Han Vu

Most of the causes of abdominal pain are not serious and can be readily diagnosed and treated. However, pain can also be a sign of a serious illness. It is important to be able to recognize symptoms that are severe and know when to call a doctor.

Symptoms of Abdominal Pain Need Concern

Fever

Inability to keep food down for several days

Inability to pass stool, especially if you are also vomiting

Difficulty breathing

Painful or unusually frequent urination

The pain occurs during pregnancy

The abdomen is tender to the touch

Vomiting blood

Bloody stools

The pain is the result of an injury to the abdomen in the previous days

The pain lasts for several days

These symptoms can be an indication of an internal problem that requires treatment as soon as possible.

Constipation

most people experience constipation at some point in their life. Constipation is the inability to have a normal bowel movement. This can be in the form of having to strain to have stools passed or not being able to have a bowel movement at all.

Causes of constipation:

change in diet or routine, or an underlying health problem.

Symptoms: include abdominal pain, abdominal pressure, swollen abdomen, difficult bowel movements, a lack of bowel movements, and vomiting.

Gastroenteritis (Stomach 'flu')

Pain due to due to the irritation and inflammation of the lining of the stomach and intestines, which can be caused by a virus or bacterial infection.

Symptoms: abdominal pain, abdominal cramps, nausea, vomiting, diarrhea, swollen lymph glands, fatigue, and fever.

Gas

Everyone produces and passes gas

Naturally formed due to food broken down by digestion system

Some food produce gas more than others such as high fiber foods such as beans, vegetables, fruits, and whole grain products

An excess of gas in the system can lead to bloating and abdominal pain.

However, frequent painful gas can be a sign of health problems, such as ulcers, gastroesophageal reflux disease (GERD), irritable bowel syndrome (IBS), and colon cancer.

Lactose Intolerance

inability to digest lactose (the sugar found in dairy products) due to the body not making enough of the enzyme lactase.

Symptoms: 30 minutes to two hours after consuming dairy products:

abdominal pain, abdominal cramping, nausea, painful gas, bloating and diarrhea.

Indigestion

discomfort felt during or after eating

Range from feeling full to actual pain.

frequently due to simply eating or drinking too much

can be a sign of a health problem, such as gastroesophageal reflux disease (GERD) or cancer

Symptoms:

abdominal pain, bloating,

belching, gas, nausea,

vomiting, acidic taste, and burning in the stomach or upper abdomen

Menstrual Pains

felt during menstruation is commonly due to menstrual cramps,

which are caused by the contraction of the muscles of the uterus brought on by hormone changes.

cramps may range from mild annoyances to strong pains that interfere with daily activities.

some women, the pain is severe or continues after menstruation.

may be other health conditions involved, such as pelvic inflammatory disease, endometriosis or fibroids.

Ulcer: the causes

Infection by H. pylori

Use of pain killers (NSAID)

Too much acid produced from gastrinoma

Symptoms of ulcer:

burning pain in the middle or upper stomach between meals or at night

Bloating, heartburn

Nausea, vomiting

Irritable Bowel Syndrome

more likely to strike women than men

Symptoms: diarrhea, constipation,

abdominal cramps, pain,

and bloating.

not yet found a specific cause for IBS

All the symptoms tend to be aggravated by stress

Treatment:

Stress reduction is a crucial part of treatment

Medicines to relax intestinal muscles can help relieve symptoms of irritable bowel syndrome

Dietary changes can also help:

Eat smaller meals

Avoid caffeine

Food Allergies

immune system response to a certain compound in food, usually a protein

Symptoms: every time the food is consumed

abdominal pain, nausea, diarrhea, rash, hives, shortness of breath, chest pain, and anaphylaxis.

How Is the Cause of Abdominal Pain Determined?

type of pain: Is it stabbing and severe? Is it a dull ache? Is the pain throughout your abdomen or is it confined to a particular area?

Where in your abdomen does the pain seem to be located?

in the morning or at night? If the pain comes and goes, about how long does it last each time? Does it occur after eating certain types of foods or after drinking alcohol?

Pain during menstruation?

radiate in your lower back, shoulder, groin or buttocks?

taking any medications or herbal supplements?

pregnant?

any activity relieve the pain?

injured recently?

Some tests to help diagnose your pain

Stool or urine tests, barium swallows or enemas, endoscopy, x-ray, ultrasound, CT scan

antibiotics for infections

changes in personal behavior for certain foods or beverages.

In some cases, surgery is necessary (appendicitis, herniation)

Here’s a case study:

A woman in her 80s presented after two weeks of intermittent generalized abdominal pain. worsened over a 48-hour period

Symptoms: no bowel movements, severe pain, and nausea and vomiting. PE showed significant for abdominal distention and tenderness.

CT scan demonstrated a high-grade bowel obstruction secondary to a cecal mass.

Specimen of a 24-cm segment of terminal ileum shows a mass at the ileocecal junction.

mass is present at the ileocecal junction

Diff Dx:

1. Constipation/obstruction by mantle cell lymphoma

(ruled in due to no bowel; a mass found by CT & confirmed by specimen)

2. Lactose intolerance (r/0 due to no bloating, no gas, no diarhea)

3. Food allergies (r/o due to no rash/hive)

4. Gastroenteritis (r/o due to no fever, no swollen lymphatic glands)

5. Gas ( r/o due to no gas ever been complained)

She was diagnosed with abdominal obstruction by mantle cell lymphoma

Mantle cell lymphoma demonstrates features of both low-grade and high-grade non-Hodgkin lymphomas.

The vast majority of patients cannot be cured

median survival : 3-5 years

Treatment Options

depends on the stage of the disease

Monoclonal antibody using drugs Rituximab to destroy cancer cells

Interferon to boost immune to fight dz

New chemotherapy drug Fludarabine used to fight dz

Radiation treatment used in Stage I or II

Radiation coupled w/chemotherapy in later stage

Stem cell, an aggressive therapy, used for late stages of the disease.

REFERENCES:1. Jaffe ES, Harris NL, Stein H, Vardiman JW

(Eds.): World Health Organization Classification of Tumours. Pathology and Genetics of Tumours of Haematopoietic and Lymphoid Tissues. IARC Press: Lyon 2001

2. Romaguera J, Hagemeister B. Lymphoma of the colon. Curr Opin Gastroenterol. 2005 Jan; 21 (1): 80-4.

3. Bertoni F, Zucca E, Cavalli F. Mantle cell lymphoma. Curr Opin Hematol. 2004 Nov; 11 (6): 411-8.

4. Tamura S, Ohkawauchi K, Yokoyama Y, Higashidani Y, Daibata M, Hiroi M, Yamamori S, Onishi S. Non-multiple lymphomatous polyposis form of mantle cell lymphoma in the gastrointestinal tract. J Gastroenterol. 2004 Oct; 39 (10): 995-1000.

5. Okazaki K. Multiple lymphomatous polyposis form is common but not specific for mantle cell lymphoma in the gastrointestinal tract. J Gastroenterol. 2004 Oct; 39 (10): 1023-4.

6. DiRaimondo F, Albitar M, Huh Y, O'Brien S, Montillo M, Tedeschi A, Kantarjian H, Lerner S, Giustolisi R, Keating M. The clinical and diagnostic relevance of CD23 expression in the chronic lymphoproliferative disease. Cancer. 2002 Mar 15; 94 (6): 1721-30.

7. http://www.webmd.com/digestive-disorders/abdominal-pain

8. http://www.associatedcontent.com/article/2367624/the_most_common_causes_of_abdominal.html?cat=5

9. http://www.lymphomainfo.net/nhl/types/mantle.html

10. http://www.webmd.com/digestive-disorders/digestive-diseases-peptic-ulcer-disease

11. http://women.webmd.com/features/3-common-conditions-women-dont-talk-about?page=2

Thank You