Three-step algorithm for treating abdominal pain

Acute stomach pain is one of the most common symptoms, which indicates the presence of acute and chronic diseases of the gastrointestinal tract. To diagnose the disease, specialists determine the nature of the pain, its intensity, and the area of ​​development of painful symptoms. Acute pain in the stomach is also caused by other factors, which representatives of the private medical clinic “KDS Clinic” will tell you about.

Acute pain in the stomach occurs not only with disorders of the gastrointestinal tract. With this symptom, problems with the kidneys, liver and other organs are diagnosed. If the patient is bothered by acute pain in the stomach, the treatment method depends on the patient's condition. Experts resort to the following treatment options:

• Traditional methods;
• Drug treatment;
• Homeopathy;
• In advanced cases - surgical intervention.

What is stomach pain

Pain in the stomach area is called gastralgia.
It can be caused by many factors. These include serious pathologies of internal organs and minor temporary ailments, for example, after eating too much. Pain in the stomach is easily confused with unpleasant sensations in other organs located in the abdominal cavity and retroperitoneal space:

• small and large intestines,
• kidneys,
• appendix,
• spleen,
• gallbladder,
• liver,
• pancreas.

Often, stomach pain is accompanied by other symptoms of gastrointestinal disorders - nausea, vomiting, diarrhea.

How does my stomach hurt?

To determine that it is the stomach that hurts, you need to understand its anatomy. The stomach is located in the abdominal cavity just below the diaphragm. Its shape and size constantly change depending on the amount of food eaten. The largest part of the organ is located on the left directly under the ribs, and the smaller part is located immediately under the sternum (Fig. 1). This area is called the epigastric region.

Figure 1. Where is the stomach in the human body. Source: MedPortal

Adjacent to the posterior wall of the stomach are the pancreas, spleen and the upper part of the left kidney.

Pain in the stomach is usually localized in the upper abdomen - the epigastrium, but in the same area pain can appear with pancreatitis, cholelithiasis, and even with myocardial infarction and aortic aneurysm (Fig. 2).

Figure 2. Cause of pain depending on location. Source: MedPortal

Acute and severe “dagger” pain is characteristic of perforation of a stomach ulcer and peritonitis. In case of indigestion, the pain is localized on the left under the ribs; a sign of chronic gastritis with low acidity is pain in the middle of the abdomen; if the body of the stomach is affected, complaints are associated with painful sensations above the navel.

But the localization of pain is not an unambiguous sign of stomach diseases. For example, pain in the left side of the abdomen often occurs with osteochondrosis and cardiovascular pathologies. In women, such pain can appear due to pathologies of the ovaries and uterus.

The most likely sign of stomach problems is pain that appears after eating or during a long break between meals. But even in this case, its cause can be established only after a comprehensive examination.

Prevention

Doctors at the 5th Hospital will not only select the optimal diagnostic and treatment option for each patient, but will also advise on how to prevent relapses.

Diet occupies a special place among measures to prevent intestinal and stomach diseases. It is important to learn to maintain balance in nutrition. You should not overeat; you should chew food carefully and slowly. Water and willow tea https://teahelp.ru/tea/herbal-tea/ivan-chaj/ should be consumed in sufficient quantities; coffee is not recommended in this case. At the same time, when choosing a diet, experienced doctors take into account all factors:

• functional state of the intestines, liver, pancreas
• secretory function of the stomach,
• intestinal motility,
• the presence of other concomitant diseases.

In addition to your diet, it is important to reconsider how you store and process food. Do not leave food open in the sun. Avoid damp food storage areas. Otherwise, they may begin to mold and rot. Avoid contact between raw foods and cooked foods.

Exercise therapy is also of great importance in the complex of preventive measures. Instructors-methodologists select their own loads and exercises for each patient.

Why does my stomach hurt?

Stomach pain can be caused by situational reasons that do not threaten human health, and by very serious pathologies of internal organs.

Situational factors include:

• Flatulence (bloating) is a condition in which gases accumulate in the stomach, distending the organ from the inside and causing pain. The accumulation of gases is usually associated with poor nutrition and a sedentary lifestyle.
• Constipation. The causes of constipation are mainly associated with eating large amounts of fatty foods and baked goods, a lack of fresh fruits and vegetables in the diet, and physical inactivity.
• Premenstrual syndrome often causes pain that is similar in nature and location to stomach pain.
• Irritable bowel syndrome and other functional disorders of the digestive tract.
• Sprains during pregnancy.

Pain caused by situational factors is temporary and goes away fairly quickly without the help of a doctor or taking medications. Prolonged pain is a signal indicating serious health problems.

Diseases that cause stomach pain:

• Gastritis is an acute or chronic inflammation of the gastric mucosa, the most common cause of pain. The disease is most often caused by the bacterium Helicobacter pylori. Exacerbation of pathology and severe pain in the stomach can be associated with improper eating behavior, nervous strain, and taking certain medications.
• Stomach and duodenal ulcers occur against the background of chronic gastritis, problems with blood supply to the gastric mucosa and some other diseases. The ulcer manifests itself as pain in the stomach during long breaks between meals and at night (hunger pain).
• Pancreatitis is inflammation of the pancreas. Pancreatic juice secreted by the gland neutralizes hydrochloric acid. If there is insufficient juice production, the acid irritates the gastric mucosa, causing pain.
• Crohn's disease is a chronic inflammatory process in all parts of the intestine.
• Cholecystitis is inflammation of the gallbladder. Disturbance in the process of bile outflow is one of the causes of inflammation of the gastric mucosa and pain.
• Damage to the gastric mucosa by the bacterium Helicobacter pylori and other types of pathogenic microflora. Gastritis and stomach ulcers often develop as a result of infectious diseases of the digestive system.
• Stomach tumors of any etiology. Severe pain is one of the symptoms of stomach cancer, but it can also be caused by benign formations - polyps, lipomas, neuromas and others.

Pain can also be caused by diseases not related to the stomach itself: acute appendicitis, colitis, spasm of the diaphragm, thrombosis of intestinal vessels, coronary heart disease and others (Fig. 3).

Figure 3. Causes of pain in the upper and lower abdomen. GERD is gastroesophageal reflux disease. Source: verywellhealth.com

Stomach pain in women

Women often experience stomach pain during pregnancy for various reasons.
Firstly, due to an increase in progesterone levels, the intestinal muscles relax, and the time it takes for food to pass through it increases, which leads to flatulence. Secondly, the uterus, increasing in size, puts pressure on the digestive organs, slowing down the process of food digestion. During pregnancy, stomach pain can also be associated with constipation, the causes of which are hormonal fluctuations, insufficient physical activity, nervous tension, and dietary habits.

Acute pain in the stomach in women can be a signal to immediately call an ambulance, as its cause can be an ectopic pregnancy, preeclampsia, miscarriage and placental abruption.

Bibliography:

1. Practical Manual of Gastroesophgeal Reflux Disease /Ed.by Marcelo F. Vela, Joel E. Richter and Jonh E. Pandolfino, 2013 –RC 815.7.M 368
2. Danilov D.V. Modern possibilities for the treatment of erosive esophagitis / Danilov D.V., Shuleshova A.G., Bondareva K.A. // Evidence. gastroenterology. - 2021. - T. 6; No. 1. – pp. 26-30.
3. Initial and maintenance therapy in patients with gastroesophageal reflux disease / Simanenkov V.I., Tikhonov S.V., Lishchuk N.B. // Med. alphabet. - 2021. - T. 1; No. 9 (306). — P. 8-12.
4. INSTRUCTIONS for the use of the medicinal product for medical use OMEZ®10 mg LP 00328 dated 07/11/17 Date of access 11/26/18
5. Kardasheva, S. S. Gastroesophageal reflux: new treatment prospects / Kardasheva S. S., Shulpekova Yu O., Leshchenko V. I. // Med. advice. - 2021. - No. 11. - P. 92-99.
6. Tarasova, G. N. Pathogenetic features of damage to the mucous membrane of the esophagus during gastroesophageal reflux disease / Tarasova G. N., Smirnova E. A. // Consilium Medicum. - 2017. - T. 19; No. 8-2. — P. 7-12.
7. Trukhan, D. I. Current aspects of antisecretory therapy of gastroesophageal reflux disease / Trukhan D. I., Grishechkina I. A. // Med. advice. - 2021. - No. 15. - P. 28-35.

Types of stomach pain

Stomach pain varies significantly in nature and intensity depending on the causes that caused it. An accurate description of the pain syndrome greatly facilitates the diagnosis of pathology. But it must be remembered that the same factor can cause pain of varying intensity and nature. Our test will help you understand the causes of your own pain.

Acute pain

Acute severe cramps in the stomach are a sign of the development of a pathological process.
The attacks usually pass quickly, but recur after a short period of time. The intensity of pain attacks depends on the degree of damage to organs and tissues. Acute pain requires immediate consultation with a doctor, as the causes that cause it can lead to a tragic outcome. This symptom is typical for:

• acute gastritis,
• poisoning with food, chemicals and toxic substances,
• infectious damage to internal organs,
• peptic ulcer,
• acute pancreatitis and cholecystitis,
• acute appendicitis.

Acute stomach pain is often accompanied by nausea and vomiting. In addition to stomach diseases, acute epigastric pain can be caused by pulmonary pathologies, diseases of the diaphragm, cardiovascular system, in particular myocardial infarction.

Self-medication for acute stomach pain is contraindicated; the diagnosis can only be made by a doctor after a full examination.

Strong

Severe pain occurs with acute gastritis, irritable bowel syndrome, poisoning, stomach and duodenal ulcers, and acute pancreatitis.

To correctly diagnose the causes of severe pain, the presence of accompanying symptoms is important. Nausea and vomiting are signs of acute gastritis, poisoning, biliary colic. Peptic ulcer disease is accompanied by heartburn and sour belching, irritable bowel syndrome - diarrhea and flatulence.

The intensity of pain is a rather subjective sensation, so a full examination is necessary for a correct diagnosis.

Sharp

Sharp pain may be a sign of aggressive chemicals entering the stomach, such as acids or alkalis. Spoiled food also causes burns to the gastric mucosa.

Such pain in the area above the navel is a symptom of acute appendicitis. In addition, sharp pain sometimes occurs with neoplasms in the stomach and pancreas, with complications of peptic ulcer disease, when adhesions develop in adjacent tissues.

cutting

A dull cutting pain is characteristic of acute pancreatitis. If the pain covers the entire abdomen, and severe pain is felt in the epigastric region, then with a high degree of probability it can be assumed that the ulcer has perforated. Any movement in this case causes increased pain, so the person takes the “fetal position”, bending his knees and pressing them to his chest.

Cramps in the stomach can be triggered by taking certain medications, for example, non-steroidal anti-inflammatory drugs and antipyretics.

Aching

Aching pain after eating is a sign of increased acidity of gastric juice. Such pain often occurs due to indigestion, poor diet, or eating too much food.

The cause of aching pain may be chronic gastritis, a stomach ulcer outside the period of exacerbation, infection or a malignant tumor. The stomach aches after alcohol abuse, overeating, or eating stale foods.

Pulling

Nagging pain often occurs in pregnant women due to pressure on the digestive organs by the increasing size of the uterus. Similar sensations are familiar to most nursing mothers. Such pain can also occur with gastritis and cholecystitis.

Constant pain

Constant pain is often present with advanced gastric cancer. Such complaints also arise with advanced gastritis, stomach ulcers and other inflammatory diseases. Constant pain in the stomach can be a consequence of prolonged stress, alcohol abuse, or poor diet.

Periodic pain

Periodic pain may not be associated with gastric pathologies and go away without medical intervention. Sometimes abdominal pain occurs after eating unusual food, with bloating or constipation.

Pain before eating

Pain after a long break from eating is characteristic of a duodenal ulcer. Also, if pain occurs on an empty stomach, one can assume the presence of an inflammatory process on the mucous membrane - gastritis or gastroduodenitis.

Nausea and pain

The combination of such symptoms is typical for food poisoning, taking large doses of alcohol, and consuming fatty foods. Nausea and stomach pain often bother women in the first trimester of pregnancy. A similar condition can occur due to stress and certain neurological disorders.

Night stomach pain

Most often at night, the stomach hurts due to irritation of the mucous membrane with hydrochloric acid and pepsin, an enzyme of gastric juice. Night pain can be a consequence of overeating during dinner, prolonged stress, excessive physical activity and inflammatory processes in the stomach.

Stomach pain due to coronavirus

Stomach pain is not a typical symptom of COVID-19, but in rare cases, problems in the digestive system begin when the virus enters the body through the oral-fecal route.

About 10% of those infected experience nausea, vomiting, diarrhea and stomach pain. In isolated cases, the disease occurs with symptoms similar to those of serous peritonitis. Stomach pain with coronavirus is typical for young patients.

Surveys

An effective examination of a patient who is bothered by abdominal pain consists of an interview, palpation of the abdomen, and laboratory and functional diagnostics.

For a doctor to make a diagnosis, the smallest details are important. For example, even a basic assessment of stool can clarify a lot in the case of abdominal pain.

• Hard lumps (“sheep” feces) are a frequent companion to colitis, elongation of the sigmoid colon, and gastric ulcers.
• Watery stools often accompany poisoning and infectious diseases.
• With a parasitic disease (presence of worms in the intestines), dysbacteriosis, stool particles are usually very loose.

Also, to select a tool and diagnostic technology, an oral interview with the patient is important. The doctor asks the patient how long the pain lasts, whether there are attacks, what exactly causes the pain - physical movements, going to the toilet, eating, taking a certain position.

When to see a doctor?

Any pain in the stomach requires consultation with a gastroenterologist, but in some cases it is necessary to immediately call an ambulance (Fig. 4). You should immediately consult a doctor if you have the following symptoms:

• severe pain after injury;
• heat;
• bloody stools;
• constant nausea and vomiting;
• sudden weight loss;
• yellow skin;
• pain when touching the stomach.

Figure 4. When stomach pain is a medical emergency.
Source: MedPortal Important! Stomach cancer often, although not always, is accompanied by specific symptoms:

• Rectal bleeding, traces of blood in the stool,
• Persistent lack of appetite,
• Unexplained weight loss
• Fatigue,
• Heat,
• Anemia.

Diagnostics

Diagnosis is aimed at finding out the causes of stomach pain and identifying the underlying disease.

First of all, the gastroenterologist collects anamnesis, finding out:

• localization of pain - the entire abdomen or limited to a certain area;
• the nature of the pain - stabbing, cutting, constant, periodic, etc.;
• when the pain appears: in the morning or evening, before or after meals, duration of the attack, connection with alcohol or certain foods;
• does the pain radiate to other organs;
• what medications are taken;
• is there any pregnancy;
• whether there were abdominal injuries.

Depending on the medical history, instrumental and laboratory research methods are prescribed:

• Ultrasound of the abdominal organs;
• endoscopy of the stomach;
• radiography;
• pH-metry;
• stool analysis.

How to treat

Therapy for stomach pain is aimed at treating the underlying disease.

Conservative treatment includes relief of symptoms, pain relief and removal of toxins.

Surgical treatment is prescribed if there is no effect from taking medications and if malignant tumors are detected.

First aid for stomach pain

If you have stomach pain, it is better to stop eating for a while and lie down quietly.
You should not immediately take painkillers, as they can irritate the mucous membranes and aggravate the condition. If you have stomach pain:

• replace food with warm drinks and low-fat broth;
• you need to lie down, pressing your knees to your stomach as much as possible;
• place a cold towel on your stomach;
• massage your stomach in a circular motion;
• in case of poisoning, take activated carbon or other absorbents;
• drink as much plain, clean water as possible.

Seek medical help as soon as possible.

Drugs

The choice of medications is determined by the cause of stomach pain. The doctor may prescribe:

• antisecretory agents that reduce acidity;
• antacids that neutralize the stomach environment;
• antispasmodics to relieve pain;
• prokinetics to stimulate intestinal motility;
• gastroprotectors to protect the gastric mucosa from aggressive influences.

Only a doctor can select a treatment regimen based on the results of the examination.

Diet

Any pain in the stomach requires a gentle diet. There is no need to force yourself to eat if you have no appetite.

You should eat regularly, avoid spicy, smoked and fried foods, do not eat too hot food, and be sure to have breakfast. The best foods for stomach pain are bananas, rice, applesauce, and toast (Figure 5).

Figure 5. Diet rules for stomach pain. Source: MedPortal

Folk remedies

For stomach pain, decoctions and infusions of berries and vegetables help well:

• gooseberry infusion (pour a few glasses of water over the berries and boil for 15 minutes, drink every 2 hours),
• potato juice (three times a day before meals),
• rowan infusion (one tablespoon before meals),
• white cabbage juice, cucumber, pomegranate, quince juice (drink before meals),
• decoction of crushed oats,
• rye bran infusion,
• dandelion syrup,
• infusion of dill seeds,
• white mistletoe decoction.

Pharmacies offer a wide range of herbal teas to normalize stomach function, but before using any herbal remedy, you should consult your doctor.

Sodium channel blockers

These drugs block intracellular calcium stores through a cascade of reactions. The most famous drug is a derivative of veratric acid - mebeverine. Unlike anticholinergics, it does not cause hypotension of the colon. Most often, this drug is prescribed for functional disorders of the gastrointestinal tract or as an adjuvant for organic diseases of the gastrointestinal tract. Mebeverine is used only for course treatment. Mebeverine is most effective in combination with other pathogenetic drugs. Mebeverine is mainly available by prescription, but there is a dosage form in tablets that does not require a doctor's prescription.

We will not dwell on calcium channel blockers in more detail, since these drugs do not have any over-the-counter forms.

The over-the-counter myotropic antispasmodic trimebutine stands apart. Trimebutine acts on the enkephalinergic system of the intestine and peripheral opiate receptors - µ, κ and δ. Having an affinity for receptors that enhance and suppress peristalsis, it stimulates the contraction of intestinal smooth muscles in hypokinetic conditions and is an antispasmodic in hyperkinetic conditions. Trimebutine reduces the tone of the esophageal sphincter, promotes gastric emptying and increased intestinal motility, as well as the response of the smooth muscles of the colon to food irritants. It is used for various functional disorders of the gastrointestinal tract.