Abdominal Pain Localization

Anamnese & Untersuchung – Schmerzlokalisation

• The image presents a diagram illustrating the likely locations of pain associated with various medical conditions in the abdominal area.

Right Upper Quadrant

• Gallstone ileus (Gallenkolik) can manifest with pain in this area.
• Cholecystitis, or inflammation of the gallbladder, is a potential cause of discomfort.
• Choledocholithiasis, involving gallstones in the common bile duct, may lead to right upper quadrant pain.
• Cholangitis, an infection of the bile duct, presents a risk.
• Peptic ulcers can sometimes cause referred pain to this region.
• Hepatitis, commonly known as liver inflammation.
• Liver tumors (Neoplasma der Leber) and liver abscesses can both induce pain.
• Pneumonia or lung infection.
• Pneumothorax or collapsed lung.
• Subphrenic abscess, or collection of pus beneath the diaphragm.
• Pyelonephritis is a kidney infection.
• Nephrolithiasis is kidney stones.
• Colitis or colon inflammation, and finally, Herpes Zoster, or shingles.

Epigastric Region

• Peptic ulcers may result in pain in the epigastric region.
• Duodenitis, is inflammation of the duodenum.
• Pancreatitis an inflamed pancreas.
• Gastroenteritis, is inflammation of the gastrointestinal tract.
• Mesenteric adenitis, is inflamed mesenteric lymph nodes.
• Inflammatory bowel disease (entzündliche Darmerkrankung).
• Mesenteric occlusion, or blockage of blood flow to the mesentery.

Left Upper Quadrant

• Peptic Ulcer
• Splenic infarction
• Splenic rupture
• Pancreatitis
• Pancreatic neoplasm
• Pneumonia
• Pulmonary embolism
• Pneumothorax
• Subphrenic abscess
• Pyelonephritis
• Nephrolithiasis
• Colitis
• Myocardial ischemia
• Herpes zoster

Right Lower Quadrant

• Appendicitis is inflammation of the appendix.
• Inflammatory bowel disease is a chronic inflammation of the digestive tract.
• Ovarian tumor
• Tubo-ovarian abscess: Abscess involving the fallopian tube and ovary.
• Twisted ovarian cyst (stielgedrehte Ovarialzyste).
• Ovarian torsion.
• Salpingitis is inflammation of the fallopian tubes.
• Ectopic pregnancy a pregnancy outside womb.
• Hernia is a bulge protruding through muscle.
• Pyelonephritis
• Nephrolithiasis

Periumbilical Region

• Early stages of Appendicitis
• Small bowel obstruction.
• Gastroenteritis.
• Ruptured abdominal aortic aneurysm (BAA-Ruptur).
• Dissection of the abdominal aorta.
• Mesenteric ischemia is insufficient blood flow to the small intestine.
• Hernia.

Left Lower Quadrant

• Sigmoid diverticulitis is inflammation of the diverticula in the sigmoid colon.
• Inflammatory bowel disease is a chronic inflammation of the digestive tract.
• Ovarian tumor
• Tubo-ovarian abscess: Abscess involving the fallopian tube and ovary.
• Twisted ovarian cyst (stielgedrehte Ovarialzyste).
• Ovarian torsion
• Salpingitis is inflammation of the fallopian tubes.
• Ectopic pregnancy is a pregnancy outside womb.
• Hernia

Referred Pain Localization

• Diaphragm pain (C4 dermatome).
• Gallbladder pain refers to the upper right abdominal area.
• Heart pain refers to the chest and left arm (Th3 + 4 dermatomes).
• Esophageal discomfort refers to the mid-chest area (Th4 + 5 dermatomes).
• Stomach pain around the upper abdomen (Th8 dermatome).
• Liver and gallbladder pain can be felt in the right upper quadrant (Th8-11 dermatomes).
• Small intestine discomfort circles around the umbilicus (Th10 dermatomes).
• Large intestine pain is around the lower abdomen (Th11-L1 dermatomes).
• Urinary bladder pain may be located in the suprapubic region (Th11-L1 dermatomes).
• Kidney and testicle discomfort is generally located around the flank and groin (Th10-11 dermatomes).

Appendicitis

• Rovsing's sign: Pain in the right lower quadrant upon palpation of the left lower quadrant
• McBurney's point: Tenderness located one-third of the distance from the anterior superior iliac spine to the umbilicus
• Blumberg sign: Rebound tenderness (pain upon release of pressure) in the right lower quadrant.
• Lanz point: Point located on the line between the anterior superior iliac spines
• Spina iliaca is a bony projection of the ilium
• Nabel refers to the umbilicus

Appendicitis

• Bacterial infection: Originates in the intestines and spreads to the appendix.
• Blockage: Occurs from foreign objects (like cherry pits) or hardened stool (especially with constipation) obstructing the appendiceal lumen.
• Symptoms: Intensifying abdominal pain starts near the navel or upper abdomen, shifting later to the lower right abdomen.
• Characterized by a throbbing or drilling sensation.
• Fever
• Nausea and vomiting
• Cold sweats

Ileus = "Darmverschluss" (Intestinal obstruction)

• Mechanical: Indicates physical blockage of the intestinal lumen.
• Paralytic: Loss of peristalsis.
• Mechanical: Obstruction caused by hindrance of the normal passage in the intestine - build up of hardened stool, scar tissue, or foreign objects.
• Compression or twisting of the intestines, tumors, scar tissue, and hernias.
• Symptoms: Constipation, bloated abdomen, colicky abdominal pain, nausea or vomiting
• Paralytic: Reduced bowel movement, severe abdominal inflammation, mesenteric artery infarction, hypokalemia, medications, metabolic disorders, and nerve disorders
• Symptoms: Nausea or vomiting, distended abdomen, and absence of bowel sounds.
• Common sites for obstruction are the distal small intestine (2/3) and the colon (1/3).
• Pain description: Colicky, with wave-like cramping.

Morbus Crohn (Crohn's Disease)

• Risk markers: Hereditary, smoking, imbalance in flora, environmental influence, existing inflammation, mucosal damage.
• Symptoms: Abdominal pain, diarrhea, fever, anemia, loss of appetite, weight loss, fatigue
• Pain described as dull, cramping, or colicky
• Pain linked with food intake or bowel movements
• The most common location is the lower right abdomen

Gastroenteritis

• Pathophysiology: Varies depending on the organism, includes, bacterial, viral, stress, or deslaminases
• Distinct age groups affected
• Symptoms include: Upper abdominal pain, nausea, vomiting, diarrhea, lack of appetite, and bloating.
• Localized to the epigastric (upper middle) area.
• Pain is cramping, dull/pressing, or colicky.

Refluxösophagitis (acid reflux)

• Causes: Stress, fatty foods, coffee, alcohol, smoking, increased abdominal pressure, and a weakened sphincter.
• Symptoms: heartburn, acid reflux, difficulty swallowing, hoarseness, chronic cough.
• Pain behind the breastbone or in the upper abdomen or back.
• Burning sensation, pressure
• Symptoms worsen after eating or lying down

Mesenteric Infarction

• Development: Ischemia caused by arterial thrombosis or embolism
• Risk factors: AFib, endocarditis, birth control, heart issues
• Symptoms: Abdominal pain, diarrhea, peritonitis
• Difficult to locate
• Pain described as diffuse and colicky or crampy

Diverticulitis

• Development: Inflammation of the diverticula caused by genetic factors that cause weakening of the colon wall.
• Risk Factors: Advanced age, low-fiber diet, genetic problems or motility disorders
• Presents as left side problems can show up on the right size
• Divertikel are usually with the colon sigmoudeum
• Pain is acute and increases with movement