Stomach ache - what should I do?
Patient complaints of abdominal pain are the most frequent in the practice of general practitioners, gastroenterologists, general surgeons, coloproctologists, gynecologists, and urologists. Many patients ignore episodic abdominal pain and self–medicate with over-the-counter medications widely advertised in the media, however, some types of abdominal pain are the causes of serious illnesses and require urgent medical care, often in specialized hospitals.
Causes of abdominal pain
It is generally believed that the cause of abdominal pain is most often a spasm of the smooth muscle organ (spastic) or inflammation. Spastic pain (colic) develops acutely, suddenly, and may be short-lived or prolonged, depending on the source and cause of the pain. Examples of spastic pain are intestinal, renal, and biliary colic.
Pain as a result of inflammation increases gradually, up to a certain point it can be tolerated. As an example, it is for this reason that patients with acute appendicitis often seek medical help late, already at the stage of phlegmonous or gangrenous appendicitis.
The nature of the pain has diagnostic significance.
In order to make a correct diagnosis, the doctor asks questions about the nature of the pain the patient is experiencing. You should describe the nature and location of the pain as accurately as possible. Usually, the doctor asks the patient to lie on his back in order to relax the abdominal muscles. With pressing movements, he gently feels the abdomen with his fingertips, without sudden movements, and determines the place where the pressure causes the most pain. It is important to inform the doctor about the nature of the pain: dull, aching, sharp, cutting, bursting, whether the pain radiates away, increases with coughing or walking and bending over, under what circumstances the pain appeared - suddenly, or after eating, physical exertion, defecation.
Localization of pain
There is no 100% connection between the localization of pain and the damaged organ. Pain near the navel, moving to the lower right part of the abdomen, is most often a symptom of appendicitis, and pain from inflammation of the pancreas can begin "in the pit of the stomach" and then become shingles. A doctor may assume a diagnosis based on complaints and examination, but it is often necessary to conduct a number of studies to determine the condition of internal organs – ultrasound, CT, MRI.
For example, pain in the upper abdomen on the right may indicate a disease of the liver, gallbladder, biliary tract, duodenum. Pain in the upper abdomen on the left may be a symptom of gastritis, stomach ulcers, hernia of the esophageal orifice of the diaphragm. Emergency medical care is required for severe, rapidly increasing pain in the right hypochondrium, epigastric region radiating to the right shoulder, collarbone, shoulder blade, iliac region, lower back (symptoms of biliary colic); also, if the pain is severe, it occurs suddenly and is accompanied by fever, nausea, vomiting (symptoms of intestinal perforation, peritonitis), increasing pain concentrating in the lower abdomen on the right (a symptom of acute appendicitis).
Pain in the lower abdomen on the right may be a symptom of appendicitis, mainly in the left or right half of the abdomen — diseases of the colon (colitis, acute intestinal obstruction, diverticulitis, Crohn's disease, ulcerative colitis), above the pubis — genitals, bladder.
Abdominal pain in women
It could be either menstrual pain caused by contraction of the uterine muscles, or pain as a result of gynecological diseases and inflammatory phenomena in sexually transmitted infections. Pain may be felt in the lower abdomen above the pubis, in the groin areas on the left/right. If the next menstruation is delayed, if severe pain occurs in the lower abdomen on the right or left, not accompanied by vomiting and fever, it should be excluded ectopic pregnancy.
What can and cannot be done if your stomach hurts?
Before going to the doctor, you should follow three main rules: hunger, cold and rest. In no case should you warm your stomach. If pain is a symptom of the inflammatory process, its development may accelerate.
It is not necessary (however, this is not mandatory) to take painkillers and antispasmodics before contacting a doctor — these drugs smooth out the clinical picture and complicate diagnosis. You should also refrain from enemas and laxatives.
If the patient suspects what the cause of the pain is, for example, he knows about the existence of a gallstone or suffers from chronic gastritis, he should take an ambulance medication recommended by his doctor, and then consult a doctor as soon as possible.
When should I call an ambulance?
Abdominal pain is a reason for immediate medical attention if:
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The pain appeared suddenly, severe and lasts for more than 3 hours.
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The pain appeared as a result of an abdominal injury — a strong blow to the stomach or a fall;
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There was an acute cutting pain, stabbing pain, which shifted to the right hypochondrium;
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There was shingles pain
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Pain is accompanied by fever, darkening of urine, nausea or vomiting;
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Pain is accompanied by blood discharge from the rectum or vomiting with blood;
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Pain is accompanied by discharge of blood from the vagina;
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The pain is accompanied by dizziness, increased pulse rate, general severe weakness, pallor and sweating of the skin.
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Any abdominal pain during pregnancy.
Mild episodic short-term abdominal pain is most often associated with digestive problems. But if the pain persists continuously for more than 4 weeks, you should consult a doctor: it can often hide diseases of the stomach, intestines, kidneys, and female genital organs.
Emergency and emergency care for patients in EMS
If there is a need for urgent medical advice, a patient with abdominal pain can contact EMC Emergency department: the doctor visits the house at any time of the day.