Abdominal pain (right, left, high, low)

The stomach is not a single organ, like a bone or heart. It is a large container filled with a lot of different tissues and structures. They are all perfect - until they begin to get sick.

Before we go any further, remember: a sudden, sharp, unfamiliar abdominal pain is a red alarm for immediate medical attention. I do not make you panic at every spasm, when your gases go off, or every time diarrhea and stomach aches. But something sharp enough to make you bend in half and feel a lack of breathing, which lasts 30 minutes or more, is "something" that can cause immediate surgical intervention. You can fantasize about the diagnosis as much as you like, but only on the way to the hospital. Many abdominal organs are hollow (stomach, intestine, gallbladder). If one of them is leaking, clogged or bursting, your life is in danger. Perforation should be protected, the blockage eliminated quickly .

To distinguish one cause of abdominal pain from another, you should know what is located and where in the abdominal cavity. You will never recognize the symptoms of ovarian disease unless you know that a woman has two ovaries and that they do not lie near the liver.

To better understand the information on the following pages, mentally draw two imaginary lines through your navel: one vertical, from the base of the chest to the pubis, the second horizontal, from one side to the other. Your abdomen is now divided into four segments, or quadrant, - the right upper, upper left, lower right and lower left. The localization of any symptom can now be tied to one of the four quadrants.

Pain in the upper right quadrant.

The right upper quadrant of your abdomen contains organs that are almost familiar to everyone - at least by name: liver, gallbladder, part of the intestine (each part of the stomach includes part of the intestine), the pancreas and the right part of the diaphragm (the muscle that separates the lungs from the abdominal Cavities and moves up and down when breathing). The disease or injury of these organs will give you pain in the upper abdomen. How strong it is and what kind of pain it will be will depend on what happens and where.

Is that liver?

All that causes the swelling of the liver makes her sick. Infection, a chemical agent or heart failure usually lead to this.

Here are the most common diseases.

Some parasites can infect the liver. Whatever is the cause of inflammation or infection, the result is called hepatitis (hepatitis means liver, it is inflammation). Infectious agents that most often attack the liver are viruses (viral hepatitis).

There are three main types of hepatitis:

• hepatitis A,
• Hepatitis B,
• Hepatitis C.

People usually fall ill with hepatitis A after they swallow food or water contaminated with sewage sludge (the first aggressors are the shellfish). Hepatitis B is especially common among homosexuals, drug addicts and those who were in close contact with them. Hepatitis C is almost always transmitted through transfusion of contaminated blood, medical needles and products containing blood.

Various chemical agents and medications can also damage the liver because they are toxic to it (toxic hepatitis ), or because a person has had hypersensitivity to them. A long list of appropriate drugs includes everything from antibiotics to tablets that reduce blood pressure. The same can make a widespread cleanser - carbon tetrachloride and acetaminophen (Tylenol). However, the most dangerous poison for the liver is alcohol (causing alcoholic hepatitis ).

A weak heart muscle poorly pumps the venous blood that comes into the heart. Part of it stagnates in the lungs (which gives you a lack of breathing), and later in the liver, stretching it and causing pain.

Liver pain is constant, aching, not sharp or daggerous. You feel it in the entire right upper abdomen - deep inside, not on the surface. Discomfort develops constantly and persistently, and not spasms or waves. If you feel this way, ask yourself questions:

• Have you eaten shellfish in the last few weeks? (hepatitis A);
• Did you use an infected needle with someone? (Hepatitis B);
• Have you drunk too much? (Alcoholic hepatitis);
• Have not you recently been given blood? (Hepatitis C);
• You do not have enough breath and sweat your ankles? (Signs of heart failure);
• Have not you turned yellow, and your urine has got the color of strong brewed tea? (An indicator of any form of hepatitis).

Is it a gallbladder?

Bile, formed in the liver, helps digest food. If you were hungry or were on a diet low in fat, the intestine does not need all the bile that is constantly formed in the liver. Excess of it is stored in the gallbladder. If you ate fatty and need more bile to digest fats, the gallbladder injects its contents into the intestine.

Infection, poor liver function, or gallstones are very often responsible for pain in the right upper abdomen (and sometimes also along the midline). Although these diseases affect both men and women, young and old, white and black, the Navajo Indians are at high risk (up to 70% of them have gallstones) and women with so-called "four F" are fat ; Which are over forty; Who have children and who suffer from gas.

And also women taking birth control pills.

Symptoms of gallbladder disease can sneak up to you gradually. A violent attack is often preceded by weeks, months and even years when you feel gas and bloated after an hour or two after eating fried or fatty or some vegetables (cabbage). However, you can seriously worry for the first time only with an attack. When this happens, the pain is acute, in contrast to aching liver pain. When it reaches the maximum, sweat and nausea appear, which even vomiting does not make it easier. High temperature is unlikely, unless the gallbladder is inflamed; In this case, she can jump to forty, and you will have a chill. The pain itself is strongest in the right upper quadrant, but it can also spread to the back, under the right scapula.

Most of the "bad" gallblades have stones. If the stones are small, then one or two can exit the bladder into the ducts that carry the bile into the intestines. Then you will have biliary colic , the pain that starts quickly and comes in waves, as the ducts try to squeeze out the stone that clogged them. When they succeed, you feel better. But if the stone remains in the duct, it must be removed therefrom in one way or another - by operation, dissolution or extraction without surgery. The obstructed bile ducts cause jaundice, which disappears if the stone enters the intestine.

Pancreas

Further, in the abdomen there is a pancreas (pancreas), a glandular organ, located deep in the abdominal cavity, which secretes digestive juices and insulin. It is extended from right to left; Its "head" lies in the upper right quadrant, the "body" crosses the middle line, and the "tail" is located in the left upper quadrant. Although the pancreas rarely gives pain compared to the liver and gallbladder, it can do so. Many fear, and reasonably enough, of pancreatic cancer. The most common cause of pancreatic pain, however, is inflammation ( pancreatitis ), to which alcoholics and people with gallbladder diseases are particularly prone.

The attack of acute pancreatitis can be extremely painful and is accompanied by sweating, nausea and vomiting. The symptoms differ from the symptoms in the pathology of the gallbladder in that pain penetrates directly into the back, you are worse lying down, and it is easier to sit with the inclination forward. The diagnosis usually requires confirmation by laboratory tests to determine the content of certain enzymes released by the damaged gland.

What else could there be?

The bowel turns and twists through the entire abdominal cavity. If part of it, which lies in the upper right quadrant, is inflamed as a result of diverticulitis or some form of colitis , you will feel pain. It's not too common, but it happens. The pain is usually not sharp, not sudden, more like a spasm. It lasts a few minutes and passes for about half an hour, and then the cycle repeats. Thus at you diarrhea, a constipation or both is possible or probable together.

Pneumonia in the abdomen?

In medical practice, you can often see patients who, after several days of cough and temperature as a result of cooling, suddenly develop pain in the right upper quadrant. "Cold" is pneumonia. Inflamed and infected lungs come into contact with the diaphragm, which in turn is irritated and involves the adjacent part of the intestines, which causes symptoms. Remember, therefore, that any abdominal pain that preceded the airway disease can in fact be a consequence of infection in the lungs .

Always think of shingles when you feel unexplained pain anywhere . Lishay develops as a result of inflammation of the nerves under the influence of the varicella-zoster virus. After the initial infection in childhood, this virus remains dormant in the nervous system for decades. Then he again becomes active - under stress or because the immune system that holds him back becomes weaker with age. A released virus inflames nerves anywhere in the body, causing painful pain in the affected area. The first symptoms are superficial sensation, burning sensation or itching, which later turn into severe pain. 4 or 5 days at you simply strongly hurts in any certain place. The skin seems perfectly normal, without a rash or other signaling symptoms. Except for the pain, you generally feel healthy. But if the pain is in the upper right quadrant of the abdomen, your doctor can go on the wrong path, thinking about gallbladder disease, pancreatitis or even kidney stones. He assigns analysis after analysis and finds nothing. After a few days, the characteristic reddish pimples appear exactly where they ached. The rash follows the course of the inflamed nerve, never crosses the median line and does not pass to the other side of the body. This "one-sided" rash puts you an accurate diagnosis - shingles.

Is it the kidneys?

Renal pathology can sometimes cause pain in the upper right quadrant. The kidneys are located on each side, one on each side of your body, so that kidney diseases usually cause pain in the corresponding side and back, rather than in front. However, if the right kidney becomes infected , it creates an abscess, an abscess, or there are stones , or it is affected by a blood clot , the resulting pain can be felt in the upper right quadrant of the abdomen, as well as in the back. If the problem is associated with a small stone that emerges from the kidneys, the pain finds waves, is painful and often gives in the groin and the right testis, the testicle. (You will learn more about this later when discussing pain in the side and in the testicles.)

Pain in the left upper quadrant.

The left upper quadrant of the abdomen contains its own organs, and you need to know them to recognize the symptoms: here lie the spleen, stomach, pancreas (remember, it crosses the upper half of the abdomen), the intestinal loops (as everywhere in the abdomen) and the left part of the diaphragm . There is no liver and gallbladder, so in general the pain in the left upper quadrant is less frequent than the pain in the upper right quadrant. But they do happen anyway.

Is it the spleen?

The spleen lies very close to the surface of the body, while the pancreas is located deep in the abdomen, practically on the spine. When a doctor examines your spleen, it does not press very strongly or deeply, because it is close. The main work of the spleen is to remove the red blood cells from the blood after their normal life for 120 days. It seizes them, destroys them, and then their components pass into the bone marrow, where new red blood balls are formed. When the spleen increases in size - this happens with a number of different diseases - the capsule, its wrap, stretches, and it causes pain. Similarly, when the spleen is soft and enlarged, for example in infectious mononucleosis , it is prone to ruptures precisely because it is located so close to the surface. This is why people with infectious mononucleosis should avoid active sports; In fact, it is better for them not to do anything like that at all (even in the unlikely event that they like doing sports). Any careless movement, stroke or shock can break the enlarged spleen - the second reason why your doctor does not squeeze you too much when examining it. Sometimes the enlarged spleen is broken by itself. Signal signs of rupture of the spleen , in addition to pain and sensitivity in the relevant area, is the cyanosis of the skin around the navel. This "television" shade is a consequence of the accumulation of blood (which, by the way, is blue before it comes into contact with air) in this area.

Is it the intestine?

Quite possible. The large intestine crosses the upper abdomen, bends downward in the upper left quadrant, and then descends along the left side of the abdominal cavity. Unlike other parts of the abdomen, the pain in the left upper quadrant often does not indicate any disease and can be associated with the accumulation of gases in the intestine , where it sharply turns down. However, if you have diverticulitis or any other inflammatory disease of this part of the intestine (just as it can happen on the right side), you will feel pain in it. Your symptoms will also include diarrhea and / or constipation, blood and / or mucus in your bowel movements and a low temperature.

Here's the main rule: whenever you feel discomfort in any place of the abdomen , take a look at your bowel movements. The presence of bright red blood will indicate bleeding in the lower part of the large intestine - say, from hemorrhoids; Black stools will reflect bleeding higher in the stomach or small intestine. Also remember: if your feces are black, do not panic. This may be due to the presence of iron and charcoal in your food. Pepto-bismol is able to give the same effect. But in any case, always check your feces for the presence of blood.

Is this the stomach?

It's very possible. Unlike the heart, the stomach is not exactly in the middle of your body. It is located in the upper left quadrant of the abdomen. Anything that irritates the gastric mucosa, gastritis or functional dyspepsia (whether alcohol is an irritant, bad food or a daily intake of aspirin) will cause pain. It is usually not too harsh, often aching and is often accompanied by nausea and vomiting. Antacid preparations will be of great help. If the pain keeps for more than a day, show your doctor; You may have an ulcer or even, perhaps, cancer . Much more likely, however, that this is a simple gastritis .

Is it a hernia?

In the diaphragm, which separates the thoracic cavity from the abdominal cavity, there is an opening through which the esophagus passes on its way to the stomach. When the muscles that control the size of this hole weaken, usually in the elderly, the opening increases, allowing the upper stomach to exit the abdominal cavity (where it belongs) into the chest cavity (where it should not be). This condition is called diaphragmatic hernia . Because of the acidic gastric contents, you feel pain in the left upper quadrant, but sometimes also in the chest. This, of course, causes concern about the heart, but there is the following difference between the symptoms: the discomfort from the hernia of the diaphragm almost always increases when flexed or flattened flat, while heart pain does not usually react to it. But since this difference is not always clearly expressed, be surveyed in every case of chest pain, regardless of your assumptions.

Is it the pancreas?

Definitely. Remember that the gland is stretched through the upper abdomen. When it becomes inflamed, you will feel pain on the right, in the middle and on the left side of the abdomen.

Various diseases and toxins can affect the pancreas, including cancer (for which smokers are more vulnerable), alcohol, prolonged use of diuretics or steroids (the latter are mainly prescribed for arthritis, asthma, cancer, organ transplants and certain chronic diseases), inflammation caused by The flow of bile from the ducts of the gallbladder and the passage of stones through these ducts. You should suspect the pancreas if the pain is very sharp, comes from within and is accompanied by fever, nausea and vomiting and if you belong to a group at increased risk for pancreatic disease, i.e. You have a disorder with the gallbladder, you smoke a lot, drink, suffer from diabetes, take a diuretic or steroid hormones.

What else can be?

Viral pleurisy , pneumonia or any process that irritates the lungs causes acute, acicular pain when you take a deep breath. If the irritation seizes the diaphragm, it seems to you that the pain arises in the abdomen. Think about it, if after any infection of the respiratory system you have an unexplained abdominal pain. If you hit the rib on either side, you grabbed too much at the baseball in the Sunday game or because you are a woman and you have menopause and your bones have become brittle due to osteoporosis and break easily (sometimes you just have to cough or move slightly) You will have pain that seems to arise in the abdomen. It is not difficult to decipher these symptoms. The rib pain intensifies when you cough, sneeze, move or press down to the place where it hurts. Duodenal ulcers also often give pain in the left upper quadrant.

Pain in the right lower quadrant.

Again, start with what is located in this part of the abdomen. First of all, there is an appendix, small, with a finger, a piece of tissue that departs from the large intestine. Then the intestine itself, which can be affected by various diseases, including cancer . But we have here a whole set of new organs: the ovaries and fallopian tubes in women, the ureters that divert urine from the kidneys into the bladder, both sexes.

This appendix?

Remember the good rule: any pain in the right lower abdomen is appendicitis , until it is proved that it is not. If you can specify the place of pain with one finger and it lasts 12 hours without easing, you almost certainly have appendicitis. This is especially true if the pain is also near the navel. In case you suspect that your appendix is ​​inflamed, consult a doctor immediately. When confirming the diagnosis, the doctor will almost certainly advise the operation before this organ with an unknown function is suppurated and burst.

The appendix is ​​not the only possible candidate for a source of pain. The cause of the pain may be irritation, inflammation or infection of the intestine ( ulcerative colitis, ileitis , Crohn's disease or diarrhea caused by parasites such as amoebae or worms), shingles and squeezing nerves that leave the spine and terminate in this area. The kidney stone on its way down into the bladder will also cause painful pain in this quadrant.

If a woman does not undergo another menstrual period and she suddenly feels severe pain in the left or right lower abdomen, first think - and quickly - about the break with an ectopic pregnancy . Ectopic pregnancy happens when a fertilized egg remains in the fallopian tube, rather than descending into the uterus. Such an egg will never turn into a child, because it eventually bursts, pouring its contents into the abdominal cavity and irritating it. The result is a strong, diffuse abdominal pain. On the other hand, when the pain develops gradually and is held for days, weeks, and sometimes months, it is more likely that it reflects an infection anywhere in the pelvic cavity - an inflammatory pelvic disease - due to a sexually transmitted disease such as gonorrhea or chlamydia . Ovarian cysts , especially with their ruptures, and ovarian tumors can cause similar chronic pain. Pain, which increases during menstruation, suggests an endometriosis .

Pain in the left lower quadrant.

Pain in this area can be the result of all conditions that cause pain in the right lower area, with the exception of appendicitis.

Among us there are millions of people with a disorder that exists under various names: "nervous stomach", "spastic colon", "irritable bowel syndrome". No matter how you call it, the symptoms are the same - spasms, diarrhea or constipation, a build-up of gases and bloating in the lower abdomen. Such people run from doctor to doctor, desperately asking for help. It is impossible to explain what exactly irritated the intestines, although often the disorder seems to be related to stress. These persons - and their doctors - should, of course, be 100% sure that it's not a tumor of the intestine , diverticulitis, inflammatory bowel disease or intolerance to dairy products . In addition, sometimes painful phenomena can be removed by drugs or by removing any emotional factors that can worsen the condition.

Symptom: stomach aches