Differential diagnosis of abdominal pain syndrome. Abdominal syndrome - what is it?

When there are pains in the abdomen, many people rush to take a pill of "No-shpy" or "Ftalazol", believing that they have a problem with the digestive system. However, the stomach can ache for a dozen reasons, absolutely not related to either the stomach or the intestines. This phenomenon even has a medical term - abdominal syndrome. What it is? The name comes from the Latin "abdomen", which translates as "belly". That is, everything related to this area of the human body is abdominal. For example, the stomach, intestines, bladder, spleen, kidneys are abdominal organs, and gastritis, pancreatitis, cholecystitis, colitis and other gastrointestinal problems are abdominal diseases. By analogy, abdominal syndrome - it's all troubles in the abdomen (heaviness, pain, tingling, spasms and other bad feelings). At similar complaints of the patient the task of the doctor consists in correct differentiation of signs that not to be mistaken with the diagnosis. Let's figure out how this is done in practice and what are the peculiarities of pain in every disease.

The abdominal cavity of man

To make it easier to understand the question: "Abdominal syndrome - what is it?" And to understand where it comes from, you need to clearly understand how our stomach is arranged, what organs there are in it, how they interact with each other. On the anatomical pictures one can see a schematic tube of the esophagus, a baggy stomach, an intestinal snake curving, a liver on the right under the ribs, a spleen to the left, at the very bottom a bladder with ureters stretching from the kidneys. Here, like, that's all. In fact, our abdominal cavity has a more complex structure. Conditionally it is divided into three segments. The border of the upper is - on the one hand - a domed muscle, called the diaphragm. Above it is a thoracic cavity with the lungs. On the other hand, the upper segment is separated from the middle by the so-called mesentery colon. This is a two-layer fold, with which all the organs of the gastrointestinal tract are attached to the back of the abdomen. In the upper segment there are three departments - liver, pancreas and glandular. The middle segment extends from the mesentery to the beginning of the small pelvis. It is in this part of the abdomen that the umbilical zone is located. And, finally, the lower segment is the area of the small pelvis, in which the organs of the genitourinary and reproductive systems have found their place.
Any violations (inflammation, infection, mechanical and chemical influences, pathology of formation and development) in the activity of each organ from located in the above three segments cause abdominal syndrome. In addition, the peritoneum contains blood and lymph vessels and nerve nodes. Among them the most famous are the aorta and the solar plexus. The slightest problem with them also provokes abdominal pain.

To summarize, the abdominal syndrome can be caused by any known gastrointestinal and genitourinary system, problems with the vessels and nerve plexuses of the peritoneum, chemical effects (poisoning, medication), mechanical compression (squeezing) of neighboring organs of everything located in the peritoneum.

Pain sharp

Differential diagnosis of abdominal pain syndrome, usually begins with the definition of localization and the nature of pain. The most dangerous for life and hard to tolerate by man, of course, is acute pain. It occurs suddenly, abruptly, often without any apparent causes provoking it, manifested by attacks lasting from a few minutes to an hour.

Acute pain can be accompanied by vomiting, diarrhea, fever, chills, cold sweat, loss of consciousness. Most often they have precise localization (right, left, bottom, top), which helps establish a preliminary diagnosis.

Diseases that cause such an abdominal syndrome are:

1. Inflammatory processes in the peritoneum - appendicitis acute and recurrent, Meckel diverticulitis, peritonitis, acute cholecystitis or pancreatitis.

2. Intestinal obstruction or infringement of a hernia.

3. Perforation (perforation, hole) of the peritoneal organs, which occurs when the ulcer of the stomach and / or duodenum and diverticulum. This includes liver, aortic, spleen, ovarian, and tumor ruptures.

In cases with perforation, as well as with appendicitis and peritonitis, the patient's life depends 100% on correct diagnosis and urgent surgical intervention.

Additional research:

• The analysis of a blood (gives the chance to estimate activity of inflammatory process, to define a blood group);
• X-ray (indicates the presence or absence of perforation, obstruction, hernia);
• Ultrasound;
• If there is a suspicion of bleeding in the digestive tract, do esophagogastroduodenoscopy.

Chronic pains

They grow gradually and last for many months. Feelings as it were as though dulled, pulling, aching, often "poured" on all periphery of a peritoneum, without definite localization. Chronic pain can subside and recur, for example, after a meal. In almost all cases, this abdominal syndrome indicates chronic diseases of the abdominal cavity. It can be:

1) gastritis (pain in the upper segment, nausea, heaviness in the stomach, belching, heartburn, problems with defecation);

2) gastric ulcer and / or duodenal ulcer in early stages (pains "under the spoon" on an empty stomach, at night or a short time after eating, heartburn, acidic eructation, bloating, flatulence, nausea);

3) urolithiasis (pain in the side or in the lower abdomen, blood and / or sand in the urine, soreness with urination, nausea, vomiting);

4) chronic cholecystitis (pain in the upper segment on the right, general weakness, bitterness in the mouth, low temperature, not passing nausea, vomiting - sometimes with bile, belching);

5) chronic cholangitis (pain in the liver, fatigue, icterus of the skin, low temperature, with acute form, pain can be given to the heart and under the scapula);

6) oncology of the gastrointestinal tract in the initial stage.

Pain relapsing in children

Recurrent are pains that recur after a period of time. They can be observed in children of any age and in adults.

In newborns, intestinal colic becomes the common cause of stomach pains (it can be determined by sharp piercing crying, restless behavior, bloating, refusal of food, arching of the back, chaotic rapid movements of the pens, legs, regurgitation). An important sign of intestinal colic is that when they are eliminated, the baby becomes calm, smiles, eats well. Cope with the ailment helps warmth, tummy massage, dill vodichka. With the growing up of a baby, all these troubles go away by themselves.

A much more serious problem is the abdominal syndrome with somatic pathology in children. "Soma" means "body" in Greek. That is, the term "somatic pathology" implies any disease of the organs of the body and any of their inherent or acquired defect. In newborns most often observed:

1) infectious diseases of the gastrointestinal tract (temperature up to critical markers, refusal of food, lethargy, diarrhea, regurgitation, vomiting fountain, crying, in some cases, discoloration of skin);

2) pathology of the digestive tract (hernia, cyst, and others).

The diagnosis in this case is complicated by the fact that the baby is not able to show where it hurts, and to explain his feelings. Differential diagnosis of abdominal pain syndrome in newborns is carried out using additional surveys, such as:

• Coprogramme;
• Ultrasound;
• blood test;
• Esophagogastroduodenoscopy;
• X-ray with barium of the abdominal cavity;
• Daily pH-metry.

Pain relapsing in adults

In older children (mainly school age) and in adults the causes of recurrent abdominal pain are so many that they are divided into five categories:

• Infectious;
• Inflammatory (without infection);
• Functional;
• Anatomical (associated with one or another body);
• Microbiological (cause various parasites, settling in the digestive tract).

What is infectious and inflammatory pain is more or less clear. And what does functional mean? If they are indicated in the diagnosis, how to understand the term "abdominal syndrome in children"? What it is? Explain the concept of functional pain can be as follows: patients are concerned about discomfort in the abdomen for no apparent reason and without diseases of the peritoneum. Some adults even think that a child is lying about his pain, since he does not find any violations. However, this phenomenon exists in medicine, and it is observed, as a rule, in children older than 8 years. The cause of functional pain can be:

1) abdominal migraine (pain in the abdomen becomes a headache, accompanied by vomiting, nausea, refusal to eat);

2) functional dyspepsia (in a completely healthy child, pains appear in the upper segment of the abdomen and disappear after defecation);

3) irritation of the intestine.

Another controversial diagnosis is "ARVI with abdominal syndrome" in children. The treatment in this case has some specificity, since the kids have symptoms and colds, and intestinal infection. Often doctors put such a diagnosis to children who have the slightest signs of ARVI (for example, a common cold), and confirmation of diseases of the gastrointestinal tract is not detected. The frequency of such cases, as well as the epidemic nature of the disease deserve more detailed coverage.

ARI with abdominal syndrome

This pathology is more often observed in preschool children and younger schoolchildren. In adults, it is extremely rare. In medicine, ARI and ARVI are referred to as a single type of ailments, since RH (respiratory diseases) are most often caused by viruses, and they automatically become a RVI. It is most easy to "pick them up" in children's groups - school, kindergarten, day nursery. In addition to all known respiratory flu, the so-called "gastric flu", or rotavirus, is also a big danger. It is also diagnosed as an ARVI with an abdominal syndrome. In children, the symptoms of this disease appear 1-5 days after infection. The clinical picture is as follows:

• Complaints of pain in the tummy;
• Vomiting;
• nausea;
• temperature;
• diarrhea;
• Coryza;
• cough;
• Red throat;
• Painful to swallow;
• Lethargy, weakness.

As can be seen from the list, there are symptoms and colds, and intestinal infection. In rare cases, a child may indeed have a common cold plus GI disease, which doctors should clearly distinguish. Diagnosis of rotavirus infection is extremely difficult. It includes enzyme-linked immunosorbent assay, electron microscopy, diffuse precipitation, multiple reactions. Often pediatricians diagnose without such complex analyzes, only on the clinical manifestation of the disease and on the basis of anamnesis. With rotavirus infection, although there are cold symptoms, not ENT organs are infected, but the gastrointestinal tract, mostly the large intestine. The source of infection is a sick person. Rotaviruses penetrate into the body of the new host with food, through dirty hands, household items (for example, toys) that the patient used.

Treatment of acute respiratory viral infection with abdominal syndrome should be based on diagnosis. So, if the abdominal pain in a child is caused by pathological products of respiratory viruses, the therapy of the underlying disease, plus rehydration of the body by sorbents, is performed. In case of confirmation of rotavirus infection, it makes no sense to prescribe antibiotics to the child, since they do not have an effect on the pathogen. Treatment consists of taking activated charcoal, sorbents, dieting, drinking abundantly. If the child has diarrhea, probiotics are prescribed. Prevention of this disease is vaccination.

Paroxysmal pain without bowel disease

To make it easier to determine what causes the abdominal syndrome, the pain is divided into categories in place in the abdominal area, where they are felt most strongly.

Paroxysmal pain without symptoms of dyspepsia occurs in the middle segment (mesogastrium) and lower (hypogastrium). Possible reasons:

• Infection with worms;
• The Payra syndrome;
• Pyelonephritis;
• Hydronephrosis;
• Problems with the sexual organs;
• Intestinal obstruction (incomplete);
• Stenosis (squeezing) of the celiac trunk;
• SRK.

If the patient has just such an abdominal syndrome, the treatment is prescribed on the basis of additional examinations:

• Advanced blood test;
• Sowing feces for eggs of worms and intestinal infections;
• Analysis of urine;
• Ultrasound of the digestive tract;
• Irrigography (irrigoscopy with barium radiation method);
• Dopplerography of abdominal vessels.

Abdominal pain with bowel disorders

All five categories of recurrent pain can be observed in the lower and middle segments of the peritoneum with problems with the intestine. The reasons for this abdominal syndrome are very many. Here are just a few of them:

• Helminthiosis;
• Allergy to any products;
• Ulcerative colitis nonspecific (diarrhea is additionally observed, the stool can be with pus or blood, flatulence, decreased appetite, general weakness, dizziness, weight loss);
• Celiac disease (most often observed in young children during the beginning of feeding with their infant formula on cereals);
• Infectious diseases (salmonellosis, campylobacteriosis);
• Pathology in the large intestine, for example, dolichosigma (sigmoid colon elongated), while pain is added to prolonged constipation;
• Disaccharidase insufficiency;
• Hemorrhagic vasculitis.

The last disease occurs when the inflammation and, as a consequence, swell the blood vessels in the intestine, they are thrombosed. The causes - a violation in the processes of blood circulation and a shift in hemostasis. This condition is also known as hemorrhagic abdominal syndrome. It differentiates in three degrees of activity:

I (mild) - symptoms are poorly expressed, determined by the indices of ESR in the blood.

II (moderate) - there are weak pains in the peritoneum, the temperature rises, weakness and headache appear.

III (severe) - high temperature, severe head and abdominal pain, weakness, nausea, vomiting with blood, urine and feces with blood impurities, bleeding in the stomach and in the intestine, perforation may occur .

If pain occurs in the middle and lower parts of the peritoneum with suspicion of any problems with the intestines, the diagnosis includes:

• Advanced blood test (biochemical and general);
• Coprogramme;
• Fibrocolonoscopy;
• Irrigography;
• Sowing of feces;
• A blood test for antibodies;
• Hydrogen test;
• EGDS and biopsy of small intestine tissue;
• Immunological tests;
• Sugar curve.

Pain in the upper segment of the peritoneum (epigastrium)

Most often, the abdominal syndrome in the upper segment of the peritoneum is a consequence of food intake and can manifest itself in two forms:

• Dyspepsia, that is, with a violation of the stomach ("hungry pain", after eating);
• Dyskinetic (burgeoning pain, a feeling of overeating, regardless of the amount of food taken, eructation, vomiting, nausea).

The causes of such conditions can be gastroduodenitis, in the stomach, hypersecretion of hydrochloric acid, infections, worms, diseases of the pancreas and / or bile ducts, impaired gastroduodenal motor skills. In addition, epigastric pain can provoke the Dunbar syndrome (pathology of the celiac trunk of the aorta when squeezed by its diaphragm). This ailment is congenital, hereditary (often) or acquired when a person develops a neurofibrotic tissue.

The celiac trunk (a large short branch of the peritoneal aorta) is compressed by compression down to the aorta, severely narrowed in its mouth. This causes abdominal ischemic syndrome, diagnosed by contrast radiography (angiography). The celiac trunk, together with other blood vessels of the abdominal cavity, supplies blood to all the organs of the digestive tract. In squeezing, the delivery of blood, and consequently the supply of the necessary substances to the organs, is not fully realized, which leads to their oxygen starvation (hypoxia) and ischemia. Symptoms of this disease are similar to those that are observed with gastritis, duodenitis, stomach ulcer.

If the deficit of blood supply experiences the intestine, develops ischemic colitis, enteritis. If blood in insufficient quantity enters the liver, hepatitis develops, and the pancreas responds to malfunctions in blood supply with pancreatitis.

In order not to be mistaken with a diagnosis, additional examinations of patients with suspected abdominal ischemic syndrome should be carried out. Endovascular diagnosis is the advanced method, which consists in the fact that blood vessels are examined by inserting into them a catheter with X-ray properties. That is, the method will allow to see problems in the vessels without surgery. Endovascular diagnosis is used in all diseases of the vessels of the abdominal cavity. If there are indications, endovascular operations are also carried out. To suspect abdominal ischemic syndrome it is possible on such complaints of the patient:

• Permanent pain in the abdomen, especially after eating, when doing any physical work or emotional stress;
• Sensation of bursting and heaviness in the upper segment of the peritoneum;
• Eructation;
• heartburn;
• Feeling of bitterness in the mouth;
• Diarrhea or, conversely, constipation;
• Frequent headaches;
• dyspnea;
• Pulsation in the abdomen;
• Loss in weight;
• General fatigue and weakness.

Only an external examination of the patient, as well as standard diagnostic methods (blood, urine, ultrasound) are not decisive in detecting the disease.

Vertebral abdominal syndrome

This type of pathology is one of the most difficult to detect. It consists in the fact that patients have obvious signs of gastrointestinal problems (abdominal pain, vomiting, belching, heartburn, diarrhea or constipation), but they are caused by diseases of the spine or other parts of the musculoskeletal system. Often doctors do not immediately correctly determine the cause, so they perform treatment that does not bring results. So, according to statistical data, about 40% of patients who have osteochondrosis of the thoracic region are treated for nonexistent bowel and stomach diseases. Even sadder picture with diseases of the spine. Pain in such cases is often aching, dull, completely unrelated to eating, and if patients have constipation or diarrhea, they are not treated with classical methods. The following diseases can cause a vertebral abdominal syndrome:

• Spondylosis;
• scoliosis;
• Tuberculosis of the spine;
• Syndromes associated with neoplastic changes in the vertebral column;
• Visceral syndromes (Gutsheyta).

The sad thing is that patients who complain of abdominal pain and who do not have gastrointestinal pathologies are often perceived as simulators. To find out the cause of unexplained abdominal pain, additional diagnostic methods should be used, such as spondylography, x-rays, MRI, X-ray tomography, echoespondilography and others.