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Central Abdominal PainCentral abdominal pain, is pain occurring in any area about a hand's breadth around the umbilicus or belly button While most causes of abdominal pain do not often lead to serious consequences, pain in the central part of the abdomen is one that should be looked into with even more diligence. Trapped wind, indigestion, heartburns, gastritis (erosion of the lining of the wall of the stomach), gastric (stomach) ulcer, duodenal ulcer, early stage of appendicitis, food poisoning, pancreatitis, stomach cancer, ischaemic colitis (dying bowel from reduced blood supply), messenteric thrombosis (blood clot in the gut), intestinal obstuction, ruptured abdominal aortic aneurysm, are a few conditions that could cause central abdominal pain. As a general guide, pain in this region of the abdomen is usually caused by diseases affecting midline structures like the lower oesophagus, stomach, pancreas, small and large intestines, large blood vessels passing through the abdomen like the aorta, and occasionally from the bladder, uterus, and some other organs not related to the abdomen like the heart, the back bones (chance fracture following seat belt injury in road traffic accident), the spinal cord as in tabes dorsalis or even the eye as in glaucoma! Doctors should always take complaints of central abdominal pain seriously, and meticulously investigate the possible causes along the lines of infection, bowel obstruction, malignancy, gall bladder or biliary disease, heart problems, and gut ischemia. Once potentially serious causes of abdominal pain are excluded, non specific causes like trapped wind, irritable bowel syndrome, abdominal migraine, fibromyalgia should then be considered. Not infrequently, diabetes (especially in the young or those not previously known to be diabetic), is a cause of central abdominal pain. Common causes of central abdominal pain discussed here include:
For ease of understanding and narrowing down the site of pain and its possible cause, pain in the central abdomen can be further divided into: Typical PresentationThough central abdominal pain could present in various form from individual to individual, the symptoms and sign depends on the cause.Pain in this part of the abdomen is commoner in children, and young adults. Emma is 36. She developed stabbing central abdominal pain which comes on and goes off in the last two weeks. Eating makes the pain worse, and this pain wakes her up in the middle of night between 23:00 Hours and 03:00 Hours. The pain spreads through to her back between the shoulder blades. She feels sick and actually vomited on a few occasions. because of the pain in her central abdomen, Emma is cared of eating, and has lost some weight. What could this be?She saw her doctor who suspected she may be having duodenal ulcer. She was given a prescription of lanzoprazole 30mg daily and an arrangement was made for a camera test to see her stomach and upper small intestine as soon as was possible. The diagnosis of duodenal ulcer was confirmed, and she continued on the Lansoprazole, along with Rannitidine 150mg twice daily for 6 weeks. She was cured of her ulcer pain. Georgina, 23 has been out with friends two days earlier drinking. She developed central abdominal pain, severe, biting, feels as if fire as been set inside her stomach. She feels sick, pain not resolving with common pain killer. On checking into her local Emergency Department, she was diagnosed with Gastritis, which is inflammation of her stomach or erosion of the lining of the stomach. What about Joshua? Her mother suffered with irritable bowel syndrome as a child. He is 21. He gets this bloated feeling in his abdomen, with associated crampy abdominal pain. The pain is often mild to moderate in severity, but sometimes bad enough to make him stop what he is doing. He also gets constipated. He discovers that passing wind or opening his bowel helps to reduce the pain. He has been to his family doctor several times, and no diagnosis was made. He was referred to a Gastroenterologist who diagnosed irritable bowel syndrome. He has since made progress with his symptoms. So diverse could central abdominal pain present that they often needs to be investigated. Investigations of Central Abdominal PainThe investigation of causes of abdominal pain should follow the general pattern of investigations in medicine, bearing in mind that common things occur more commonly. Simple blood test like Full Blood Count FBC or CBC, to look for evidence of infection or inflammation, Blood biochemistry including amylase and CRP, Liver Function Test, Blood glucose levels, and the clotting profile should be done as basic routine tests for abdominal pain. Simple urine test, pregnancy test in ladies between age 12 and 55, or test for blood in the urine for kidney stone should be undertaken. Thanks fully, most of these blood test can even be done from the comfort of one's home. In the United kingdom, home testings for abdominal pain is provided outside the NHS by private government approved laboratories like YORKTEST. They could help with tests for irritable bowel disease, gluten allergy and other food related causes of abdominal pain. In North America, many patients and health workers use the Home Health Testing® - FDA approved home medical tests to test for:
The liberal use of imaging and scanning like CT Scan, Ultrasound scan is highly advocated in trying to resolve diagnostic dilemmas posed by abdominal conditions.
What to DoIf you or your loved one is suffering with unexplained central abdominal pain, why not see your family doctor as soon as possible. If it is very serious, waste no time. Go into your local Emergency Department.ReferenceChiche L, Roupie E, Delassus P.Management of adult abdominal pain in the Emergency RoomJ Chir (Paris). 2006 Jan-Feb; 143(1):6-14 Dang C, Aguilera P, Dang A, Salem L.Acute abdominal pain. Four classifications can guide assessment and management.Geriatrics. 2002 Mar;57(3):30-2, 35-6, 41-2. Mayo-Smith WW Imaging the patient with acute abdominal pain: current concepts. Med Health R I. 1999 Jun;82(6):202-6.
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