Abdominal Pain

Abdominal pain is one of the most challenging symptoms in medicine. Every at least a little responsible physician is in great awe of abdominal pain. Many seemingly serious cases turn to be utter banalities and, in turn, seemingly discreet troubles can develop into fatal conditions.

It is very difficult to create a classification of abdominal pain causes. These conditions are often divided according to their typical pain occurrence area. This division is necessarily imprecise because in the majority of pathological states, the pain may occur in different locations, or it can move as the disease develops. It is the reason, why in this article abdominal pain causes are divided according to body systems.

  1. Digestive tract tube
  2. Liver, gallbladder, pancreas
  3. Excretory system
  4. Gynecological tract
  5. Male reproductive system
  6. Heart, arteries, lungs
  7. Abdominal wall
  8. Spleen affections
  9. Metabolic causes

1. The digestive tract tube

Digestive tract infections

Infectious diseases of stomach and intestines are usually accompanied by abdominal pain. Common viral infections (such as rotaviruses) are typical with sudden onset of troubles and short duration. Bacterial infections are less frequent, but they tend to have more serious course. Possible causative bacteria are groups of Salmonella, Campylobacter, Clostridium, etc. Besides cramp abdominal pain, vomiting and diarrhea occur, mucus in stool is often found. Some bacterial infections cause blood in stool emergence. When there is a suspicion of a more serious condition, it is possible to pick a stool sample for microbiological examination to find the causative agent. The treatment is usually mainly parenteral hydration, antibiotics are used less often.

Peptic ulcers

They are usually accompanied by chronic pain in upper abdomen. Pain is dependent on food, while ulcers located in stomach start to hurt after a meal (when larger amount of stomach acid is released), while duodenal ulcers hurt rather by empty stomach and their pain is relieved by food digestion. Sharp pain in the upper abdomen can result from an ulcer rupture. This is an emergent condition (digestive tract perforation) that is followed by abdominal muscles contraction and significant stiffening of abdominal wall. Through newly-emerged hole in the stomach wall gastric contents leak into abdominal cavity and the pain starts to move lower into the area around navel and further into lower abdomen. Perforated peptic ulcer is a life -threatening condition that needs an urgent surgical intervention.


Pain during a diverticular inflammation is likely to occur in the left lower abdomen where the sigmoid intestine is located. Sigmoid colon is the most commonly site of diverticula presence. Pain is accompanied by fever, loss of appetite and vomiting.

Acute appendicitis

Pain starts around the navel; it is dull and can not be precisely located. It may be accompanied by nausea and vomiting. Gradually, the pain moves into the right lower abdomen and becomes sharp. High fever and diarrhea are not typical symptoms.

Mesenteric lymphadenitis

This is a relatively common disease of younger patients. It is caused by bacterium known as Yersinia enterocolitica. It is typical by intestinal lymph nodes enlargement that is discovered using abdominal ultrasound. This disease has, unfortunately, otherwise symptoms mimicking acute appendicitis and therefore it often ends by surgical intervention.

Crohn's Disease

Terminal ileum (ending of small intestine) located in right lower abdomen is most often affected. First outbreak of Crohn's disease may be very similar to acute appendicitis. If a surgical intervention is performed, inflammation of small intestine is found instead of inflammated appendix. It should be noted that Crohn's disease may attack virtually every part of digestive tube.

Ulcerative colitis

Abdominal pain can occur in virtually any location, it depends on length of colon affection. Attacks of this illness are associated with diarrhea containing blood and mucus in stool.

Celiac disease

This autoimmune disorder may exhibit a variety of non-specific symptoms including abdominal pain. You find more information in relevant article.

Intestinal obstruction (ileus)

Most cases of intestinal obstruction are associated with persistent or recurrent abdominal pain. The patient may complain of vague pain around the navel, abdomen is usually tactile painful virtually everywhere. These conditions are often serious and they can be associated with many diseases of abdominal organs (we distinguish mechanical, vascular and neurogenic ileus). It should be hospitalized in the surgical ward, patient monitoring, determine the cause of the ileum and, if necessary, a surgical solution. The various types of intestinal obstruction and its causes, read the relevant texts.

Ischemic colitis

This is an inflammatory bowel process caused by lack of oxygen and nutrients coming into intestinal wall.

Functional disorders

Psychological factors such as stress or depression are reflected by digestive tract and mimic organic diseases Pain in practically all parts of the abdomen may be present, as well as nausea, occasional vomiting or diarrhea. Diagnosis should be made by excluding organic abdominal diseases. So-called irritable bowel syndrome is a typical example of a functional disorder.

2. Liver, gallbladder, pancreas

Liver congestion

Sudden congestion and enlargement of liver may be associated with pain below the right costal arch. Very often this type of pain appears in untrained individuals during a significant physical effort (e.g. when running). It may be also present by right ventricular heart failure, when blood starts to accumulate in big veins and in liver.

Liver inflammation

Liver tissue inflammatory processes may be associated with abdominal pain in the right upper quadrant. Most often these are viral infections (infectious hepatitis group), but even bacteria can attack liver tissue with high risk of liver abscesses development.

Gallbladder inflammation and bile ducts inflammation

Inflammation of gallbladder (cholecystitis) or bile ducts (cholangitis) are associated with abdominal pain in the right upper quadrant and usually with fever. By cholangitis fever is very high, there are chills and shivering. In addition to clinical picture blood tests are important for proper diagnosis as well as abdominal ultrasound. Inflammation is treated with bed rest, cool compressions and drugs to reduce fever, antibiotics and diet. Surgical therapy consists in removal of gallblader (cholecystectomy).

Liver tumors

Primary liver tumors (liver cancer, intrahepatic bile duct cancer) and liver metastases can cause unpleasant pressure pain and liver enlargement. The deterioration of liver functions and decreased ability to process bilirubin pigment can manifest as jaundice.

Biliary colic

This very painful condition occurs when there is a blockage of biliary tract by a gallstone. Pain has colicky character and it is classically located in the right upper abdominal quadrant. In addition to pain there is usually nausea and vomiting.

Acute pancreatitis

Acute inflammation of pancreas is often caused by a gallstone blockage in biliary tree, or by alcohol excess. The pain is sharp; it is located rather in middle upper abdomen and spreads to the sides. The patient must be hospitalized in internal or surgical ward, monitored and properly treated. It is advisable to treat mild cases conservatively (infusions, painkillers, antibiotics), serious complications such as bacterial infection and necrosis emergence need to be solved surgically. Mortality of severe forms of acute pancreatitis is very high.

Chronic pancreatitis

It is a common condition among chronic alcoholics (but not only by them) where there is a gradual change of pancreatic gland into fibrous tissue. It is often accompanied by weight loss, abdominal pain of varying intensity and impaired nutrient absorption in small intestine. Generally, best way of treatment is administering pancreatic enzymes in forms of special capsules. Surgical therapy is reserved for cases with serious abdominal pain or for other complications.

Pancreas cancer

Advanced forms of the disease are sometimes associated with significant pain that is caused by tumor growth into local neural plexuses. The pain occurs mostly in the upper abdomen and can be very cruel. In addition, the patient suffers from loss of appetite and weight loss. The solution is usually only administering strong painkillers.

3. Excretory system

Kidney infection

Pyelonephritis usually has dramatic manifestation including high fever, headache and backache. Typically, percussion is painful in lumbar area on side of the inflamed kidney, but abdominal pain can also be present.

Urinary bladder overfilling

Urine outflow disorders may lead to overfilling of urinary bladder. It is connected with its distension and dull pressure pain in lower abdomen.

Urinary tract infections

Infections manifest with burning sensations during urination and abdominal pain localized in the lower abdomen can occur. Palpation of the abdomen above bladder is usually unpleasant, with otherwise virtually painless rest of the abdomen.

Renal colic

This condition is associated with blockage of urinary tract by a urinary stone. Pain is usually intermittent, located in lower abdomen and radiates to the back or into the groin.

4. Gynaecological causes

Ovarian torsion

In this case sudden and intensive pain emerges in the lower abdomen on the side of affected ovary. The ovary is stabilized in abdomen by a ligament apparatus that contains blood vessels bringing blood and oxygen into the ovary. When ovary rotates around its axis, it can strangle the arteries causing blood flow stop. It is more often by young women during sport when jumping (basketball, volleyball).

Gynecological inflammations

Abdominal pain in the lower abdomen by women must always be suspicious of gynecological causes. Inflammation can affect virtually every organ of female reproductive system, e.g. ovaries, uterus and fallopian tubes. In addition to abdominal pain there is usually fever and other general sings of infection.

Ectopic pregnancy

Ectopic pregnancy is very insidious and potentially fatal condition. It manifests as lower abdominal pain in a young woman, who missed a menstrual period, or who suffers an irregular gynecological bleeding. Fertilized egg should nest in womb. In ectopic pregnancy it nests, most often in fallopian tube where it starts to grow. Growing embryo can cause sudden bleeding or perforation of the tube. Sharp pain in the lower abdomen occurs; the woman usually collapses and can quickly die of internal bleeding. It is important to perform an abdominal ultrasound and do blood test to know serum levels of pregnancy hormone.


This gynecological disease is responsible for many cases of abdominal pain in women. Pain is typically localized in the lower abdomen and its presence is often dependent on menstrual cycle. Its probable causes are small pieces of endometrium located in abdominal cavity outside womb.

5. Male reproductive system

Testicular torsion

It means twisting of a testicle around its axis that leads to strangulation and constriction of arteries supplying testicles with blood. Pain is sharp, shocking and radiating from testicle towards the groin. Irreversible necrosis of affected testicle can occur and that is why this condition is labeled as emergency situation in urology.

6. Heart, arteries, lungs

Myocardial infarction

Heart attack of bottom wall of heart muscle is treacherous, because it may manifest as abdominal pain situated in upper abdomen. Therefore, ECG examination is appropriate with every patient of sudden abdominal pain.

Rupture of abdominal aortic aneurysm

It manifests with sudden and strong abdominal pain. A shock condition quickly follows because of blood loss into abdominal cavity. Diagnosis can be made by ultrasound or computed tomography of the abdomen, solution is mainly surgical and mortality rate is very high.


Pneumonia can lead to irritation of diaphragm and that can cause a pain transmitted to abdomen. Pain usually manifests in the upper abdominal quadrant on side of affected lung.


7. Abdominal wall

Shingles is probably the most common cause of abdominal wall pain. Pain is often very sharp ad burning; it is accompanied by characteristic vesicular rash with many blisters. Pain and fever emerge by bacterial infection of skin and subcutaneous tissue.

8. Spleen

Injuries and diseases of the spleen may manifest by pain in left subcostal area. Spleen injuries are insidious and ruptured spleen can easily cause death by bleeding into the abdominal cavity. Spleen may become painful by its enlargement in blood disorders (e.g. leukemia). Probably the most banal and yet the most common cause of spleen pain is its congestion and enlargement during physical exertion by untrained individuals. It typically occurs as pain in upper left abdomen when running.

9. Metabolic causes

Abdominal pain tends to be dull and the patient can not locate it accurately. It is connected with accumulation of nitrogenous waste products in acute or chronic kidney failure, or by diabetes decompensation. Unpleasant colicky abdominal pain occurs even by lead poisoning as the Saturnine colic.


Abdominal pain is a common problem. When there is a sudden strong pain or chronic pain; you should visit your doctor. It is advisable to seek a doctor especially when some of below stated symptoms follow abdominal pain:


a) pain wakes you from sleep
b) blood in stool or blood in urine presence
c) alternating diarrhea with constipation
d ) body temperature elevated above 37 ° C ( continuously or intermittently)
e ) unwanted weight loss
f ) jaundice, pale stool or dark urine
g ) women with a menstrual cycle disorder or with gynecological bleeding


We can divide abdominal pain into the following quadrants:Abdominal quadrants

Jiri Stefanek, MD  Author of texts: Jiri Stefanek, MD
 Contact: jiri.stefanek@seznam.cz
 Sources: basic text sources