Abdominal pain
Abdominal pain usually results from a GI disorder, but can also be caused by drug use, ingestion of toxins, or disorders of the reproductive, genitourinary (GU), musculoskeletal, or vascular systems. At times, such pain signals life-threatening complications.
Abdominal pain arises from the abdominopelvic viscera, the parietal peritoneum, or the capsules of the liver, kidney, or spleen. It may be acute or chronic, diffuse or localized. Visceral pain develops slowly into a deep, dull, aching pain that’s poorly localized in the epigastric, periumbilical, or lower midabdominal (hypogastric) region. In contrast, somatic (parietal, peritoneal) pain produces a sharp, more intense, and well-localized discomfort that rapidly follows the insult. Movement or coughing aggravates somatic pain. (See Abdominal pain: Types and locations, page 2.)
Pain may also be referred to the abdomen from another site with the same nerve supply. This sharp, well-localized, referred pain is felt in the skin or deeper tissues and may coexist with skin and muscle hypersensitivity to painful stimuli.
Mechanisms that produce abdominal pain include stretching or tension of the gut wall, traction on the peritoneum or mesentery, vigorous intestinal contraction, inflammation, ischemia, and sensory nerve irritation.
Act Now: If the patient is experiencing sudden and severe abdominal pain, quickly take his vital signs and palpate pulses below the waist. Stay alert for signs of hypovolemic shock, such as tachycardia and hypotension. Establish I.V. access.
Emergency surgery may be required if the patient also has mottled skin below the waist and a pulsating epigastric mass or rebound tenderness and rigidity.
Assessment
History
If the patient’s condition permits, obtain his history. Ask whether he has had this type of pain before. Because some patients report abdominal pain as indigestion or gas pain, it’s important to ask the patient to describe his pain in detail. For example, is it dull, sharp, stabbing, or burning? Ask him where the pain is located and whether it radiates to other areas. If a language barrier exists between you and the patient, use a pain rating scale with visual cues such as faces.
Ask the patient about factors that relieve the pain or make it worse. For example, do movement, coughing, exertion, vomiting, eating, elimination, or walking relieve the pain or worsen it? Ask him when the pain began and whether it’s intermittent or constant. If pain is intermittent, ask about the duration of a typical episode.
Intermittent, cramping abdominal pain suggests obstruction of a hollow organ. Constant, steady abdominal pain suggests organ perforation, ischemia, or inflammation or blood in the peritoneal cavity.
Ask the patient about substance abuse and a history of vascular, GI, GU, or reproductive disorders. Ask the female patient about the date of her last menses, changes in her menstrual pattern, or dyspareunia.
Ask the patient about appetite changes. Ask about the onset and frequency of nausea or vomiting. Has he experienced increased flatulence, constipation, diarrhea, or changes in stool consistency? When was the patient’s last bowel movement? Ask about urinary frequency, urgency, or pain. Is the urine cloudy or pink?
Physical examination
Obtain the patient’s vital signs, and assess skin turgor and mucous membranes. Inspect his abdomen for distention or visible peristaltic waves and, if indicated, measure his abdominal girth.
Auscultate for bowel sounds in all four quadrants for at least 10 to 15 seconds and characterize their motility. Listen for systolic bruits in such locations as the abdominal aorta, renal artery, or iliac artery. (See Auscultating for vascular sounds.)
Percuss all quadrants, noting the percussion sounds.
ALERT: Abdominal percussion or palpation is contraindicated in patients with suspected abdominal aortic aneurysm, those who have received abdominal organ transplants, and children with suspected Wilms’tumor. If performing abdominal percussion or palpation in patients with suspected appendicitis, use extreme caution to avoid precipitating a rupture.
Palpate the entire abdomen for masses, rigidity, and tenderness. Involuntary rigidity is generally asymmetrical, evident on inspiration and expiration, unaffected by relaxation techniques, and painful when the patient sits up using his abdominal muscles alone. Check for costovertebral angle (CVA) tenderness, abdominal tenderness with guarding, and rebound tenderness. Peritonitis and appendicitis can cause rebound tenderness. Because appendicitis may be accompanied by increased abdominal wall resistance and guarding, perform the maneuver for rebound tenderness only once — repeating the maneuver can rupture an inflamed appendix. (See Eliciting rebound tenderness, page 4.)
Pediatric pointers
Because a child commonly has difficulty describing abdominal pain, you should pay close attention to nonverbal cues, such as wincing, lethargy, or unusual positioning such as a side-lying position with knees flexed to the abdomen. Observing the child while he coughs, walks, or climbs may also offer diagnostic clues. Remember that a parent’s description of the child’s complaints is a subjective interpretation of what the parent believes is wrong. In a child, abdominal pain can signal a disorder with greater severity or different associated signs than in an adult. Appendicitis, for example, has higher rupture and mortality in children, and vomiting may be the only other sign. Acute pyelonephritis may cause abdominal pain, vomiting, and diarrhea in children without the classic urologic signs found in adults. Peptic ulcer causes nocturnal pain and colic, which, unlike peptic ulcer in adults, may not be relieved by food.
Abdominal pain in children can also result from lactose intolerance, allergic-tension-fatigue syndrome, volvulus, Meckel’s diverticulum, intussusception, mesenteric adenitis, diabetes mellitus, juvenile rheumatoid arthritis, and such uncommon disorders as heavy metal poisoning.
Geriatric pointers
Advanced age may decrease the manifestations of acute abdominal disease. Pain may be less severe, fever less pronounced, and signs of peritoneal inflammation diminished or absent. The influence of mental status changes also provide misleading findings.
Medical causes
See Abdominal pain: Causes and associated findings, pages 6 to 11.
Abdominal aortic aneurysm (dissecting)
Initially, life-threatening abdominal aortic aneurysm may produce dull lower abdominal, lower back, or severe chest pain. Typically, it produces constant upper abdominal pain, which may worsen when the patient lies down and may abate when he leans forward or sits up. Palpation may reveal an epigastric mass that pulsates before rupture but not after it.
Other findings may include mottled skin below the waist, absent femoral and pedal pulses, lower blood pressure in the legs than in the arms, mild to moderate abdominal tenderness with guarding, and abdominal rigidity. Signs of shock, such as tachycardia and tachypnea, may appear.
Abdominal cancer
Abdominal pain usually occurs late in abdominal cancer. It may be accompanied by anorexia, weight loss, weakness, depression, and an abdominal mass and distention.
Adrenal crisis
Severe abdominal pain appears early, along with nausea, vomiting, dehydration, profound weakness, anorexia, and fever. Later signs are progressive loss of consciousness; hypotension; tachycardia; oliguria; cool, clammy skin; and increased motor activity, which may progress to delirium or seizures.
Anthrax, GI
Anthrax is an acute infectious disease caused by the gram-positive, spore-forming bacterium Bacillus anthracis. Although the disease most commonly occurs in wild and domestic grazing animals, such as cattle, sheep, and goats, the spores can live in the soil for many years. The disease can occur in humans exposed to infected animals, tissue from infected animals, or biological warfare. Most natural cases occur in agricultural regions worldwide. Anthrax may occur in cutaneous, inhaled, or GI forms.
Eating contaminated meat from an infected animal causes GI anthrax. Initial signs and symptoms include loss of appetite, nausea, vomiting, and fever. Late signs and symptoms include abdominal pain, severe bloody diarrhea, and hematemesis.
Appendicitis
With appendicitis, a life-threatening disorder, pain initially occurs in the epigastric or umbilical region. Anorexia, nausea, or vomiting may occur after the onset of pain. Pain localizes at McBurney’s point in the right lower quadrant and is accompanied by abdominal rigidity, increasing tenderness (especially over McBurney’s point), rebound tenderness, and retractive respirations. Later signs and symptoms include malaise, constipation (or diarrhea), low-grade fever, and tachycardia.
Cholecystitis
Severe pain in the right upper quadrant may arise suddenly or increase gradually over several hours, usually after meals. It may radiate to the right shoulder, chest, or back. Accompanying the pain are anorexia, nausea, vomiting, fever, abdominal rigidity, tenderness, pallor, and diaphoresis. Murphy’s sign (inspiratory arrest elicited when the examiner palpates the right upper quadrant as the patient takes a deep breath) is common.
Cholelithiasis
Patients may suffer sudden, severe, and paroxysmal pain in the right upper quadrant lasting several minutes to several hours. The pain may radiate to the epigastrium, back, or shoulder blades. The pain is accompanied by anorexia, nausea, vomiting (sometimes bilious), diaphoresis, restlessness, and abdominal tenderness with guarding over the gallbladder or biliary duct. The patient may also experience fatty food intolerance and frequent indigestion.
Cirrhosis
Dull abdominal aching occurs early and is usually accompanied by anorexia, indigestion, nausea, vomiting, constipation, or diarrhea. Subsequent right upper quadrant pain worsens when the patient sits up or leans forward. Associated signs include fever, ascites, leg edema, weight gain, hepatomegaly, jaundice, severe pruritus, bleeding tendencies, palmar erythema, and spider angiomas. Gynecomastia and testicular atrophy may also be present.
Crohn’s disease
An acute attack causes severe cramping pain in the lower abdomen, typically preceded by weeks or months of milder cramping pain. Crohn’s disease may also cause diarrhea, hyperactive bowel sounds, dehydration, weight loss, fever, abdominal tenderness with guarding, and possibly a palpable mass in the lower quadrant. Abdominal pain is usually relieved by defecation. Milder chronic signs and symptoms include right lower quadrant pain with diarrhea, steatorrhea, and weight loss. Complications include perirectal or vaginal fistulas.
Cystitis
Abdominal pain and tenderness are usually suprapubic. Associated signs and symptoms include malaise, flank pain, low back pain, nausea, vomiting, urinary frequency and urgency, nocturia, dysuria, fever, and chills.
Diabetic ketoacidosis
Rarely, severe, sharp, shooting, and girdling pain may persist for several days. Fruity breath odor, a weak and rapid pulse, Kussmaul’s respirations, poor skin turgor, polyuria, polydipsia, nocturia, hypotension, decreased bowel sounds, and confusion also occur.
Diverticulitis
Mild cases usually produce intermittent, diffuse left lower quadrant pain, which is sometimes relieved by defecation or passage of flatus and worsened by eating. Other signs and symptoms include nausea, constipation or diarrhea, low-grade fever and, in many cases, a palpable abdominal mass that’s usually tender, firm, and fixed. Rupture causes severe left lower quadrant pain, abdominal rigidity, and possibly signs and symptoms of sepsis and shock (high fever, chills, and hypotension).
Duodenal ulcer
Localized abdominal pain — described as steady, gnawing, burning, aching, or hunger like — may occur high in the midepigastrium, slightly off center, and usually on the right. The pain usually doesn’t radiate unless pancreatic penetration occurs. It typically begins 2 to 4 hours after a meal and may cause nocturnal awakening. Ingestion of food or antacids brings relief until the cycle starts again, but it also may produce weight gain. Other symptoms include changes in bowel habits and heartburn or retrosternal burning.
Ectopic pregnancy
Lower abdominal pain may be sharp, dull, or cramping, and constant or intermittent in ectopic pregnancy — a potentially life-threatening disorder. Vaginal bleeding, nausea, and vomiting may occur, along with urinary frequency, a tender adnexal mass, and a 1- to 2-month history of amenorrhea. Rupture of the fallopian tube produces sharp lower abdominal pain, which may radiate to the shoulders and neck and become extreme with cervical or adnexal palpation. Signs of shock (such as pallor, tachycardia, and hypotension) may also appear.
Endometriosis
Constant, severe pain in the lower abdomen usually begins 5 to 7 days before the start of menses and may be aggravated by defecation. Depending on the location of the ectopic tissue, the pain may be accompanied by constipation, abdominal tenderness, dysmenorrhea, dyspareunia, and deep sacral pain.
Escherichia Coli O157:H7
E. coli O157:H7 is an aerobic, gram-negative bacillus that causes food-borne illness. Most strains of
E. coli are harmless; some are present in the normal intestinal flora of healthy humans and animals.
E. coli O157:H7, one of hundreds of strains of the bacterium, is capable of producing a powerful toxin and can cause severe illness. Eating undercooked beef or other foods contaminated with the bacteria causes the disease. Signs and symptoms include watery or bloody diarrhea, nausea, vomiting, fever, and abdominal cramps. Elderly people and children younger than age 5 may develop hemolytic uremic syndrome, which may ultimately lead to acute renal failure.
Gastric ulcer
Diffuse, gnawing, burning pain in the left upper quadrant or epigastric area commonly occurs 1 to 2 hours after meals; it may be relieved by ingestion of food or antacids. Vague bloating and nausea after eating are common. Indigestion, weight change, anorexia, and episodes of GI bleeding may also occur.
Gastritis
With acute gastritis, the patient experiences a rapid onset of abdominal pain that can range from mild epigastric discomfort to burning pain in the left upper quadrant. Other typical features include belching, fever, malaise, anorexia, nausea, bloody or coffee-ground vomitus, and melena. However, significant bleeding is unusual unless the patient has hemorrhagic gastritis.
Gastroenteritis
Cramping or colicky abdominal pain, which can be diffuse, originates in the left upper quadrant and radiates or migrates to the other quadrants, usually in a peristaltic manner. It’s accompanied by diarrhea, hyperactive bowel sounds, headache, myalgia, nausea, and vomiting.
Heart failure
Right upper quadrant pain commonly accompanies the hallmarks of heart failure: jugular vein distention, dyspnea, tachycardia, and peripheral edema. Other findings include nausea, vomiting, ascites, productive cough, crackles, cool extremities, and cyanotic nail beds. Clinical signs are numerous and vary according to the stage of the disease and amount of cardiovascular impairment.
Hepatic abscess
Steady, severe abdominal pain in the right upper quadrant or midepigastrium typically accompanies hepatic abscess, a rare disorder; however, right upper quadrant tenderness is the most important finding. Other signs and symptoms are anorexia, diarrhea, nausea, fever, diaphoresis, elevated right hemidiaphragm and, in rare cases, vomiting.
Hepatic amebiasis
Hepatic amebiasis, which is rare in the United States, causes relatively severe right upper quadrant pain as well as tenderness over the liver and, possibly, the right shoulder. Accompanying signs and symptoms include fever, weakness, weight loss, chills, diaphoresis, and jaundiced or brownish skin.
Hepatitis
Liver enlargement from any type of hepatitis causes discomfort or dull pain and tenderness in the right upper quadrant. Associated signs and symptoms may include dark urine, clay-colored stools, nausea, vomiting, anorexia, jaundice, malaise, and pruritus.
Herpes zoster
Herpes zoster of the thoracic, lumbar, or sacral nerves can cause localized abdominal and chest pain in the areas served by these nerves. Pain, tenderness, and fever can precede or accompany erythematous papules that rapidly evolve into grouped vesicles. Although rare, herpes zoster can also affect the viscera of the abdominal cavity, causing adhesions and chronic pain.
Insect toxins
Generalized, cramping abdominal pain usually occurs, along with low-grade fever, nausea, vomiting, abdominal rigidity, tremors, and localized pain and swelling.
Intestinal obstruction
Short episodes of intense, colicky, cramping pain alternate with pain-free intervals in intestinal obstruction, a life-threatening disorder. Accompanying signs and symptoms may include obstipation, pain-induced agitation, visible peristaltic waves, and abdominal distention, tenderness, and guarding. The patient may also exhibit high-pitched, tinkling, or hyperactive sounds proximal to the obstruction; distally, sounds may be hypoactive or absent. In jejunal and duodenal obstruction, nausea and bilious vomiting occur early. In distal small- or large-bowel obstruction, nausea and vomiting are commonly feculent. Bowel sounds are absent in complete obstruction. Late-stage obstruction produces signs of hypovolemic shock, such as hypotension and tachycardia.
Irritable bowel syndrome
Lower abdominal cramping or pain is aggravated by eating coarse or raw foods and may be alleviated by defecation or passage of flatus. Related findings include abdominal tenderness, diurnal diarrhea alternating with constipation or normal bowel function, and small stools with visible mucus. Dyspepsia, nausea, and abdominal distention with a feeling of incomplete evacuation may also occur. Stress, anxiety, and emotional lability may intensify the symptoms.
Listeriosis
Listeriosis is a serious infection caused by eating food contaminated with the bacterium
Listeria monocytogenes. This illness primarily affects pregnant women, neonates, and those with weakened immune systems. Signs and symptoms include fever, myalgia, abdominal pain, nausea, vomiting, and diarrhea. If the infection spreads to the nervous system, meningitis may develop; signs and symptoms include fever, headache, nuchal rigidity, and a change in the level of consciousness (LOC). Infections during pregnancy may lead to premature delivery, infection of the neonate, or stillbirth.
Mesenteric artery ischemia
Initially, the abdomen is soft and tender, with decreased bowel sounds. Associated findings include vomiting, anorexia, alternating periods of diarrhea and constipation and, in late stages, extreme abdominal tenderness with rigidity, tachycardia, tachypnea, absence of bowel sounds, and cool, clammy skin.
Always suspect mesenteric artery ischemia in patients older than age 50 with chronic heart failure, cardiac arrhythmias, cardiovascular infarct, or hypotension who develop sudden, severe abdominal pain after 2 to 3 days of colicky periumbilical pain and diarrhea.
Myocardial infarction (MI)
Substernal chest pain may radiate to the abdomen in an MI, a life-threatening disorder. Associated signs and symptoms include weakness, diaphoresis, nausea, vomiting, anxiety, syncope, jugular vein distention, and dyspnea.
Ovarian cyst
Torsion or hemorrhage causes pain and tenderness in the right or left lower quadrant. Sharp and severe if the patient suddenly stands or stoops, the pain becomes brief and intermittent if the torsion self-corrects or dull and diffuse after several hours if it doesn’t. Pain may be accompanied by slight fever, mild nausea and vomiting, abdominal tenderness, a palpable abdominal mass and, possibly, amenorrhea. Abdominal distention may occur if the cyst is large. Peritoneal irritation causes high fever and severe nausea and vomiting; these symptoms also occur with rupture and ensuing peritonitis.
Pancreatitis
Life-threatening acute pancreatitis produces fulminating, continuous upper abdominal pain that may radiate to both flanks and the back. To relieve this pain, the patient may bend forward, draw his knees to his chest, or move about restlessly. Early findings include abdominal tenderness, nausea, vomiting, fever, pallor, tachycardia and, in some patients, abdominal rigidity, rebound tenderness, and hypoactive bowel sounds. Turner’s sign (ecchymosis of the abdomen or flank) or Cullen’s sign (a bluish tinge around the umbilicus) signals hemorrhagic pancreatitis. Jaundice may occur as inflammation subsides.
Chronic pancreatitis produces severe left upper quadrant or epigastric pain that radiates to the back. Abdominal tenderness, a midepigastric mass, jaundice, fever, and splenomegaly may occur. Steatorrhea, weight loss, poor digestion, and diabetes mellitus are common.
Pelvic inflammatory disease
Pain in the right or left lower quadrant ranges from vague discomfort worsened by movement to deep, severe, and progressive pain. Metrorrhagia occasionally precedes or accompanies the onset of pain. Extreme pain accompanies cervical or adnexal palpation. Associated findings include abdominal tenderness, a palpable abdominal or pelvic mass, fever, occasional chills, nausea, vomiting, urinary discomfort, and abnormal vaginal bleeding or purulent vaginal discharge.
Perforated ulcer
With a perforated ulcer — a life-threatening disorder — sudden, severe, and prostrating epigastric pain may radiate through the abdomen to the back or right shoulder. Other signs and symptoms include boardlike abdominal rigidity, tenderness with guarding, generalized rebound tenderness, absent bowel sounds, grunting and shallow respirations and, in many cases, fever, tachycardia, hypotension, and syncope.
Peritonitis
In peritonitis, a life-threatening disorder, sudden and severe pain can be diffuse or localized in the area of the underlying disorder; movement worsens the pain. The degree of abdominal tenderness usually varies according to the extent of disease. Typical findings include fever, chills, nausea, vomiting, hypoactive or absent bowel sounds, rebound tenderness and guarding, hyperalgesia, tachycardia, hypotension, tachypnea, and abdominal tenderness, distention, and rigidity. Positive psoas and obturator signs also occur.
Pleurisy
Pleurisy may produce upper abdominal or costal margin pain referred from the chest. Characteristic sharp, stabbing chest pain increases with inspiration and movement. Many patients have a pleural friction rub and rapid, shallow breathing; some develop a low-grade fever.
Pneumonia
Lower-lobe pneumonia can cause pleuritic chest pain and referred, severe upper abdominal pain, tenderness, and rigidity that diminish with inspiration. It can also cause fever, shaking chills, achiness, headache, blood-tinged or rusty sputum, dyspnea, and a dry, hacking cough. Accompanying signs include crackles, egophony, decreased breath sounds, and dullness on percussion.
Pneumothorax
Potentially life threatening, pneumothorax can cause pain across the upper abdomen and costal margin; this pain is referred from the chest. Characteristic chest pain arises suddenly and worsens with deep inspiration or movement. Accompanying signs and symptoms include anxiety, dyspnea, cyanosis, decreased or absent breath sounds over the affected area, tachypnea, and tachycardia. Watch for asymmetrical chest movements on inspiration.
Prostatitis
Vague abdominal pain or discomfort in the lower abdomen, groin, perineum, or rectum may develop. Other findings include dysuria, urinary frequency and urgency, fever, chills, low back pain, myalgia, arthralgia, and nocturia. Scrotal pain, penile pain, and pain on ejaculation may occur in chronic cases.
Pyelonephritis (acute)
Progressive lower quadrant pain in one or both sides, flank pain, and costovertebral angle tenderness characterize acute pyelonephritis. Pain may radiate to the lower midabdomen or groin. Additional signs and symptoms include abdominal and back tenderness, high fever, shaking chills, nausea, vomiting, and urinary frequency and urgency.
Renal calculi
Depending on the location of calculi, severe abdominal or back pain may occur. However, the classic symptom is severe, colicky pain that travels from the costovertebral angle to the flank, suprapubic region, and external genitalia. The pain may be excruciating or dull and constant. Pain-induced agitation, nausea, vomiting, abdominal distention, fever, chills, hypertension, and urinary urgency with hematuria and dysuria may occur.
Sickle cell crisis
Sudden, severe abdominal pain may accompany chest, back, hand, or foot pain. Associated signs and symptoms include weakness, aching joints, dyspnea, and scleral jaundice.
Smallpox (variola major)
Worldwide eradication of smallpox was achieved in 1977. The United States and Russia have the only documented storage sites for the virus, and the virus is considered a potential agent for biological warfare. Initial signs and symptoms include high fever, malaise, prostration, severe headache, backache, and abdominal pain. A maculopapular rash develops on the mucosa of the mouth, pharynx, face, and forearms and spreads to the trunk and legs. Within 2 days, the rash becomes vesicular and, later, pustular. The lesions, which develop simultaneously rather than gradually increasing in number, occur more frequently on the face and extremities. The pustules are round, firm, and embedded in the skin. After 8 to 9 days, the pustules form a crust. Later, the scab separates from the skin, leaving a pitted scar. In fatal cases, death results from encephalitis, extensive bleeding, or secondary infection.
Splenic infarction
Fulminating pain in the left upper quadrant occurs with chest pain that may worsen on inspiration. Pain commonly radiates to the left shoulder with splinting of the left diaphragm, abdominal guarding and, occasionally, a splenic friction rub.
Systemic lupus erythematosus
Generalized abdominal pain is unusual but may occur after meals. Butterfly rash, photosensitivity, alopecia, mucous membrane ulcers, and nondeforming arthritis are characteristic. Other common signs and symptoms include anorexia, vomiting, abdominal tenderness with guarding, abdominal distention after meals, fatigue, fever, and weight loss. Precordial chest pain and a pericardial rub may also occur.
Ulcerative colitis
Ulcerative colitis may begin with vague abdominal discomfort that leads to cramping lower abdominal pain. As ulcerative colitis progresses, the pain may become steady and diffuse, increasing with movement and coughing. The most common symptom — recurrent and possibly severe diarrhea with blood, pus, and mucus — may relieve the pain. The abdomen may feel soft, squashy, and extremely tender. High-pitched, infrequent bowel sounds may accompany nausea, vomiting, anorexia, weight loss, and mild, intermittent fever.
Uremia
Characterized by generalized or periumbilical pain that shifts and varies in intensity, uremia causes diverse GI signs and symptoms, including nausea, anorexia, vomiting, and diarrhea. Abdominal tenderness that changes in location and intensity may occur, along with vision disturbances, bleeding, headache, decreased LOC, vertigo, and oliguria or anuria. Chest pain may occur secondary to pericardial effusion. Localized or diffuse pruritus is common.
Other causes
Abdominal trauma
Generalized or localized abdominal pain occurs with ecchymosis on the abdomen, abdominal tenderness, vomiting and, with hemorrhage into the peritoneal cavity, abdominal rigidity. Bowel sounds are decreased or absent. The patient may have signs of hypovolemic shock, such as hypotension and a rapid, thready pulse.
Diet
Highly acidic foods, such as coffee, chocolate, tomatoes, and citrus products, may cause sharp or gnawing upper quadrant pain.
Drugs
Salicylates and nonsteroidal anti-inflammatory drugs commonly cause burning, gnawing pain in the left upper quadrant or epigastric area and nausea and vomiting.
Nursing considerations
Help the patient find a comfortable position to ease his distress. A supine position, with his head flat on the table, arms at his sides, and knees slightly flexed, will relax the abdominal muscles. Monitor him closely because abdominal pain can signal a life-threatening disorder.
ALERT: Be particularly vigilant for such indications as tachycardia, hypotension, clammy skin, abdominal rigidity, rebound tenderness, a change in the pain’s location or intensity, or sudden relief from the pain, which indicate a ruptured abdominal aortic aneurysm. Notify the physician immediately and prepare the patient for emergency surgery. Initiate oxygen therapy, verify that a patent I.V. line is in place, and administer fluids or blood products as ordered.
Withhold analgesics to avoid masking symptoms that may help to determine the diagnosis; also, withhold food and fluids because the patient may require surgery. Prepare for I.V. infusion and insertion of a nasogastric or other intestinal tube. Peritoneal lavage or abdominal paracentesis may also be required.
Patient teaching
Inform the patient that pain relief medications may not be ordered immediately because such agents can mask findings that would facilitate diagnosis. Analgesics can also interfere with surgical medications and might therefore be withheld until it’s determined whether surgery will be necessary. Teach the patient how to use positioning to help alleviate discomfort. Inform him about what to expect from diagnostic testing, which may include pelvic and rectal examinations, X-rays and computed tomography scans, barium studies, and collection of blood, urine, and stool samples. Ultrasonography, endoscopy, and biopsy may also be performed. If surgery is needed, provide preoperative teaching.
Pictures
Book Source Details
- Book Title: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series
- Author(s): Springhouse
- Year of Publication: 2007
- Copyright Details: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, Copyright © 2007 Lippincott Williams & Wilkins.
Other Book Chapters Related to Cramps
Read excerpts from these other book chapters related to Cramps:
Medical Books Excerpts
- Dyspepsia
- "Handbook of Signs & Symptoms (Third Edition)" (2006)
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- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
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- Abdominal Pain
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
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- Abdominal pain
- "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
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- Dyspepsia
- "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
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- Abdominal Pain
- "The Diagnostic Approach to Symptoms and Signs in Pediatrics" (2006)
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- Dyspepsia
- "Nursing: Interpreting Signs and Symptoms" (2007)
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Copyright Details: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, Copyright © 2008 Williams & Wilkins.
More About Causes of Cramps
» Next page: Abdominal pain (Signs & Symptoms: A 2-in-1 Reference for Nurses)
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