Why is diagnosing abdominal pain often challenging for doctors?

The article is professionally consulted by Master, Specialist II Phan Thi Minh Huong - Gastroenterologist - Department of Medical Examination & Internal Medicine - Vinmec Danang International General Hospital

Abdominal pain is an atypical, common symptom of many different diseases. The nature of the abdominal pain can also assess the severity of the disease. Therefore, diagnosing abdominal pain and providing appropriate treatment is always a challenge for the doctor.

Acute abdominal pain: is one of the forms of abdominal pain, abdominal pain usually comes on suddenly and lasts no more than 2 weeks. This can be a warning symptom of a dangerous condition that needs to be treated promptly, besides abdominal pain can also be due to a digestive disorder. About 80% of cases of abdominal pain are related to gastrointestinal diseases (stomach, intestines, hepatobiliary, pancreatic, ..). However, extra-gastrointestinal diseases that cause dangerous acute abdominal pain can also be encountered such as renal colic due to stones, ectopic pregnancy rupture causing shock, dissection of the thoracic-abdominal aorta, myocardial infarction. The lower wall, ..
The main mechanisms that cause abdominal pain include:
Inflammation: The peritoneum is damaged or irritated. Caused by inflammation of an organ in the abdomen such as appendicitis, diverticulitis,... In some organs, there are contractions, distention or stretching such as: biliary obstruction, intestinal obstruction, liver capsule strain in inflammation. liver ,... Due to an organ loss of blood supply: Due to torsion of a certain organ or anemia due to occlusion due to thrombosis. In addition, abdominal pain can also occur for no apparent reason and is referred to as functional pain, usually due to neurologic factors such as the abdominal pain seen in irritable bowel syndrome.

To accurately diagnose the cause of abdominal pain, the doctor needs to exploit the characteristics of the pain from the patient. Diagnostic directions for abdominal pain include:
Type of onset of pain: Slowly or suddenly Pain duration: How long the pain lasts and since when,... Location of pain: Right or right to the left of the navel, above or below the navel, or the entire abdomen. Pain level: Calculated on a pain scale from 1-10 points. In which 1 point is the lightest and 10 points is the heaviest pain ever. Nature of pain: Dull pain, severe pain, intermittent or intermittent pain on the background of dull pain,... Direction of pain: The pain can spread to other parts of the body. Factors that increase or decrease pain: Lying down, moving, or eating,... Accompanying symptoms such as: Fever, nausea, vomiting, constipation, diarrhea, difficulty urinating, hematuria, ...

Diagnosing abdominal pain is always a challenge for doctors, because abdominal pain is a common symptom in many atypical diseases. In addition, there are many organs in the abdomen, these organs may be located close to each other, so the symptoms of pain are similar. Therefore, accurate diagnosis requires doctors to have examination skills, combined with understanding and correct use of subclinical diagnostic tools. In some cases, it is difficult to diagnose, requiring laparoscopic or intra-abdominal surgery to accurately diagnose.
For example, appendicitis presents with pain most commonly in the right lower quadrant of the abdomen. However, pain in the right upper quadrant abdomen may be caused by:
The appendix is ​​located under the liver. Posterior appendix: Pain in the right hip. Appendice located in the pelvis: Pain in the lower abdomen. A long appendix with an abnormally displaced tip: Pain in the middle of the abdomen.

On the other hand, pain in the right lower quadrant abdomen may not be due to appendicitis but due to other causes such as:
cecal inflammation ileitis cecal diverticulitis Small bowel diverticulitis Mesenteric lymphadenitis Intestinal Open torsion in the abdomen Inflammation of the fallopian tubes,... Some causes of abdominal pain are difficult to diagnose such as:
Elderly patients and corticosteroid users may have little or no pain. abdomen with inflammation, such as cholecystitis and diverticulitis. Because the elderly have fewer symptoms and signs of inflammation and use of corticosteroids to reduce inflammation. Blood tests and imaging tests showed no abnormal results. Leads to misdiagnosis due to misuse of subclinical diagnostic measures. The disease may present with symptoms similar to another disease such as: typical appendicitis symptoms can be confused with cecal diverticulitis. The characteristics and nature of abdominal pain can be varied, such as: abdominal pain due to acute pancreatitis is usually localized above the navel, but later the pain can spread throughout the abdomen.

Therefore, in order for the diagnosis of abdominal pain to be accurate, the patient needs to coordinate with the doctor in:
Describe in detail and fully the symptoms that you feel at the moment. Report past medical history: Include medical history of yourself and family members. Fully cooperate and comply with the doctor's instructions when examining the patient. When you have any unusual symptoms during the monitoring of the disease, you should notify your doctor immediately. When having questions, it is necessary to consult a medical staff, do not do or listen to the advice of others. In summary, abdominal pain is an atypical symptom common in many different diseases. Diagnosing and differentiating abdominal pain with indications for surgical emergency from common abdominal pain is always a challenge for doctors. Therefore, patients need to follow the indications and describe the pain as well as inform the medical history in the past, so that the doctor can make an accurate diagnosis and take appropriate treatment measures.
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