I’m doubled over in pain with my hand clutching my stomach. my skin is damp with perspiration. I’ve never felt this intensity of pain before and I don’t know what to do. Through clenched teeth I summon “Dr Google”, but the information overload is giving me a headache on top of the agony already in my midriff.
Thankfully I’m not alone in my distress and my husband knows exactly what to do. He quickly palms his phone and with amazing calm he dials the Doctors on Call team. I feel rather childish when he reports to the responder, that I have an intense tummy ache, but the soothing voice on the other side of the phone, stresses that I need need urgent medical attention for what they call acute abdominal. It is imperative that the cause of the pain is discovered in the least amount of time possible. In record time I receive a home visit by a professional medical clinician and I am examined with serious efficiency.
What does she want from me?
Whille the doctor is doing most if the work, I have to put in my share of effort by providing her with a full medical history. Like any normal doctor visit she produces her stethoscope and listents for pertinent sounds in my abdomen. Simultaneously she presses on various parts of my stomach in an attempt to locate the pain. She quickly determines that I should be taken to the hospital where an inter-professional team of specialists will examine me and determine the cause of my pain.
What was the source of my misery?
In my case, it turned out to be a minor obstruction of the bowel; something I had suffered from before, but it could have been one of several more severe possibilities. Later, following my recovery, I asked the doctor for some more information. The term “acute abdominal pain” is quite a broad term. In my quest for a “medical explanation for dummies”, I acquired some extensive knowledge. A lot of it is very technical, but I have come away with a far greater understanding of an area of medicine that I have been affected by. Even with my new-found knowledge, I still find it difficult to get my tongue round some of the names of the conditions she described, but I still want to share it with you in some “byte-sized” chunks.
If you feel a sudden onset of stomach pain (which does not decrease over time) and maybe nausea or vomiting as well, don’t wait. Seek urgent attention. As worried as you certainly will be, you must try to stay calm and allow the doctor on call to go through all the necessary procedures. it is vital that the clinician learn about your medical history while also performing a preliminary physical exam.
The most important goal for the doctor, is finding the source of the pain. (S)he presses down on your stomach (medically speaking, that’s called palpation) to determine where the point of pain is most prevalent. (S)he listens for any abdominal sounds through a stethoscope (Sound familiar? You can feel comforted by the fact that there is nothing new or scary in this initial investigation).
I didn’t realise how many possible conditions a doctor runs through in his mind and will need to eliminate before (s)he can diagnose or attempt to diagnose an acute abdominal pain.
I wanted to find out about these conditions, but I didn’t want to come away even more confused by the complicated terms. So, here is a partial list of possible causes taught to me in a language I could understand. It’s not exhaustive and you may have heard of some of those on the list. Still, I hope you can come away from this article with a better idea of what these conditions mean from my translation of the language I call “medical-ese”. Some may sound terrifying, but forearmed is forewarned. They are all treatable once diagnosed. The condition could be:
- Appendicitis – your appendix (which is found on the lower right-hand side of your abdomen) is inflamed or swollen. In an earlier unfortunate experience, I can tell you that “ow”, is rather an understatement of the pain it can cause
- Peritonitis – just the name of this conditions can make you cringe. This one can occur when the wall of your abdomen becomes inflamed
- Heard of a perforated peptic ulcer? I refer to the condition that develops when you have an abscess (or sore) in the lining of your stomach which suddenly develops a hole. Painful just to imagine, right?
- Pancreatitis occurs when the organ, known as the pancreas, (which is found behind your stomach and is joined to your small intestine), becomes swollen.
- Another possibility is a ruptured sigmoid diverticulum (can you pronounce that one?) In simpler language, this is a tear of the colon
- A woman might develop something called an ovarian torsion. This scary-sounding condition can occur if one of her ovaries twists around the ligaments that holds it in place. This twisting can cut off blood flow to that ovary
- She may also experience pain from an ectopic pregnancy; this is a tragic condition that happens if an embryo is implanted in a place other than the uterus; often in the fallopian tubes. This may be a life-threatening illness over and above its sad outcome
- Volvulus is the name given when a loop of intestine twists around itself and a blockage occurs in the stomach
- Possibly the most critical condition is a ruptured aortic aneurysm. The aorta is the main blood vessel that supplies blood from the heart to the body. An aneurysm in the stomach would be caused when the abdomen has weakened and is causing a bulging of the portion of the aorta which is in the stomach.
- There are other critical conditions which affect different organs located in the abdomen:
- The spleen or liver may become lacerated (this is a breakage in the organ which causes internal bleeding in the area)
- If the intestines do not receive enough oxygenated blood causing this may lead to an ischemic bowel
- The gall bladder may be blocked, perhaps from a gallstone, causing a condition called cholecystitis
- There may even be a urologic reason for the pain, such as when an obstruction occurs in the urinary tract, causing ureteral colic. – I agree. It sounds absolutely excruciating.
- Another condition occurring in this area is pyelonephritis which affects the kidneys
- As with many painful conditions, children are not immune to acute abdomen. In rare cases, the wall of the intestine of new-borns can be invaded by bacteria causing something called necrotising enterocolitis. What starts off as an infection, may end by destroying the wall of the bowel
- Other abdominal conditions can appear in babies and young children; they include midgut volvulus – the children’s’ equivalent of volvulus, as described above, and intussusception (which is caused when one part of a child’s intestine folds into another part of the intestine).
Many of the above-mentioned conditions are quite rare. However, with these possibilities in mind, one sees how important diagnosis is in cases of acute abdominal due to the varying degree of seriousness of possible outcomes. One reason that diagnosing abdominal illnesses becomes complex is that many of the conditions have the same symptoms and something that appears fairly simple to diagnose may be something far more serious.
Am I a patient at risk?
Did you know that a pre-existing condition of high blood pressure (yes, that’s hypertension) can be a risk factor for an abdominal aneurysm? If you have a history of alcoholism, this could direct the doctor towards a verdict of pancreatitis. Certain pre-existing conditions lets the doctor determine whether you are a patient at risk, which adds to the importance of a speedier diagnosis/
When I got to the hospital, a number of specialists were involved and gave their input. An interdisciplinary team can speed up the diagnosis underlying abdominal pain. A diagnostic team may include a general surgeon, an obstetrician or gynaecologist, (when the patient is a woman of childbearing age). The obvious carers on the team will be the nurses who will monitor your vital signs, send your bloods for examination (if you’re over 40, doctors will probably want a full blood count) and carry out any wound treatment should it be needed. The pharmacist will ensure you receive the right correct dose of painkillers (analgesics) and the appropriate antibiotics. Of course, one of the most important members of the team will be the radiologist who runs the imaging tests. Here, again, a patient’s medical history might direct the clinician to run extra radiologic exams. He may use a bedside ultrasound if you’re taken to the emergency department. The images that are now available to clinicians have advanced tremendously over the last 30 years. The radiologist might even prescribe a CT scan to assist in diagnosis.
How will you treat me? Do I need to manage my own care?
While the team is running through the necessary examinations, you won’t be left untreated. In fact, one of the first steps a doctor might take is to begin with the administration of a general anti-biotic, through a drip. It should also come as a relief to know that pain release medication can be administered fairly soon in the process.
Why can’t I stay home, take some pain medication and call the doctor in the morning?
I’ve always avoided calling for help in the middle of the night. Doctors also need their rest, don’t they? While this attitude might be applauded, it is not actually helpful. Left untreated, your level of consideration for others, can cause complications for yourself. While not wanting to be the cause of alarm, be aware that allowing prolonged pain might lead to a very negative response by your bod. Here are some of the results:
- an infection, known as sepsis, can ensue and lead to the damage of many of your body’s organs.
Cells in an organ of the body may begin to die or blood supply may fail; you might suffer necrosis and/or gangrene of the bowel.
A fistula may form; this is when an abnormal connection occurs between two hollow spaces such as blood vessels, intestines, or other hollow organs.
Dare I say it. The most dire prognosis is death.
Now I’m terrified. What does all this mean to me in the end?
The facts are numerous. The names of the conditions and their possible symptoms are scary, but the available treatment is out there. The doctor on call has spent many years practicing for an emergency of this nature. So, don’t self-diagnose and never self-medicate. Call in the right professionals; let them examine you; provide them with as clear a medical history as you can (even through the pain). After that rest assured that your abdomen is in the best “hands”.