Abdominal Pain – Where Does it Hurt?

Understanding the type of pain you are having, where it is originating from and the severity of it, could help you get the correct treatment before symptoms worsen.

Abdominal pain can be indicative of many ailments, ranging from gas and constipation to gallstones or pancreatitis and can have a wide range of causes. To help you identify the cause of your pain, and perhaps consider consulting one of our surgeons for a more in-depth assessment we have divided the abdomen in five separate areas and included the most common surgical ailments for each:

Central Abdominal Area

Most tummy pains start off with a vague pain around the belly button. This is due to the shared pain sensors found in the lining of the gut. If the pain localizes to a specific region over the tummy, this can indicate more advanced inflammation which, then involves the inner lining of the abdominal wall. This type of ‘localization’ of the pain is typically experienced with appendicitis.

In general, organs found in this area include:

• Part of the stomach, Liver, Pancreas, Duodenum (first part of the small intestine), Spleen, Adrenal Glands
  Umbilicus (belly button), small intestine and large intestine.
• Conditions that can cause central abdominal pain include:

Gastroenteritis, this may then be associated with diarrhoea or vomiting and the pain is mostly cramp-like.

Appendicitis, peptic ulcer disease, pancreatitis, constipation, irritable bowel syndrome, inflammatory bowel diseases.

When to seek medical attention:

It is important to note the duration and severity. If abdominal pain is very severe and starts suddenly it usually indicates an acute inflammatory insult and medical assessment is warranted in most cases.

It is also important to consider full and proper assessment of your abdominal pain if it is recurrent and chronic especially if it is associated with unintentional weight loss, vomiting and change in bowel habits such as recent onset constipation or diarrhoea, or alternating diarrhoea and constipation.

Right Upper Abdominal Area

In general, organs found in this area include:

The liver, gallbladder, duodenum, upper portion of the pancreas and the right side of the large intestine.

Pain in the right upper quadrant may indicate hepatitis (inflammation in the liver), gallstone disease or cholecystitis (inflammation in the gallbladder) or peptic ulcer disease.

Cholecystitis

Cholecystitis occurs if a gallstone finds its way into a bile duct preventing bile from flowing out and causing your gallbladder to become inflamed. Symptoms of Cholecystitis include:

• Nausea and vomiting,
• Belly pain (may worsen when taking deep breaths),
• Pain that spreads to the back or right shoulder blade

Note: Bacteria in the bile can also cause Cholecystitis.

The treatment for cholecystitis or symptomatic gallstones is explained in the following link: https://generalsurgery.co.za/procedures/laparoscopic-cholecystectomy-gall-stones/

Hepatitis

Regardless of the cause, inflammation of the liver is referred to as hepatitis. Most instances of hepatitis are viral, but the disease may also be caused by drugs or alcohol. The most common types of viral hepatitis include:

• Hepatitis A – This virus causes an acute inflammation and will usually heal on its own. It’s easily spread in food and water, and often infects many people at once.
• Hepatitis B – This virus can be both acute (short-term illness) and chronic (ongoing illness), and is spread through blood or other bodily fluids in various ways from an infected individual.
• Hepatitis C – The Hepatitis C Virus (HCV) is almost always chronic and mostly spreads by contaminated blood.

Hepatitis A and B can be prevented by vaccination, but not hepatitis C. However, certain strains of Hepatitis C may be cured by a regimen of direct-acting antiviral medication.

Hepatitis can be diagnosed on blood tests and clinical evaluation and is treated with appropriate medication based on the cause.

Peptic Ulcer

A hole in the lining of the digestive tract is called a peptic ulcer. Peptic ulcers are created by erosion of the stomach lining by acid, which may be linked to any of the following:

• Helicobacter pylori (H. pylori) infection, an infection which weakens the protective barrier of the stomach lining and exposes it to stomach acids.
• Excessive use of NSAIDs (non-steroidal anti-inflammatory drugs) like aspirin (Disprin), ibuprofen (Brufen), and other anti-inflammatory drugs.
• Smoking and drinking

Peptic ulcers are very common and are readily treatable with simple medication and lifestyle modification provided the problem is managed expediently. If we suspect peptic ulcer disease as the cause for your pain, you will mostly require a gastroscopy. Please follow the link below for more information on this procedure: https://generalsurgery.co.za/procedures/gastroscopy/

Right Lower Abdominal Area

Organs found in the right lower quadrant include the appendix, the first portion of the colon or large intestine, and the right ovary and the Fallopian tube in women.

The right lower quadrant may be assessed when diagnosing appendicitis, in which case, this quadrant would be tender and painful. 

Appendicitis

Appendicitis is a condition in which the appendix becomes inflamed and filled with pus, causing pain. If left untreated, appendicitis may cause your appendix to rupture and cause infection, which can be serious and even fatal.

Appendicitis is readily manageable by a relatively simple operation as described below: https://generalsurgery.co.za/procedures/appendisectomy-laparoscopic-open/

Left Upper Area

Organs in the left upper area include the stomach, spleen, left portion of the liver, main body of the pancreas, the left kidney, adrenal glands,  and left side of the large intestine.

Conditions that can cause pain over this area include:

Constipation, inflammatory diseases of the small and large intestine, peptic ulcer disease, disorders of the spleen, kidney infections or kidney stones.

Left Lower Abdominal Area

Organs found in this area include the lower portion of the large intestine and the left ovary and Fallopian tube in women.

Pain in this quadrant may indicate colitis, diverticulitis, or kidney stones. Ovarian cysts (in women) or pelvic inflammation may also be at the root of pain in this area. 

Diverticulitis

Diverticula are small, bulging pouches that can form in the lining of your large intestine. Sometimes one or more of these pouches can become inflamed or infected. This condition is known as diverticulitis.

Ureteral Colic

This is most commonly caused by obstruction of the urinary tract by kidney stones.

Colitis

Colitis, simply put, is inflammation of the colon or inflammatory bowel disease (IBD). The three most common forms of colitis are: Ulcerative colitis, Crohn’s disease, and infective colitis.

Ulcerative Colitis

This is a chronic IBD that causes sores (ulcers) in the lining of your colon, as well as inflammation.

Crohn’s Disease

This is a chronic inflammatory bowel disease that affects the lining of the digestive tract. Inflammation can appear anywhere in the digestive tract, from the mouth to the anus, and it generally affects all the layers of the bowel wall, not just the inner lining.

Diff. Colitis

This is inflammation of the colon caused by the bacteria Clostridium difficile which can occur after treatment with antibiotics.

Colon Cancer

Colon cancer can present with abdominal pain. It is important to note that if your pain is associated with weight loss and change in bowel habits, such as recent onset constipation or diarrhoea, or constipation alternating with diarrhoea, that you should be investigated properly to exclude colon cancer. 

Most patients with suspicious symptoms and those above the age of fifty should have a colonoscopy to assess the inner lining of the colon. Please click on the attached link for information on this investigation: https://generalsurgery.co.za/procedures/colonoscopy/

If colon cancer is found during a colonoscopy or other means of investigation then a colon resection will be indicated in most instances, please click on the attached link for more information on this procedure: https://generalsurgery.co.za/procedures/colectomy/

The above list is by no means exhaustive and should be used only as guide. The exact origin of abdominal pain can be tricky to pinpoint at times. The pain may also move around. Furthermore, some organs are not fixed in the abdomen, such as the small intestine or large intestine.

If you experience severe symptoms and need assistance or a review of your symptoms and pain, please contact our rooms to schedule an appointment.

Dr Jeske at Unitas specializes in the treatment of abdominal pain, especially of the liver, pancreas, bile duct & gall bladder and Dr Basson at Midstream specializes in hernias and small bowel as well as colorectal surgery.

We look forward to helping you along your journey to sustained health.