Central Abdominal Pain
Central abdominal pain, is pain occurring in any area about a hand's breadth around the umbilicus or belly button. Pain in this part of the abdomen could be an extension of pain from the upper or lower abdomen. It could sometimes also come from the the heart, lungs, the spinal cord as in tabes dorsalis or even the eye as in acute glaucoma! In evaluating the possible causes of pain in the center of the abdomen, more serious causes like atypical heart attack, ruptured abdominal aortic aneurysm, abdominal pain associated with diabetes (diabetic ketoacidosis), blood loss to part of the bowels (acute mesenteric ischemia), perforation of a peptic ulcer, lower lobe pneumonia especially in children, and early stage of acute appendicitis needs to be excluded. The more common causes of central abdominal pain include:
Doctors always take complaints of central abdominal pain seriously, and meticulously investigate the possible causes along the lines of constipation, 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, constipation, emotional disturbance especially in children, 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. Typical PresentationThough central abdominal pain could present in various forms from individual to individual, the symptoms and sign depends on the cause. We bring you a few examples of how some of the common causes of central abdominal pain might come on: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 and 03:00 Hours. The pain spreads through to her back between the shoulder blades. She feels sick and actually vomited on an occasion. Because of the pain in her central abdomen, Emma is scared of eating, and has lost some weight. What could this be?She saw her doctor who suspected she may be having stomach 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. A diagnosis of stomach ulcer was confirmed on endoscopy, 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 severe burning central abdominal pain. Sharp "as if I am being stabbed with a knife". She felt nauseated but did not actually vomit. 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 Hannah? She is 17. Came in to see the doctor because of this pain in the center of the abdomen since last night. Pain is mainly around the navel of umbilicus. It is dull in character, continues. Hannah feels unwell in herself, not keen on eating despite having a very healthy appetite before now. She has now started feeling some pain around the right lower abdomen. The pain is worse when she moves. She opens her bowel normally and no problem passing urine. Following the examination by the doctor, she was found to have lost her appetite around the same time she developed the "stomach pain" and she is very tender on the right lower abdomen.She was suspected to have appendicitis, sent to see the surgeons who arranged for her to have an emergency operation that evening to remove her appendix. 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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