition is quite wide and includes not only viruses. If abdominal pain appears against the background of catarrh of the upper respiratory tract, you should look for confirmation or refutation of the following infections:

Enteroviral.
Adenoviral.
Mononucleosis.
Cytomegalovirus.
Pseudotuberculosis.
Hemorrhagic fever.

As you can see, the list of probable diseases also includes very dangerous conditions that are highly contagious and have a severe course. The phenomena of mesadenitis can even be provoked by pathogens of influenza, sore throat and pneumonia. One should not ignore the fact that one patient may have a combination of several diseases. Then the respiratory manifestations are in no way related to the abdominal ones, which creates the need for differential diagnosis with intestinal infections, gastroenterological and surgical pathologies.

The causes of abdominal syndrome in adults and children, which occurs against the background of signs of inflammation of the upper respiratory tract, can be various conditions. And each specific case requires careful diagnosis.

Symptoms

The nature of the clinical picture is the first thing the doctor pays attention to. Analysis of the signs of the disease makes up half of the diagnosis. First, they find out what the patient is complaining about and detail the anamnestic data. True, this information has a large share of subjectivity. Then a physical examination is carried out with inspection, palpation of the abdomen and other procedures (percussion, auscultation of the lungs). This allows us to complete the picture with important objective signs.

Enterovirus infection

The disease caused by enteroviruses (Coxsackie, ECHO) is often accompanied by damage to the gastrointestinal tract. This form of infection usually occurs among young children and newborns. The onset is acute, with fever. Then vomiting, diarrhea, and abdominal pain appear. The intestines swell, rumble, and diarrhea occurs up to 7–10 times a day. The stool is loose, profuse, yellow or greenish in color, mixed with mucus.

In children, catarrhal symptoms from the upper respiratory tract are detected with great consistency. Upon examination, redness of the mucous membrane of the palate, arches, and posterior wall of the pharynx is determined. The latter has a grainy appearance. In some patients, enteroviruses cause herpangina, a special type of tonsil lesion. They become covered with bubbles containing clear liquid, which can burst, revealing erosions. Characterized by a sore throat that gets worse when swallowing. Regional lymph nodes (submandibular) are slightly enlarged.

Adenovirus infection

Abdominal syndrome in young children also includes a pathology caused by an adenovirus. Gastroenteritis is a separate clinical form, but can accompany other variants of the disease. The infection has a violent onset with nausea, vomiting, and loose stools. First, children have a stomach ache, flatulence appears, then the temperature rises to 39 degrees, and watery diarrhea appears. In most cases, conditions characteristic of adenoviral lesions develop:

Pharyngitis.
Rhinitis.
Conjunctivitis.

Intussusception can be considered as a specific complication. It occurs mainly in childhood and is characterized by intense cramping pain, bloating, and retention of stool and gas. It is believed that its cause is mesadenitis of the intra-abdominal lymph nodes.

Mononucleosis

Damage to the abdominal organs is often observed in infectious mononucleosis. The disease is caused by the Epstein-Barr virus, which accumulates in the body for quite a long time (up to 50 days) before manifesting itself. The pathology begins with an intoxication syndrome: weakness, body aches, headaches, loss of appetite. Then signs characteristic of mononucleosis appear:

Fever.
Sore throat.
Enlarged lymph nodes.

Inflammatory changes in the throat are visible by hyperemia of the mucous membrane, hypertrophy of the follicles (granular pharyngitis). The tonsils are loosened, enlarged, and often have a delicate whitish coating on them. Children may develop adenoiditis, which causes the voice to take on a nasal tone.

With mononucleosis, many groups of lymph nodes enlarge: cervical, axillary, inguinal, mesenteric, peribronchial. This causes abdominal pain, coughing, and shortness of breath. In children, abdominal syndrome sometimes simulates the picture of acute appendicitis. A common sign of pathology is an enlarged liver and spleen (hepatosplenomegaly). This creates a feeling of heaviness and discomfort in the hypochondrium. Some patients develop a skin rash (spotty, urticarial, hemorrhagic).

Mononucleosis lasts about a month; towards the end of the disease, symptoms reverse. Sometimes the process stretches over a long period, which allows us to talk about protracted forms. In children under 2 years of age, the clinical picture is often blurred or asymptomatic.

Abdominal syndrome in mononucleosis occupies an important place in the clinical picture. Its origin is associated with damage to lymphoid-reticular tissue.

Cytomegalovirus infection

The clinical picture of the cytomegalovirus process is very diverse: with localized and generalized forms, manifest and latent courses. The most common manifestation of acute illness is mononucleosis-like syndrome. Symptoms of intoxication are mild at first: periodic low-grade fever, weakness and fatigue. But then the fever increases, rising to 39 degrees. There is a sore throat, the mucous membrane of the pharynx turns red, and regional lymph nodes become enlarged.

The infectious process can occur with liver damage in the form of hepatitis. Then patients experience nausea and vomiting, and the skin turns yellow. The development of pancreatitis with abdominal pain is also likely. But not every lesion of internal organs is accompanied by clinical manifestations and is asymptomatic. Common forms of cytomegalovirus disease occur in immunodeficiency states (including HIV infection). They are characterized by damage to almost all organs: lungs, heart, nervous system, digestive tract, eyes, kidneys.

Pseudotuberculosis

The clinical picture of pseudotuberculosis is characterized by special polymorphism. The incubation period in most cases is up to 10 days. The main syndromes that occur in patients include:

Fever.
General toxic phenomena.
Damage to the digestive tract.
Respiratory signs.
Articular manifestations.
Skin rash.

Already on the first day, body temperature can rise to 39 degrees, lasting up to 3 weeks. I am worried about headaches, body aches, and malaise. Pain in the muscles can be very intense, which even simulates surgical pathology of the abdominal cavity. At first, the joints are affected in the form of arthralgia, but then signs of inflammation appear: redness, swelling, ring-shaped erythema. Sometimes several joints are affected, including the spine.

Involvement of the digestive tract in the infectious process occurs in a variety of ways:

Pain in the iliac, periumbilical region, epigastrium.
Vomiting and nausea.
Loose stools (with mucus).
Bloating.
Enlarged liver and spleen.

Sometimes even irritation of the peritoneum occurs, and in some cases it is possible to palpate enlarged mesenteric lymph nodes. But other groups also react: submandibular, axillary. They are mobile, elastic in consistency, and painless. Of the manifestations of respiratory syndrome with pseudotuberculosis, it is worth noting:

Sore throat.
Nasal congestion.
Dry cough.

Examining the mucous membrane of the pharynx, the doctor reveals its swelling and redness, which sometimes has a very pronounced character (“flaming pharynx”). Sometimes spotted elements (enanthema) appear on the back wall of the throat, the tonsils enlarge and become loose. The patient's appearance is characteristic: the face is red and puffy, the sclera of the eyes is with injected vessels. The tongue is initially covered with a whitish coating, but after a week it clears up, becoming “crimson”. Almost all patients develop a pinpoint rash on the skin of the torso and limbs.

Pseudotuberculosis is very characterized by a combination of damage to the digestive system and catarrhal manifestations in the upper respiratory tract.

Hemorrhagic fevers

The greatest danger is from infectious diseases occurring with hemorrhagic syndrome. These include a number of fevers (Lassa, Marburg, Ebola). They have a high degree of contagiousness (infectiousness) and a severe course, and therefore can end unfavorably. Infections are caused by viruses and are accompanied by multiple organ damage. Therefore, the symptoms are extremely varied:

Fever.
Intoxication (body aches, malaise).
Pain in the throat, stomach, chest, back.
Cough.
Conjunctivitis.
Vomiting and diarrhea.
Skin rash (maculopapular, hemorrhagic).
Bleeding (nasal, uterine, gastric, hematuria).

Due to the loss of fluid through vomiting, loose stools and blood, dehydration develops. It is characterized by dry mouth, thirst, decreased skin tone, pallor and exhaustion, increased heart rate and drop in blood pressure, and lethargy. All this creates a direct danger to the patient’s life.

Additional diagnostics

To find out the exact origin of abdominal syndrome, further research should be carried out. Diagnosis of the disease may include various laboratory and instrumental methods to establish its cause and clarify the nature of the disorders. These include:

Complete blood count (leukocytes, erythro- and platelets, ESR).
General urine analysis (leukocytes, protein, red blood cells and casts).
Blood biochemistry (acute phase indicators, electrolytes, liver and kidney tests, coagulation and proteinogram).
Swab from the throat and nose (microscopy, culture, PCR).
Serological tests (determination of antibodies to the pathogen).
Stool analysis (coprogram, bacterial culture).
Ultrasound of internal organs (liver and spleen, pancreas, kidneys).
Fibrogastroscopy.

A comprehensive examination does not take place without the participation of related specialists: an ENT doctor, an infectious disease specialist, a surgeon, a gastroenterologist. And only after a comprehensive diagnosis can we say why abdominal pain occurred against the background of respiratory tract damage. And then appropriate therapy is carried out, which is prescribed by the doctor. The patient must remember that much depends on the timeliness of seeking medical help.

Abdominal pain is one of the most common complaints. It has a wide range of manifestations: from minor discomfort to unbearable suffering, it can be aching or acute and signal a wide variety of diseases (not only organs located in the abdominal cavity). The basic principles of treating abdominal pain are eliminating the causes and influencing the mechanism of its development. It is not enough to simply relieve a pain symptom. If the patient simply takes various painkillers for abdominal pain, this will help temporarily relieve the discomfort. Meanwhile, the disease will progress until it leads to catastrophic consequences.

Mechanisms and causes of abdominal pain

Abdominal pain can occur on an empty stomach, after eating, or not be associated with food at all.

The organs of the abdominal cavity, except the visceral peritoneum and the greater omentum, are equipped with pain (nociceptive) receptors. From them, excitation is transmitted to the central nervous system, and the following stimuli affect them:

Stretching of a hollow organ or mesentery. In this case, pain occurs with a very rapid increase in tension in the wall of the internal organ. If stretching occurs slowly, gradually, then pain symptoms do not appear.
Increased pressure in the cavity of the esophagus, stomach, intestines.
Inflammation or damage to the wall of the abdominal organs, parietal peritoneum. Due to the inflammatory process and violation of the integrity of the wall, mediators are damaged, biologically active substances (bradykinin) are released, irritating pain receptors.
Organ ischemia caused by circulatory disorders. Mesentral thrombosis, embolism, compression of organs lead to the release of biologically active substances.

When an organ is ruptured, crushed, or cut, no pain occurs.

The duration and severity of pain depends not only on the intensity and frequency of transmission of the pain impulse from nociceptors, but also on:

work of the endogenous opiate system;
serotonin concentrations;
the amount of norepinephrine.

Thanks to the endogenous opiate system, substances with a morphine-like effect (endorphins, enkephalins) are produced, which reduce pain. Increased concentrations of serotonin and norepinephrine help relieve pain, and also inhibit or enhance the perception of pain by higher nervous activity. For example, with depression, pain sensations are significantly reduced, and this contributes to the chronicization of the pathological process.

Depending on where the pathological process arose, the following types of abdominal pain are distinguished:

visceral;
somatic (parietal);
irradiating.

Accordingly, the mechanisms and reasons for its appearance are different. Important for diagnosis:

pain characteristics;
factors influencing it (relationship with food intake, defecation, urination, etc.);
presence of other symptoms ();
seasonality of manifestations.

In addition to a thorough questioning, a physical examination is necessary, and the first priority is palpation of the abdomen.

How and why visceral pain occurs

Visceral pain appears due to spasm of smooth muscles, sharply increased pressure in the organ cavity, stretching of the wall, tension of the mesentery. In this case, pain receptors of the muscular layer of the walls of the abdominal organs (esophagus, stomach, intestines, gallbladder, pancreatic ducts and ureters, bladder), peritoneum, and capsules of parenchymal organs (kidneys, liver) are irritated.

A sharply expressed spasm of smooth muscles occurs during obstruction or urinary ducts, formation.
Stretching of the walls of a hollow organ occurs with an ulcer and accompanies a violation of the motor-evacuation function of the gastrointestinal tract.
Inflammatory changes, ulcers, erosions cause the release of biologically active substances from mediators, which cause spasm of smooth muscles.
Spastic abdominal pain can occur due to a violation of the neurohumoral regulation of the motor activity of the gastrointestinal tract ().
Poor circulation, resulting in organ ischemia. Most often occurs in elderly and senile patients. Painful sensations occur after eating, when the organ lacks oxygen due to spasm of blood vessels and the formation of atherosclerotic plaques on their walls.

When describing visceral pain, patients find it difficult to indicate the exact location, especially if the discomfort is caused by stretching of hollow organs (such pain is called distensional pain). This is due to the fact that the organs of the abdominal cavity are innervated bilaterally, from several segments of the spinal cord, and the afferent pathways for conducting impulses from closely located organs are nearby. Distension pain occurs when:

flatulence;
atonic, hypotonic;
reduced secretory and motor function of the stomach.

This type of pain is diffuse in nature, and sometimes patients complain of discomfort and heaviness in the abdomen.

Spastic visceral pain occurs due to spasm of smooth muscles. Their nature and severity depend on the degree and rate of increase in tension in the walls of the hollow organ and the increase in pressure inside it. One of the most important diagnostic criteria for this type of pain is that antispasmodics help relieve it. It is very important to differentiate spastic visceral pain from parietal pain. In cases where the pathological process does not affect the peritoneum, upon palpation in the area of localization of the unpleasant sensation, the pain intensifies, but there is no protective tension in the muscles of the anterior abdominal wall.

One of the most striking examples of spastic visceral pain is colic (cramping, acute and very severe pain in the abdomen, it grows quickly, can last from several minutes to several hours, and then subsides). During an attack, patients rush around and extremely rarely take a forced position, in which the pain is partially relieved. Factors that provoke its appearance are poor nutrition and shaking. More often found in clinical practice:

intestinal;
hepatic;
renal.

The mechanism of colic is not only a spasm of smooth muscles. Near the place where there is obstruction or spasm, the area of the hollow organ suddenly expands, the pressure rises sharply, and the pain intensifies significantly.

Vascular pain resulting from impaired blood flow and ischemia of internal organs is diffuse in nature, gradually becoming more intense. They indicate severe disorders and require immediate treatment, otherwise they can lead to intestinal necrosis, peritonitis and death of the patient.

When the disease has just arisen, the peritoneum is not yet involved in the pathological process; palpation does not reveal pain and muscle rigidity. Sometimes abdominal pain is diffuse, patients complain of aching pain, and only on days 2–3 do typical symptoms of mesenteric thrombosis and general peritonitis appear.

With chronic disruption of mesenteric blood flow, abdominal pain occurs. The factor that provokes the appearance of pain is overeating.

How and why parietal pain occurs

In acute appendicitis, the inflamed appendix irritates the peritoneum - parietal abdominal pain occurs.

Somatic pain occurs when an irritant acts on the nociceptors of the parietal peritoneum and omentum. The reasons for its occurrence are:

Infectious inflammation. Bacterial peritonitis occurs due to inflammation or perforation of internal organs and spread of the pathological process to the peritoneum (intestinal necrosis).
Aseptic inflammation. With metastasis in the peritoneum of a cancerous tumor, polyserositis and other autoimmune processes.
Chemical irritation. The peritoneum becomes inflamed due to the contact of gastric or pancreatic juice with pancreatic necrosis, etc.

Parietal pain is constantly intensifying, accompanied by increasing intoxication, fever, vascular insufficiency (to shock), and the patient requires urgent surgical intervention.

How and why referred pain occurs

Abdominal pain can occur not only due to damage to the abdominal organs. For example, with acute pleurisy, pleuropneumonia, patients complain of pain in the upper abdomen. To establish an accurate diagnosis, the clinician must exclude acute cholecystitis, gastric and duodenal ulcers, gastritis, and esophagitis. Also, abdominal pain can occur with pathologies of the genital organs and diseases of the spine. This is why a thorough pain analysis is necessary:

determine whether there is a connection with breathing, physical activity, food intake;
conduct an X-ray examination, ultrasound, CT or MRI (depending on the expected diagnosis);
when necessary assign .

One of the important signs of referred pain is that the pain does not increase with palpation.

In addition, abdominal pain may be reflected outside the abdominal cavity. In such cases, areas of skin hyperesthesia and pain points located outside the projection of the organ are identified. This is due to the fact that the afferent innervation pathways of organs and skin are located nearby. When an organ is damaged, afferent impulses cause excitation of segments of the spinal cord and increase the sensitivity of skin receptors:

If the liver or gallbladder is damaged, the pain may radiate to the right shoulder or shoulder blade.
With pancreatic pathology, patients complain of pain in the back, left shoulder, and scapula.
Diseases of the stomach and intestines provoke pain in the back, and diseases of the spleen - in the lower back.

Only a doctor can determine whether the pain is somatic, referred or visceral, by conducting palpation, auscultation, examination of the abdomen and other clinical studies. It is categorically not recommended to make a diagnosis on your own, and even more so, you should not use painkillers without consulting a specialist (taking medications can significantly change the clinical picture and make it difficult to determine the exact cause of abdominal pain). Treatment is prescribed by a doctor, guided by certain principles.

Principles of treatment of abdominal pain

When a patient comes to the doctor complaining of abdominal pain, it is not enough to simply eliminate this unpleasant symptom. It is necessary to conduct a full examination to establish the cause of this symptom. Treatment of patients complaining of abdominal pain depends on many factors:

severity of the disease;
duration of illness;
nature of damage;
mechanism of pain;
the presence of other diseases and complications.

If the patient complains of acute abdominal pain, accompanied by fever, intoxication, signs of bleeding from the gastrointestinal tract or irritation of the peritoneum, then it is necessary to resolve the issue of urgent surgical intervention.

Patients with chronic visceral pain need a full examination to establish an accurate diagnosis and identify the mechanism of pain. Treatment principles for these patients include:

treatment of the underlying disease (not only symptomatic, but also elimination of the causes);
normalization of motor disorders;
correction of pain perception mechanisms;
decreased visceral sensitivity.

If spastic pain is detected, antispasmodics are prescribed:

M-cholinergic receptor blockers;
phosphodiesterase inhibitors;
slow calcium channel blockers;
nitrates;
sodium channel blockers.

Antispasmodics cause relaxation of smooth muscles, reduce excitation of mechanoreceptors of hollow organs, thereby reducing pain. They restore the movement of intraluminal contents and improve blood circulation. Since they do not directly affect the mechanism of pain sensitivity, their use does not cause difficulties in establishing a diagnosis. They are even recommended during fluoroscopic examination in order to most accurately determine the cause of the disease.

In addition to medications, spastic pain can be relieved by placing a warm heating pad on the stomach.

If abdominal pain is caused by acidic stomach contents entering the duodenum, it is recommended:

eat protein foods;
drink plenty of warm water (it will dilute the acidic contents of the stomach);
refuse to eat juiced food (pickles, cabbage broth, strong broths, etc.);
antacids (Almagel, Maalox, magnesia);
antisecretory drugs (ranitidine, omeprazole, etc.).

Some diseases cannot be treated, and therefore the doctor prescribes only those drugs that directly relieve pain:

Local anesthetics. Drugs that affect serotonin receptors (alosetron, tegaserod) have an analgesic effect. They are especially effective for intestinal distension.
Non-steroidal anti-inflammatory drugs. They help with pain that occurs due to irritation of the peritoneum, stretching of the liver capsule, and its metastatic damage. Moderate pain is recommended to be treated with paracetamol. It only has an antipyretic and analgesic effect, and does not give strong side effects that occur when taking most non-steroidal anti-inflammatory drugs.
Narcotic drugs. They are prescribed for very severe pain to reduce any type of pain (visceral, somatic, radiating). These drugs have a huge drawback - they are addictive.

Other medications are also prescribed whose main effect is not analgesia:

antidepressants;
tranquilizers.

These drugs enhance the effect of analgesics.

Antidepressants are effective for neuropathic pain (caused by damage to nerve structures). For the treatment of abdominal pain, they are prescribed in a lower dose than for the treatment of depression.

Tranquilizers have a hypnotic effect, relieve muscle tension, and reduce anxiety symptoms.

Abdominal pain is not always a sign of a pathological process in the abdominal cavity. The pain may be due to the stomach and esophagus, damage to the lungs or heart. Why does abdominal pain develop and in what cases should you immediately visit a doctor?

Causes and mechanisms of development

Abdominal pain syndrome is caused by 4 groups of factors:

visceral;
parietal;
reflected;
psychogenic.

Visceral

The cause of smooth muscle spasm can be:

stone obstruction (urolithiasis or cholelithiasis);
the appearance of an ulcer (duodenum, stomach);
overstretching of the walls of the organ (gastritis, flatulence);
a non-infectious inflammatory process that provokes the release of mediators in nerve receptors (erosions, ulcers of the digestive tract);
spasms due to impaired neurohumoral regulation (spastic constipation, dyskinesia);
development of ischemia during vascular spasm (a spasmodic vessel does not allow enough blood to pass through, and the organ does not receive enough oxygen).

Diseases of the following organs provoke spasmodic pain in the abdomen:

gallbladder and bile ducts;
digestive tract;
pancreatic ducts;
bladder and ureters;
uterus, fallopian tubes (in women).

Pain is also caused by inflammation of the prostate parenchyma (in men), liver and kidneys, and ovaries (in women).

With visceral pain syndrome, a person cannot accurately convey where it hurts (points only to part of the abdomen). Vague soreness is often accompanied by increased sweating, nausea and vomiting, and pale skin.

Parietal

The receptors of the omentum and peritoneum are irritated. Pain increases when coughing, changing position or pressing on the abdominal wall. Life-threatening conditions provoke parietal abdominal pain:

infectious-inflammatory process (perforation of internal organs, acute appendicitis, peritonitis);
the influence of an aseptic irritant (polyserositis and other autoimmune processes, metastasis of the abdominal wall);
chemical irritation of the peritoneum (at the early stage of perforation of the ulcer, until the contents of the organ have penetrated into the abdominal cavity, the irritating factor is the entry of duodenal or stomach secretions into the omentum and peritoneum).

With parietal abdominal syndrome, pain develops acutely and gradually increases, fever appears, and dyspeptic disorders are possible.

Reflected

The nerve impulse is transmitted from the diseased area to the upper abdomen. The causes of pain are:

pleurisy;
pneumonia;
heart diseases;
heart attack

Palpation of the abdomen does not increase pain.

In childhood, the tummy hurts due to respiratory infections. Preschoolers often have tonsillitis or ARVI with abdominal syndrome.

There is no need to think that the reflected pain manifestations are not accompanied by indigestion. A classic example is the abdominal form of myocardial infarction, when instead of chest pain, diarrhea, nausea and vomiting appear. The stomach hurts, and externally the symptoms resemble an intestinal infection or poisoning.

Psychogenic

They occur in the absence of diseases of the internal organs. The triggering mechanism is:

Stress factor. During times of worry and excitement, a reflex spasm of smooth muscles occurs. Additionally, there may be a delay in defecation or urination. Painkillers and antispasmodics are ineffective: the pain disappears spontaneously after eliminating the cause of the anxiety.
Hypochondria. A person suspects that he has a disease, looks for similar symptoms and, despite healthy internal organs, feels discomfort. In such a situation, a placebo helps when distilled water is administered under the guise of a medicine.

Psychogenic pain does not have a clear localization, is long-lasting and is not relieved by traditional painkillers.

Classification of abdominal pain

Pain syndrome is systematized according to the following characteristics:

speed of development;
the nature of painful manifestations;
localization.

Rate of symptom formation

There are 2 forms:

Spicy. Symptoms appear suddenly (appendicitis, perforation of an ulcer), and the pain increases. The patient either rushes about, trying to find a comfortable position (pancreatitis, renal colic), or takes a forced position. Emergency medical attention required.
Chronic. Lasts for hours and sometimes days. Characteristic of dyskinesia, diverticula or exacerbation of chronic processes in the gastrointestinal tract.

Based on the nature of the abdominal syndrome, the doctor can determine the severity of the pathological process.

Nature of pain manifestations

The nature of the pain is divided as follows:

Cramping. The cause is a spasm of smooth muscles. Painful manifestations either increase or decrease, and can pass without the use of medications. Unpleasant sensations are accompanied by rushing around in search of a comfortable position, bloating and other intestinal disorders, and increased heart rate.
Aching. The intensity persists for a long time and decreases when taking a forced pose. The localization is blurred: the patient cannot clearly indicate the area where it hurts.
Growing. The pain gradually intensifies; taking a forced position brings minor relief. Weakness, increased sweating, hyperthermia and tachycardia appear. They occur both in acute disruption of the functioning of organs in the abdomen, and in other diseases (heart attack).
Vague. The patient points to the area of the abdomen, but cannot indicate the exact location of the pain. They occur with irradiation from organs located outside the abdominal cavity, psychogenic manifestations or moderate visceral pain.

Emergency assistance is required by cramping and increasing pain.

Localization

Painful discomfort occurs in different parts of the abdomen:

Epigastric region and hypochondrium. This location is typical for diseases of the stomach, liver and pancreas, as well as for referred pain from the chest organs.
The area around the navel. Pathology of the small intestine, less commonly the pancreas, liver, or referred pain syndrome.
Lower sections. Pain in the intestines in the lower abdomen below the navel indicates diseases of the colon, bladder or prostate. For pain in the lower abdomen in women, the cause may not be the intestines, but pregnancy or an inflammatory disease of the genital organs.

Using the classification, an experienced doctor, even before receiving laboratory data, will be able to guess where the patient should be hospitalized. Surgery, urology, gastroenterology, and gynecology treat the organs of the upper chest.

Diagnostic measures

To clarify the diagnosis, a standard examination plan is used:

Survey. They ask about existing diseases, the nature of the pain and the suspected causes.
Visual inspection. Pay attention to the patient’s behavior: he rushes about or takes a forced position, how he reacts to palpation (whether the pain intensifies or not).
Ultrasound. The abdominal organs are examined.
General and biochemical tests. The composition of the blood allows us to determine the cause of the disorders.
Cardiogram. Detects abnormalities in the functioning of the heart.
Radiography. Provides information about changes in the structure of the lungs and heart.

Therapy is carried out after the cause of abdominal syndrome has been established.

Treatment options

There are 2 possible patient management tactics:

conservative;
operational.

Conservative therapy

Medicines are selected depending on the cause:

analgesics and antispasmodics - to relieve pain;
agents that improve the functioning of the gastrointestinal tract in functional disorders;
medications that relieve nausea and vomiting (“Cerucal”);
antibiotics to reduce inflammation.

Home remedies for pain relief can only be used in combination with traditional therapy. Self-medication with folk recipes is prohibited: complications may arise.

Surgery

For intestinal pain, surgical treatment is indicated in the following cases:

appendicitis;
peritonitis;
perforation of the ulcer;
blockage of the bile duct with a stone;
tissue necrosis;
intestinal obstruction.

After eliminating the cause surgically, conservative therapy is carried out using antibiotics and painkillers.

Forecast

The outcome depends on the nature of the disease:

appendicitis, intestinal obstruction and other acute conditions in a healthy person do not recur, and complete recovery occurs;
dyskinesias, diverticula, chronic pancreatitis and other diseases are not dangerous to health and, subject to medical recommendations (diet, lifestyle), rarely worsen;
pathologies of the heart and lungs can be relatively safe (pneumonia), but can cause death (heart attack);
peritonitis at the initial stage is successfully cured, and if the process is advanced it leads to death;
It is impossible to eliminate metastases in the peritoneum; pain relief is used with non-narcotic and narcotic analgesics.

Not all abdominal pathologies can be successfully cured. Sometimes patients need to take medications for the rest of their lives to prevent exacerbations or relieve pain.

Localization of pain orients the clinician to the topography of a possible pathological process. The epigastric region includes three sections: the right and left hypochondrium, and the epigastrium itself. Pain in the right hypochondrium often signals diseases of the gallbladder, bile ducts, head of the pancreas, duodenum, hepatic angle of the colon, right kidney, and abnormally high located appendix. Hepatomegaly manifests itself less intensely. In the left hypochondrium, pain is recorded with lesions of the stomach, pancreas, spleen, left kidney, left half of the large intestine, and left lobe of the liver. The epigastrium is directly connected to the cardiac part of the esophagus, stomach, duodenum, diaphragm, pancreas, abdominal wall hernia, dissecting aneurysm of the abdominal aorta. The mesogastrium in its central umbilical region reflects the condition of the small intestine, abdominal aorta, hernial changes in the abdominal wall, omentum, mesentery, lymph nodes and vessels. The right iliac region is traditionally associated with changes in the appendix, the cecum, the terminal part of the small intestine with the Bauginean valve, the right kidney, the ureter, and the right ovary. Left iliac region - left half of the colon, left kidney, ureter, left ovary. Only the suprapubic region narrows the list of possible lesions to the genitourinary system and inguinal hernias. Widespread (diffuse) pain over the entire surface of the abdominal cavity is characteristic of diffuse peritonitis, intestinal obstruction, damage to the vessels of the abdominal cavity, ruptures of parenchymal organs, capillary toxicosis, and ascites.
Pathogenetically, there are 3 types of abdominal pain.
True visceral pain is provoked by changes in pressure in organs when they are stretched (both parenchymal and hollow organs) or a sharp contraction of the muscles of hollow organs, or a change in blood supply.
From a clinical point of view, true visceral pain includes three types of sensations: spastic, distensional and vascular pain. Spasmodic pain is characterized by paroxysmal pain, pronounced intensity, and clear localization. They have a clear irradiation (refers to the second type of abdominal pain, but we have no right not to mention this when describing the clinical characteristics of pain), which is associated with the anatomical proximity in the spinal and thalamic centers of the afferent pathways of innervation of the affected organ and the area to which the pain radiates. Examples include pain in the case of damage to the biliary system “up and to the right”, the right shoulder blade, shoulder, right arm, in case of damage to the pancreas - pain of a “girdling” nature, etc. Spasmodic pain is often called “colic,” although the term “colic” translated from Greek (“colikos”) means only “pain in the colon.” In practice, the use of combinations of biliary colic, renal colic, gastric colic, and intestinal colic occurs constantly. Activation of nociceptors (pain receptors) can be carried out by various stimulants: high and low temperature, strong mechanical effects, release of biologically active substances (bradykinin, histamine, serotonin, prostaglandins) at the site of inflammation or damage. The latter either reduce the threshold of sensitivity to other stimuli or directly activate pain receptors. The spastic mechanism of pain suggests a positive effect when taking antispasmodics. Concomitant phenomena may be vomiting, which often does not bring relief, fever of reflex origin and local muscle tension of the anterior abdominal wall.
The occurrence of visceral pain can be caused by both organic and functional disorders. However, in any case, they are a consequence of primarily a violation of the motor function of the gastrointestinal tract. The motor function of the gastrointestinal tract has regulatory mechanisms from external and internal innervation. External innervation is carried out through the autonomic nervous system (sympathetic and parasympathetic). The submucosal and muscular plexus of the gastrointestinal tract are united by the concept of internal innervation. The presence of intramural neurons in the Auerbach (muscular) plexus allows for autonomous control of the motor activity of the gastrointestinal tract even when the autonomic nervous system is turned off.
The contractility of the gastrointestinal tract is determined by the activity of smooth muscle cells, which is directly dependent on the ionic composition, where the dominant role is played by calcium ions, which cause contraction of the muscle fiber. The opening of calcium channels for the entry of Ca2+ ions into the cell correlates with an increase in the concentration of sodium ions in the cell, which characterizes the beginning of the depolarization phase. Intramural mediators play a significant role in the regulation of transport ion flows and direct motility of the gastrointestinal tract. Thus, the binding of acetylcholine to M receptors stimulates the opening of sodium channels.
Serotonin activates several subtypes of receptors, which causes diametrically opposite effects: connection with 5-MT-3 receptors promotes relaxation, with 5-MT-4 - contraction of muscle fiber.
New mediators currently include: substance P, enkephalins, vasoactive interstitial polypeptide, somatostatin.
Substance P (separated into a separate group from the group of tachykinins), contacting directly with the corresponding receptors of myocytes, increases their motor function due to direct activation and due to the release of acetylcholine.
Enkephalins modulate the activity of intramural neurons operating at the level of the Auerbach (muscular) plexus. Enkephalinergic receptors are widely represented in the gastrointestinal tract and are localized in gastrointestinal effector cells of smooth muscle fibers.
Endorphins also play a certain role in the regulation of gastrointestinal motor activity: when they interact with m and D-opioid receptors of myocytes, stimulation occurs, and when connected with k receptors, they slow down the motor activity of the digestive tract.
Somatostatin can both stimulate and inhibit intramural neurons, leading to similar motor changes.
The direct effect of motilin polypeptide on stimulating receptors of muscle cells has been proven, which increases the tone of the lower esophageal sphincter, accelerates gastric emptying and enhances the contractile activity of the large intestine.
Vasoactive intestinal peptide (VIP) (the predominant area of secretion is the submucosal and muscular plexus in the large intestine) is able to relax the muscles of the lower esophageal sphincter, the muscles of the fundus of the stomach, and the colon.
The basis of functional disorders of the gastrointestinal tract is an imbalance of neurotransmitters and regulatory peptides (motilin, serotonin, cholecystokinin, endorphins, enkephalins, VIP), and changes in motor activity are considered the leading component of pathogenesis. Functional disorders (FD) are a set of symptom complexes on the part of the digestive system, the occurrence of which cannot be explained by organic causes - inflammation, destruction, etc. Due to the high prevalence of this pathology, guidelines have been developed (“Rome III criteria”) on the pathogenesis, diagnosis and treatment of this nosological form. Table 1 shows the classification of risk factors of the digestive system.
Analysis of the above conditions proves that the basis for the pathogenesis of functional disorders is a change in motor activity in combination with disturbances in the central, peripheral and humoral regulation of the digestive tract, and hyperalgesia of the digestive organs.
The distensional nature of pain occurs when the volume of internal organs (both hollow and parenchymal) changes and the tension of their ligamentous apparatus. Complaints are described by patients as low-intensity, gradually occurring, long-lasting, without clear localization and irradiation of pain; taking antispasmodics does not have a positive effect, sometimes giving the opposite effect. The syndrome of flatulence, gastrointestinal dyspepsia with secretory insufficiency, hepatomegaly, splenomegaly are manifested by the clinical complaints described above. If the blood supply to the abdominal organs is disrupted (arterial embolism, mesanterial thrombosis, atherosclerosis of the abdominal aorta and its branches - “abdominal toad”), pain occurs suddenly, diffusely, usually intense, gradually increasing.
The next category of pain is parietal pain. Mechanism: irritation of the cerebrospinal nerve endings of the parietal peritoneum or the root of the mesentery, as well as perforation of the wall of hollow organs. The pathogenesis of peritonitis can be of inflammatory origin (appendicitis, cholecystitis are considered as a result of perforation). Depending on the etiology, the onset of peritoneal pain transforms from gradual to sudden acute, with a pain syndrome continuously increasing in intensity up to unbearable pain. An obligatory companion is symptoms of inflammation, intoxication, and the possible presence of acute vascular insufficiency.
Reflex (radiating, reflected) pain. The description of pain is associated with the names of G.A. Za-har-i-na and Geda, who for the first time proved the relationship between internal organs and areas of increased skin sensitivity, which occurs as a result of the interaction of visceral fibers and somatic dermatomes in the dorsal horns of the spinal cord. For example, visceral afferentation from the liver capsule, spleen capsule and pericardium enters the central nervous system via the phrenic nerve from nerve segments (dermatomes) C3-5. Afferentation from the gallbladder and small intestine passes through the solar plexus, the main celiac trunk and enters the spinal cord at the T6-T9 level. The appendix, colon and pelvic organs correspond to the T6-T9 level through the mesenteric plexus and the minor branches of the celiac trunk. Level T11-L1 is connected through the lower branches of the celiac nerve to the sigmoid colon, rectum, renal pelvis and capsule, ureter and testicles. The rectum, sigmoid colon and bladder enter the spinal cord at the S2-S4 level. In addition to areas of increased skin sensitivity (Zakharyin-Ged zones), pain is detected in deeper tissues. For example, pain caused by intestinal distension at the initial stage is perceived as visceral, but as it progresses it radiates to the back.
Treatment of pain syndrome. Domestic medicine is characterized by etiological and pathogenetic approaches to the treatment of any disease. Treatment carried out in connection with only one of the stated complaints cannot be taken as a basis, especially since there are many reasons for its occurrence, firstly, and secondly, the pain syndrome itself is diverse in the mechanisms of its development. However, the humane desire to alleviate the patient’s suffering gives us the right, with a correct assessment of all collected complaints and the patient’s status, to offer approaches to the treatment of abdominal pain. The most common mechanism for this is smooth muscle spasm. Based on the reasons for its occurrence, drugs are used that act on different parts of the reflex chain (Table 2).
Of the drugs presented in the table, myotropic antispasmodics are the most widely used. The mechanism of their action is reduced to the accumulation of c-AMP in the cell and a decrease in the concentration of calcium ions, which inhibits the connection of actin with myosin. These effects can be achieved by inhibition of phosphodiesterase or activation of adenylate cyclase, or blockade of adenosine receptors, or a combination of these effects. Due to the selectivity of pharmacological effects, myotropic antispasmodics do not have the undesirable systemic effects inherent in cholinomimetics. However, the antispastic effect of drugs in this group is not powerful and fast enough. Myotropic antispasmodics are prescribed mainly for functional diseases of the gastrointestinal tract (non-ulcer dyspepsia, irritable bowel syndrome), as well as for secondary spasms caused by organic disease.
Of the non-selective myotropic antispasmodics, papaverine and drotaverine are currently the most studied, but the latter is more preferable in the choice of a clinician. Drotaverine (Spazmonet) is highly selective. The selectivity of its action on smooth myocytes of the gastrointestinal tract is 5 times higher than papaverine. The frequency of undesirable side effects, including those from the cardiovascular system (arterial hypotension, tachycardia), is significantly lower when taking the drug. Spasmonet does not penetrate the central nervous system and has no effect on the autonomic nervous system.
A significant advantage of drotaverine, in contrast to anticholinergics, is safety of use.
Spasmonet is ideal for long-term use to ensure a long-term spasmolytic effect. In gastroenterology, the indications are: spastic dyskinesia of the biliary tract, pain relief from gastric and duodenal ulcers, pylorospasm, irritable bowel syndrome, and kidney stones.
Spasmonet reduces blood viscosity, platelet aggregation and prevents thrombus formation. This property may be useful in treating patients with intestinal ischemia.
However, in chronic pathologies such as IBS or biliary disorders, oral administration of these drugs in therapeutic doses is often insufficient, and there is a need to increase their dose or parenteral administration. In order to enhance the therapeutic effect, drugs with a higher dosage of the active substance are produced. An example is the tablet form of the drug Spasmonet-forte (KRKA). 80 mg of drotaverine in 1 tablet allows you to obtain a more pronounced antispasmodic effect while reducing the frequency of administration, as well as reducing the number of dosage forms taken.
Although drotaverine and papaverine are usually well tolerated, in large doses or when used intravenously they can cause dizziness, decreased myocardial excitability, and impaired intraventricular conduction.
Despite the fact that monotherapy for abdominal pain syndrome is not a complete treatment for both functional and organic lesions of the gastrointestinal tract, it can serve as one of the areas of complex treatment of the patient.

Literature
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4. Ivashkin V.T., Komarova F.I., Rapoport S.I. A short guide to gastroenterology. - M.: LLC M-Vesti, 2001.
5. Ivashkin V.T. Metabolic organization of gastric functions. - L.: Science, 1981.
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Abdominal syndrome manifests itself as sharp abdominal pain in the absence of acute surgical disease of the abdominal organs. It is observed mainly in children. It may be caused by hemorrhagic vasculitis, periarteritis nodosa, lobar pneumonia, rheumatism, viral hepatitis, ersiniosis, influenza, enteritis, diabetes mellitus.

Symptoms of abdominal syndrome

Abdominal pain syndrome is characterized by intermittent pain, the localization of which is difficult to determine. The disease is also accompanied by:
vomiting; tension in the muscles of the anterior abdominal wall; changes in the cellular composition of the blood, that is, leukocytosis.

Experts distinguish two types of pain:

Acute abdominal syndrome. It has a short duration and most often develops quickly.

Chronic abdominal pain syndrome. It is characterized by a gradual increase in pain that can recur over months.

The syndrome is also divided into:

- visceral;
- parental (somatic)
- reflected; (irradiating)
- psychogenic.

Visceral pain occurs in the presence of pathological stimuli in the internal organs and is carried out by sympathetic fibers. The main impulses for its occurrence are a sudden increase in pressure in a hollow organ and stretching of its wall (the most common cause), stretching of the capsule of parenchymal organs, tension of the mesentery, and vascular disorders.

Somatic pain is caused by the presence of pathological processes in the parietal peritoneum and tissues containing the endings of sensory spinal nerves.

Radiating pain is localized in various areas remote from the pathological focus. It occurs in cases where the impulse of visceral pain is excessively intense (for example, the passage of a stone) or when there is anatomical damage to an organ (for example, intestinal strangulation).
Referring pain is transmitted to areas of the body surface that have common radicular innervation with the affected organ of the abdominal region. So, for example, with increased pressure in the intestines, visceral pain first occurs, which then radiates to the back; with biliary colic, to the back, to the right shoulder blade or shoulder.

Psychogenic pain occurs in the absence of peripheral influence or when the latter plays the role of a trigger or predisposing factor. Depression plays a special role in its occurrence. The latter often occurs hidden and is not realized by the patients themselves. The close connection between depression and chronic abdominal pain is explained by general biochemical processes and, first of all, by the insufficiency of monoaminergic (serotonergic) mechanisms. This is confirmed by the high effectiveness of antidepressants, especially serotonin reuptake inhibitors, in the treatment of pain. The nature of psychogenic pain is determined by personality characteristics, the influence of emotional, cognitive, social factors, the psychological stability of the patient and his past “pain experience.” The main signs of these pains are their duration, monotony, diffuse nature and combination with other localizations (headache, back pain, throughout the body). Often, psychogenic pain can be combined with other types of pain mentioned above and remain after their relief, significantly transforming their character, which must be taken into account during therapy.

The causes of abdominal pain are divided into intra-abdominal and extra-abdominal.

Intra-abdominal causes: peritonitis (primary and secondary), periodic disease, inflammatory diseases of the abdominal organs (appendicitis, cholecystitis, peptic ulcer, pancreatitis, etc.) and pelvis (cystitis, adnexitis, etc.), obstruction of a hollow organ (intestinal, bi -liary, urogenital) and ischemia of the abdominal organs, as well as irritable bowel syndrome, hysteria, drug withdrawal, etc.

Extra-abdominal causes of abdominal pain include diseases of the chest cavity (pulmonary embolism, pneumothorax, pleurisy, diseases of the esophagus), polyneuritis, spinal diseases, metabolic disorders (diabetes mellitus, uremia, porphyria, etc.), exposure to toxins (insect bites, poisoning poisons).

Pain impulses arising in the abdominal cavity are transmitted through the nerve fibers of the autonomic nervous system, as well as through the anterior and lateral spinotholamic tracts.

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