Gastrointestinal Pain: Causes
GI Pathology: Abdominal Pain
Overview:
- GI System Pathologies:
- Gallstone disease, which arises in the gallbladder and biliary system.
- Appendicitis, which is inflammation of the vermiform appendix.
- Esophagitis, which is inflammation of the esophagus.
- Gastritis/ulcer disease of the stomach.
- Pancreatitis, which is inflammation of the pancreas.
- Several intestinal disorders: inflammatory bowel disease, diverticulitis, ischemia, obstruction, and functional bowel disease.
- Pathologies arising in the renal and gynecological systems can also cause abdominal pain.
- For infectious illnesses regarding the GI tract, please see: Gastroenteritis, E. coli gastroenteritis
Details
We'll start with those that arise in the gastrointestinal tract.
- Esophagitis can cause upper abdominal pain; inflammation of the esophagus is most often caused by acid reflux, medications, and eosinophilic esophagitis. Treatments include proton pump inhibitors to reduce acid production by the stomach.
- Gastritis and stomach ulcers are caused by H. pylori infection, drugs, stress, and, in the case of gastritis, autoimmune dysfunction.
- Inflammation can travel up and down the esophagus to and from the stomach.
- Treatments include proton pump inhibitors, antacids, H2 blockers, and prostaglandins.
- GI strictures and obstruction are caused by hernias, adhesions, volvulus, tumors, inflammatory narrowing, foreign bodies, and fecal impaction.
- In our diagram, we show scar tissue adhesions that formed after abdominal surgery; adhesions bind and restrict the intestinal tract, which obscures movement of materials.
- Diverticulitis occurs when there is inflammation (often with bacterial infection) in diverticula.
- Intestinal ischemia can be the result of systemic hypotension, atherosclerosis, blood clots, and constricting fibrosis or strictures that inhibit blood flow; ischemia is more common in the intestines than in the stomach or esophagus.
- Surgery and/or medications to restore blood flow are prescribed.
- Inflammatory bowel disease comprises the chronic/remitting autoimmune disorders Crohn's disease and ulcerative colitis.
- Patients often experience diarrhea in addition to abdominal cramping and other symptoms. In ulcerative colitis, the diarrhea is frequently bloody, as show in our diagram.
- Anti-inflammatories and immune suppressors are often prescribed.
- Functional bowel disorders (FBDs) are characterized by disordered brain-gut interactions. The most common FBD is Irritable bowel syndrome, and patients experience constipation and diarrhea with abdominal pain.
- Etiologies are uncertain, but are thought to include infection and/or psychosocial causes.
Pathologies that arise in the accessory digestive organs and non-digestive organs.
We'll focus on locations of pain to help us in diagnosis.
Abdominal quadrants
- Pancreatitis is the result of bile duct stones, alcohol abuse, and/or cigarette smoking.
- Early/acute pancreatitis is characterized by elevated serum amylase and lipase levels.
- Late/chronic pancreatitis can result in loss of endocrine and exocrine functions (i.e., patients have diabetes mellitus, etc.).
- Pancreatitis causes epigastric pain that radiates towards the back.
- Gallstone disease causes pain in the right upper abdominal quadrant; we can remember this, because the gallstones get stuck in the biliary system, which is towards the right side of the abdomen.
- Appendicitis often presents early on with pain in the peri-navel area that later moves to the right lower abdominal quadrant (where we find the appendix).
- Kidney stones cause "flank" pain – pain in the side of the torso; pain can travel to the groin area, too.
- Gynecological causes include: ruptured ovarian cysts, pelvic inflammatory disease, ectopic pregnancy, and endometriosis – essentially, anything that causes inflammation and swelling of the uterus or ovaries can cause lower abdominal and back pain.