ROJoson PEP TALK: Abdominal Pain - An Overview

Empowerment
objective - for
laypeople to have an
understanding of
the FUNDAMENTALS
and GENERALITIES in
the MEDICAL
MANAGEMENT of
ABDOMINAL PAIN.
Health Disorder
Course–
Fundamentals
and
Generalities in
Medical
Management
of
ABDOMINAL
PAIN
[OVERVIEW]
March 26, 2022
1400H - 1500H
Via Zoom

Empowerment
objective - for
understanding of
the FUNDAMENTALS
and GENERALITIES in
the MEDICAL
MANAGEMENT of
ABDOMINAL PAIN.
Health Disorder
Course–
Fundamentals
and
Generalities in
Medical
Management
of
ABDOMINAL
PAIN
ROJoson PEP Talk
I have a Patient
Empowerment
Program in which I
like to empower the
lay people or
patients to take
control in the
management of
their health.

There are 3 courses
in the PEP Talk.
I completed the Core
Course on October 9,
2021.

From October 23,
2021 onwards, I have
been tackling Health
Disorder and Health
Issue Courses. This
may take 3 years or
longer.

Empowerment
objective - for
understanding of
the FUNDAMENTALS
and GENERALITIES in
the MEDICAL
MANAGEMENT of
ABDOMINAL PAIN.
Health Disorder
Course–
Fundamentals
and
Generalities in
Medical
Management
of
ABDOMINAL
PAIN
My PEP TALK today
is entitled:
Fundamentals and
Generalities in
Medical
Management of
ABDOMINAL PAIN
[AN OVERVIEW].
This is part of the
Health Disorder
Course.

Fundamentals
and Generalities
in Medical
Management of
ABDOMINAL
PAIN
Definition of Terms in Title AND Delimitation of
Coverage of Talk:
Fundamentals – simplest and essential facts and
theories which can serve as a basis or foundation
and support for advanced information
Generalities – general statements of info, not
covering specifics and details
Medical Management – diagnosis and treatment
by physicians

Contents of ABDOMINAL DISORDERS
[OVERVIEW]
• What is an abdominal disorder?
• What are the different types of abdominal
disorders?
• What are the causes of abdominal disorders?
• How common are the abdominal disorders?
• Clinical diagnosis of abdominal disorders?
• Paraclinical diagnostic procedures for
abdominal disorders?
• Basic treatment modalities for abdominal
disorders?
Fundamentals
and Generalities
in Medical
Management of
ABDOMINAL
PAIN
March 19, 2022
1400H - 1500H
Via Zoom
• Abdominal Pain
• Abdominal Mass
• Abdominal Obstruction
• Abdominal Bleeding
• Jaundice

Fundamentals
and Generalities
in Medical
Management of
ABDOMINAL
PAIN
Contents of ABDOMINAL PAIN
• What is an abdominal pain?
pain?
• What are the causes of abdominal pain?
• How common are the abdominal pain?
• Clinical diagnosis of abdominal pain?
abdominal pain?
pain?

Fundamentals
and Generalities
in Medical
Management of
ABDOMINAL
PAIN

Fundamentals
and Generalities
in Medical
Management of
ABDOMINAL
PAIN
What is an ABDOMINAL PAIN?
This phrase defies a simple and straightforward
definition.
It is better to explain it in terms of concept or idea
with interjection of practical meaning and uses.
Reasons:
• Different expressions of abdominal pain
(different English and local dialect terms used)
• Different degrees of pain with different terms
Abdominal pain –
pain in the
abdomen

Fundamentals
and Generalities
in Medical
Management of
ABDOMINAL
PAIN
Examples of different expressions of abdominal
pain in Filipino and English languages:
• “Sakit ng tiyan” or “sakit sa tiyan”
• “Sinisikmura”
• “Mahapdi”
• “Humihilap”
• “Tinutusok”
• “Mahangin” or “may kabag”
• “Discomfort”
“Unpleasant or uncomfortable sensation”
• “Ache”
• “Crampy pain” or “colicky pain”
• “Burning pain”
• “Pain”
Some of these terms
are in general forms
(e.g. sakit,
discomfort,
unpleasant
sensation, pain).

Fundamentals
and Generalities
in Medical
Management of
ABDOMINAL
PAIN
• “Mahapdi”
• “Humihilap”
• “Tinutusok”
• “Ache”
• “Pain”
Some of these terms
are descriptive of the
unpleasant sensation
felt (e.g. mahapdi,
humihilap, tinutusok,
kabag, crampy or
colicky pain).

Fundamentals
and Generalities
in Medical
Management of
ABDOMINAL
PAIN
• “Mahapdi”
• “Humihilap”
• “Tinutusok”
• “Ache”
• “Pain”
Some of these terms
have connotations of
severity of the
unpleasant sensation
felt (e.g. discomfort –
mild; ache – mild;
pain and sakit – more
severe than ache and
discomfort).

Fundamentals
and Generalities
in Medical
Management of
ABDOMINAL
PAIN
ABDOMINAL PAIN (defies simple straightforward
definition)
ROJoson’s Recommendations:
Abdominal pain is any feeling of unpleasant
senstation in/on the belly (or abdomen).
Start with this meaning then let the person with
an unpleasant sensation on the abdomen
describe or amplify further on the feeling
(allowing whatever descriptions to be given
followed by a best effort to interpret them with
the aim of identify the source and cause of the
unpleasant sensation).
Abdominal pain –
any unpleasant
sensation in / on
the belly or
abdomen

Fundamentals
and Generalities
in Medical
Management of
ABDOMINAL
PAIN
In the real world, oftentimes, it is NOT easy to:
• describe precisely the character or nature of
the pain that will facilitate identifying the
cause in the belly.
I will tell you why, later on.
But, my advice is to at least TRY as it may be
helpful in the end, in the diagnosis.
Abdominal pain –
any unpleasant
sensation in / on
the belly or
abdomen

Fundamentals
and Generalities
in Medical
Management of
ABDOMINAL
PAIN
As an offshoot of the difficulty in describing
precisely the character or nature of the pain, it is
NOT easy to
• make a specific diagnosis just based on the
character or nature of the pain.
• One has to gather more data (more symptom
data particularly on the presence of other
associated symptoms and also sign data) to be
able to make a specific diagnosis of the
abdominal pain.
Abdominal pain –
any unpleasant
sensation in / on
the belly or
abdomen

Fundamentals
and Generalities
in Medical
Management of
ABDOMINAL
PAIN
REASONS why it is NOT easy to:
• Describe precisely the character or nature of
the unpleasant sensation that will facilitate
identifying the cause in the belly.
• Essentially, unpleasant sensation can
originate from the
• abdominal wall
• lining of the abdominal cavity or
peritoneum
• solid organs
• hollow organs inside the abdominal
cavity

Fundamentals
and Generalities
in Medical
Management of
ABDOMINAL
PAIN
originate from the
• abdominal wall
peritoneum
• solid organs
cavity
Question:
Are the character or
nature of unpleasant
sensations
originating from the
different sources
DISTINCT from each
other?
If YES, it may
facilitate diagnosis.
In reality,
OFTENTIMES, not
DISTINCT!

Fundamentals
and Generalities
in Medical
Management of
ABDOMINAL
PAIN
originate from the
• abdominal wall
peritoneum
• solid organs
cavity
ROJoson GENERAL
CUES for source of
unpleasant
sensation:
• Abdominal wall –
constant,
superficial
• Peritoneal lining –
constant, deeper
• Sold organs –
constant, deep
• Hollow organs –
crampy or colicky

Fundamentals
and Generalities
in Medical
Management of
ABDOMINAL
PAIN
originate from the
• abdominal wall
peritoneum
• solid organs
cavity
Situations that make
differentiation
difficult:
• Source of
unpleasant
sensation is not
just from one, but
multiple, such as
hollow organs and
peritoneum lining;
abdominal wall and
peritoneal lining;
solid and hollow
organs; etc.

Fundamentals
and Generalities
in Medical
Management of
ABDOMINAL
PAIN
originate from the
• abdominal wall
peritoneum
• solid organs
cavity
differentiation
difficult:
• Early stage of
medical condition
or disease or mild
medical condition
in the 4 sources
usually produces
NO distinct
character or
nature. (Just mild
feeling of
discomfort!)

Fundamentals
and Generalities
in Medical
Management of
ABDOMINAL
PAIN
originate from the
• abdominal wall
peritoneum
• solid organs
cavity
differentiation
difficult:
• Early stage of
medical condition
or disease or mild
medical condition
in the 4 sources
usually produces
NO distinct
character or
nature. (Just mild
feeling of
discomfort!)
At times, watchful waiting may
allow more distinct character or
nature of the unpleasant feeling
to show up, thereby facilitating
diagnosis. (usefulness of
watchful waiting)

Fundamentals
and Generalities
in Medical
Management of
ABDOMINAL
PAIN
definition)
sensation in/on the belly (or abdomen).
Abdominal pain –
any unpleasant
sensation in / on
the belly or
abdomen

Fundamentals
and Generalities
in Medical
Management of
ABDOMINAL
PAIN
Examples of different expressions of abdominal pain in Filipino and
English languages: [A ROJoson’s ATTEMPT AT INTERPRETATION]
• “Sakit ng tiyan” or “sakit sa tiyan”; pain [non-specific – usually more severe than
discomfort and ache”]
• “Sinisikmura” [epigastric pain – stomach – gastritis, gastric ulcer]
• “Mahapdi”; “burning pain” [usually, referring to stomach as source]
• “Humihilap”; “crampy or colicky pain” [hollow organ involvement]
• “Tinutusok” [piercing pain, sharp pain, vs dull pain – non-specific]
• “Mahangin” or “may kabag” [bloatedness – intestine involvement]
• “Discomfort” [non-specific, mild]
“Unpleasant/uncomfortable sensation” [non-specific, mild unless otherwise
qualified]
• “Ache” [non-specific, mild compared to pain]

Fundamentals
and Generalities
in Medical
Management of
ABDOMINAL
PAIN
definition)
Abdominal pain –
any unpleasant
sensation in / on the
belly or abdomen
What abdominal
pain is NOT?
It is not the same as
its severity – mild,
moderate and
severe.

Fundamentals
and Generalities
in Medical
Management of
ABDOMINAL
PAIN
definition)
Abdominal pain –
any unpleasant
sensation in / on the
belly or abdomen
What abdominal
pain is NOT?
It is not the same as
its onset and course
– acute, chronic,
recurrent,
progressive, etc.

Fundamentals
and Generalities
in Medical
Management of
ABDOMINAL
PAIN
pain?

Fundamentals
and Generalities
in Medical
Management of
ABDOMINAL
PAIN
Essentially, the different types will be based on
the origin of the unpleasant sensation:
• abdominal wall
peritoneum
• solid organs
cavity
pain?

Fundamentals
and Generalities
in Medical
Management of
ABDOMINAL
PAIN
Essentially, the different types will be based on
the origin of the unpleasant sensation:
• abdominal wall
peritoneum
• solid organs
cavity
pain?
ROJoson GENERAL
CUES for source of
unpleasant
sensation:
• Abdominal wall –
constant,
superficial
• Peritoneal lining –
constant, deeper
• Sold organs –
constant, deep
• Hollow organs –
crampy or colicky

Fundamentals
and Generalities
in Medical
Management of
ABDOMINAL
PAIN
Different types of unpleasant abdominal
sensation or pain can also be based on the
specific organs with a medical condition or a
disease and the nature of the medical condition
or disease.
Example:
Stomach -
Pain can be burning, bloatedness, colicky,
constant dull or sharp pain, etc. [gastritis, gastric
ulcer, obstruction, etc.]
pain?
Example:
Abdominal wall -
Pain can be constant
dull or sharp pain.
Colon -
Pain can be
bloatedness;
distended abdomen
because of
obstruction; colicky
pain, etc.

Fundamentals
and Generalities
in Medical
Management of
ABDOMINAL
PAIN
Onset and course of pain – aids in clinical
diagnosis
• Acute or recent - about a week or two
• Chronic – lasting for about 3 months
• Recurrent – 3 episodes within 3 months
• Progressive – increasing in intensity
Some abdominal
conditions and
diseases have typical
courses.
Some have chronic
and recurrent track
records – such as
duodenal ulcer and
colonic diverticulitis.
Others just one bout
or rarely recur.
Progressive connotes
serious diagnosis.

Fundamentals
and Generalities
in Medical
Management of
ABDOMINAL
PAIN
Another way of classifying the different types of
unpleasant abdominal sensation or pain that will
be useful in diagnosis and urgency of treatment is
based on severity:
• Mild
• Moderate
• Severe (of greatest urgency)
pain?
Some abdominal
conditions and
severity score.
Some are usually
mild. Some usually
moderate in pain.
Some usually severe.
Example: pain caused
by gallbladder stones
causing acute
obstruction will have
severe pain.

Fundamentals
and Generalities
in Medical
Management of
ABDOMINAL
PAIN
• What are the different causes of abdominal
pain?

Fundamentals
and Generalities
in Medical
Management of
ABDOMINAL
PAIN
pain?
CAUSES
So many causes in terms of medical conditions
and diseases that I will not be able to cover in this
PEP Talk.
Will just focus on fundamentals and generalities.

Fundamentals
and Generalities
in Medical
Management of
ABDOMINAL
PAIN
pain?
CAUSES
TRAUMA
• Penetrating injuries (stab wound, gunshot)
• Blunt injuries (vehicular accidents, mauling)
NON-TRAUMA
• Cancers on abdominal wall and internal organs
• Non-cancers on the abdominal wall and
internal organs

Fundamentals
and Generalities
in Medical
Management of
ABDOMINAL
PAIN
pain?
NON-TRAUMA
• Abdominal MASS (cancers / non-cancers)
• Abdominal OBSTRUCTION (gastrointestinal /
biliary / ureteral – tumors / non-tumors, e.g.
stones)
• Abdominal BLEEDING (from gastrointestinal
masses / ulcerative diseases)
• Abdominal INFLAMMATION / INFECTION
(gastroenteritis / abscess)
PERITONITIS – inflammation of peritoneal lining
(may be seen in TRAUMA and NON-TRAUMA)

Fundamentals
and Generalities
in Medical
Management of
ABDOMINAL
PAIN
pain?
What are the mechanisms of abdominal pain?
Pain from solid organs
• Stretching of the capsule of the organs
• Inflammation
Pain from hollow organs
• Stretching or distention of the lumen
• Inflammation
Pain on peritoneal lining – inflammation
Pain on abdominal wall - inflammation

Fundamentals
and Generalities
in Medical
Management of
ABDOMINAL
PAIN

Fundamentals
and Generalities
in Medical
Management of
ABDOMINAL
PAIN
VERY COMMON
Where do you think PAIN occurs most frequently
among the different regions of the body?
• Head and Neck such as HEADACHE?
• Chest such as CHEST PAIN?
• Abdomen – ABDOMINAL PAIN?
• Extremities – BONE and JOINT PAIN?
NO DATA
However, I surmise PAIN
is most common in the
ABDOMEN (if we include
even the mildest form of
discomfort). Why?
Because of the varying
kinds of foods that we
eat 3x – 6x a day which
always have potential
side-effects.

Fundamentals
and Generalities
in Medical
Management of
ABDOMINAL
PAIN

Fundamentals
and Generalities
in Medical
Management of
ABDOMINAL
PAIN
Processes used in clinical diagnosis of
abdominal pain:
• Pattern recognition process means realization
that the patient’s presentation conforms to a
previously learned picture or pattern of
disease.
• Prevalence process means choice of a diagnosis
is based on the frequency of occurrence of the
disease in a certain locality, in a certain age and
sex group, and in the affected organ and
system.
BASIC PROCESSES

Fundamentals
and Generalities
in Medical
Management of
ABDOMINAL
PAIN
TIPS:
BASIC EVALUATION METHODS:
• HISTORY TAKING – TO GET SYMPTOMS
• PHYSICAL EXAMINATION – TO GET SIGNS
CLINICAL DIAGNOSIS
SYMPTOM-BASED
EVALUATION
SIGN-BASED
EVALUATION
CLINICAL DIAGNOSIS

Fundamentals
and Generalities
of
ABDOMINALin
Medical
Management
PAIN
TIPS in evaluating / diagnosing ABDOMINAL PAIN
upon onset of pain (any unpleasant sensation)
• Determine the location of the pain.
• Try to determine the type of pain as best as
you can.
• Feel for any associated symptoms like fever,
nausea vomiting, diarrhea, etc.
• Recall any antecedent /precipitating events
that may lead to the pain.
• Monitor closely the pain – course and its
associated symptoms.
SYMPTOM-based
evaluation

Fundamentals
and Generalities
in Medical
Management of
ABDOMINAL
PAIN
you can.
nausea, vomiting, diarrhea, etc.

Fundamentals
and Generalities
in Medical
Management of
ABDOMINAL
PAIN
• Clinical diagnosis of abdominal pain? Location of pain as
cue for diagnosis

Fundamentals
and Generalities
in Medical
Management of
ABDOMINAL
PAIN
you can.
Try your best – it
may not be easy.
Initially, it may just a
discomfort without
distinct
characteristics.
Monitor until you
can be definite on
the type of pain,
that is, if the pain
persists.

Fundamentals
and Generalities
in Medical
Management of
ABDOMINAL
PAIN
you can.
A simple classification
of pain that may have
diagnostic import:
Crampy / colicky pain
– hollow organ
involvement
Non-crampy / colicky
pain - may be from
any source even
hollow organ
involvement

Fundamentals
and Generalities
in Medical
Management of
ABDOMINAL
PAIN
you can.
Associated symptoms
may give clues to the
diagnosis such as
• Fever – an
inflammation /
infection may be
going on
• Vomiting – possible
obstruction
• Diarrhea – possible
gastroenteritis
• etc.

Fundamentals
and Generalities
in Medical
Management of
ABDOMINAL
PAIN
you can.
An antecedent /
precipitating event
may give clues to the
diagnosis such as
• History of recent
vehicular accident -
possible blunt
injury
• History of recent
binge-eating –
possible food
indigestion

Fundamentals
and Generalities
in Medical
Management of
ABDOMINAL
PAIN
you can.
After onset,
monitoring closely the
course of the
abdominal pain may
give clues to the
diagnosis such as
• Over time, the type
of pain may be
clearer in character
to enable pattern
recognition of a
medical condition
or disease.

Fundamentals
and Generalities
in Medical
Management of
ABDOMINAL
PAIN
you can.
After onset,
monitoring closely the
course of the
abdominal pain may
give clues to the
diagnosis such as
• Over time, the
appearance of
associated
symptoms may
enable pattern
recognition of a
medical condition
or disease.

Fundamentals
and Generalities
in Medical
Management of
ABDOMINAL
PAIN
PHYSICAL EXAMINATION
LOOK AND PALPATE
SIGN-based
evaluation

TIPS:
BASIC EXAMINATION OF THE ABDOMEN:
LOOK AND PALPATE
• LOOK for unusual bulge that may suggest
mass.
• LOOK for abdominal distention that may
suggest intestinal obstruction, mass or fluid.
• PALPATE for possible presence of mass.
• PALPATE for presence of tenderness (pain on
pressure) – if present, location and severity.
An abdominal mass
can cause abdominal
pain.
Fundamentals
and Generalities
in Medical
Management of
ABDOMINAL
PAIN

TIPS:
LOOK AND PALPATE
mass.
An abdominal
distention, obstruction,
mass and fluid can cause
abdominal pain.
Fundamentals
and Generalities
in Medical
Management of
ABDOMINAL
PAIN

TIPS:
LOOK AND PALPATE
mass.
If an abdominal mass is
present, it may be the
cause of the abdominal
pain.
Fundamentals
and Generalities
in Medical
Management of
ABDOMINAL
PAIN

TIPS:
LOOK AND PALPATE
mass.
pressure) – if present, evaluate further.
Fundamentals
and Generalities
in Medical
Management of
ABDOMINAL
PAIN

Fundamentals
and Generalities
in Medical
Management of
ABDOMINAL
PAIN
TIPS:
LOOK AND PALPATE
mass.
pressure) – if present, evaluate further.

Fundamentals
and Generalities
in Medical
Management of
ABDOMINAL
PAIN
TIPS:
In looking for the SPECIFIC CAUSE of ABDOMINAL
PAIN,
use PATTERN RECOGNITION of a particular
medical condition or disease and PREVALENCE
process in those with similar presentation of
symptoms and signs.
• Primary clinical diagnosis: Most probable
• Secondary clinical diagnosis: Second most
probable
Clinical Diagnosis
General Statements:
Abdominal pain
secondary to:
• Non-specific
cause
• Specific cause
(specify the
disease)

Fundamentals
and Generalities
in Medical
Management of
ABDOMINAL
PAIN
CUES for:
• ABDOMINAL MASS – palpable mass
• GASTROINTESTINAL OBSTRUCTION – vomiting,
abdominal distention, and no bowel
movement
• GASTROINTESTINAL BLEEDING - vomiting of
frank blood; passage of frank blood per anus;
black stools per anus
• JAUNDICE – yellowing of the white part of the
eyes
If there are cues for
a specific disorder,
then specify the
disorder and then
look for the specific
cause.

Fundamentals
and Generalities
in Medical
Management of
ABDOMINAL
PAIN
In patients with ABDOMINAL PAIN but without
clear-cut CUES for
• Abdominal mass
• Abdominal obstruction
• Abdominal bleeding
• Jaundice
and ABDOMINAL PAIN is mild and with no clear-
cut characteristics and with NO CUES for a specific
disease whatsoever,
DIAGNOSIS is usually “Non-specific abdominal
pain”. [This has to be monitored afterwards.]
Clinical Diagnosis
General Statements:
Abdominal pain
secondary to:
• Non-specific
cause
• Specific cause
(specify the
disease)
If there are cues for
a specific disease,
then specify the
disease.

Fundamentals
and Generalities
in Medical
Management of
ABDOMINAL
PAIN
Case Illustration:
A patient presenting with epigastric pain.
Based on location, possible common organs of
involvement: stomach, pancreas, liver, and
intestines (small and large).
If no mass, no
bleeding, no signs of
obstruction, and no
jaundice,
consider STOMACH
first as it is the most
common organ
affected in the area.
If there is jaundice,
think of LIVER.

Fundamentals
and Generalities
in Medical
Management of
ABDOMINAL
PAIN
Case Illustration:
If no mass, no
obstruction, and no
jaundice,
consider STOMACH
common organ
Then, determine
characteristic of pain
to zero into the
specific STOMACH
condition or disease.

Fundamentals
and Generalities
in Medical
Management of
ABDOMINAL
PAIN
Case Illustration:
If no mass, no
obstruction, and no
jaundice,
consider STOMACH
common organ
Examples:
• Food indigestion
• Gastritis
• Gastric ulcer

Fundamentals
and Generalities
in Medical
Management of
ABDOMINAL
PAIN
Case Illustration:
If no mass, no
obstruction, and no
jaundice,
consider STOMACH
common organ
If cannot specify
based on symptoms
and signs, diagnosis
is NON-SPECIFIC
EPIGASTRIC PAIN.

Fundamentals
and Generalities
in Medical
Management of
ABDOMINAL
PAIN
Case Illustration:
A patient presenting with right upper quadrant
pain.
involvement: liver, gallbladder, and intestines
If no mass, no bleeding,
no signs of obstruction,
no jaundice, and no liver
enlargement
consider GALLBLADDER
common organ affected
in the area.
If with jaundice,
evaluate LIVER,
GALLBLADDER and
PANCREAS.

Fundamentals
and Generalities
in Medical
Management of
ABDOMINAL
PAIN
Case Illustration:
pain.
enlargement
in the area.
If there is
tenderness where
the GALLBLADDER is
located, diagnosis is
CHOLECYSTITIS –
inflammation of
Gallbladder.

Fundamentals
and Generalities
in Medical
Management of
ABDOMINAL
PAIN
Case Illustration:
pain.
enlargement
in the area.
If cannot specify
based on symptoms
is NON-SPECIFIC
RUQ ABDOMINAL
PAIN.

Fundamentals
and Generalities
in Medical
Management of
ABDOMINAL
PAIN
Case Illustration:
A patient presenting with right lower quadrant
pain.
involvement: appendix, intestines, ovary (female)
and no jaundice,
consider APPENDIX first
as it is the most common
organ affected in the
area.
If there is definite,
persistent,
increasing RLQ
tenderness, consider
ACUTE
APPENDICITIS.

Fundamentals
and Generalities
in Medical
Management of
ABDOMINAL
PAIN
Case Illustration:
A patient presenting with right lower quadrant
pain.
involvement: appendix, intestines, ovary (female)
and no jaundice,
consider APPENDIX first
as it is the most common
area.
If cannot specify
based on symptoms
is NON-SPECIFIC RLQ
ABDOMINAL PAIN.

Fundamentals
and Generalities
in Medical
Management of
ABDOMINAL
PAIN
Case Illustration:
A patient presenting with left lower quadrant
pain.
involvement: intestines, ovary (female)
and no jaundice,
consider COLON first as
it is the most common
area.
If there is bowel
disturbance,
consider colon and
evaluate further for
specific condition
and disease.

Fundamentals
and Generalities
in Medical
Management of
ABDOMINAL
PAIN
Case Illustration:
A patient presenting with left lower quadrant
pain.
involvement: intestines, ovary (female)
and no jaundice,
consider COLON first as
it is the most common
area.
If cannot specify
based on symptoms
is NON-SPECIFIC LLQ
ABDOMINAL PAIN.

Fundamentals
and Generalities
in Medical
Management of
ABDOMINAL
PAIN
Aids in clinical diagnosis:
• Location of pain
• Character of pain
• Specific (as much as possible)
• Non-specific clinical diagnosis (allowed)
• Onset and course of pain
• Severity of pain
• Acute abdomen (acute surgical abdomen vs
acute non-surgical abdomen)

Fundamentals
and Generalities
in Medical
Management of
ABDOMINAL
PAIN
Severity of pain – aids in clinical diagnosis
• Mild
• Moderate
• Severe (of greatest urgency)
Some abdominal
conditions and
severity score.
Some are usually
mild. Some usually
moderate in pain.
Some usually severe.
Example: pain caused
by gallbladder stones
causing acute
obstruction will have
severe pain.
Food
indigestion is
usually mild
to moderate.
SEVERE PAIN – aside from
implying greatest urgency in
medical treatment, it also has a
connotation in diagnosis and
subsequent treatment. Example:
ACUTE ABDOMEN

Fundamentals
and Generalities
in Medical
Management of
ABDOMINAL
PAIN
ACUTE ABDOMEN is a condition, usually with
severe abdominal pain, that demands urgent
attention and treatment.
ACUTE SURGICAL ABDOMEN is a condition,
usually with severe abdominal pain, that
demands urgent attention and operative
treatment.
ACUTE NON-SURGICAL ABDOMEN is a condition
that demands urgent attention and non-operative
treatment.
Sometimes the
specific cause of the
acute abdomen
cannot be definitely
established.
It is enough for the
physician to decide
whether it is a
SURGICAL or NON-
SURGICAL abdomen.
This is a special
category of clinical
diagnosis of
abdominal pain.

Fundamentals
and Generalities
in Medical
Management of
ABDOMINAL
PAIN
abdominal pain?

Fundamentals
and Generalities
in Medical
Management of
ABDOMINAL
PAIN
abdominal pain?
Common instrumental and laboratory diagnostic
procedures for ABDOMINAL PAIN:
• Imaging procedures (x-rays – plain / with
barium dye; ultrasound; CT scan; MRI; PET
scan; etc.)
• Endoscopy (upper - esophagogastroscopy /
lower – colonoscopy, sigmoidoscopy,
proctoscopy)
• Blood tests (CBC; liver function tests; tumor
markers; etc.)

Fundamentals
and Generalities
in Medical
Management of
ABDOMINAL
PAIN
abdominal pain?
The foremost indication for a paraclinical
diagnostic procedure can be stated this
way:
if you are not certain on the primary
clinical diagnosis and you need to be
certain or be more certain before
treatment, then go for a paraclinical
diagnostic procedure.

Fundamentals
and Generalities
in Medical
Management of
ABDOMINAL
PAIN
abdominal pain?
To decide on indication of the paraclinical
diagnostic procedure,
the physician uses two processes –
- degree of certainty on the primary
clinical diagnosis and
- comparison of the treatment plans for
the primary and secondary clinical
diagnoses.
As a rule, there is no need
for a paraclinical
diagnostic procedure if:
• you are quite
certain of your
primary clinical
diagnosis.
• treatment plans for
primary and
secondary
diagnoses are the
same.

Fundamentals
and Generalities
in Medical
Management of
ABDOMINAL
PAIN
abdominal pain?
Competencies required of physicians managing
abdominal pain:
• Know the uses and indications of all known
instrumental and laboratory diagnostic
procedures for abdominal pain.
• Use as needed and indicated.
• Select the most cost-effective one using the
BRCA process.
• Know how to interpret the results.

Fundamentals
and Generalities
in Medical
Management of
ABDOMINAL
PAIN
abdominal pain?
BRCA Process in selecting diagnostic procedures
Procedures Benefit
(goal – to
be more
definite on
the
diagnosis)
Risk Cost Availability
Option1
Option2
Option3

Fundamentals
and Generalities
in Medical
Management of
ABDOMINAL
PAIN
ACUTE ABDOMEN is a condition, usually with
severe abdominal pain, that demands urgent
attention and treatment.
ACUTE SURGICAL ABDOMEN is a condition,
usually with severe abdominal pain, that
demands urgent attention and operative
treatment.
ACUTE NON-SURGICAL ABDOMEN is a condition
that demands urgent attention and non-operative
treatment.
Sometimes the
specific cause of the
acute abdomen
cannot be definitely
established.
It is enough for the
physician to decide
whether it is a
SURGICAL or NON-
SURGICAL abdomen.
This is a special
category of clinical
diagnosis of
abdominal pain.
In patients with ACUTE SURGICAL
ABDOMEN, NO TIME should be wasted on
paraclinical diagnostic procedures just to
establish the definite cause. A surgeon
should operate without establishing the
specific cause. The operation can serve as
the paraclinical diagnostic procedure as it
will establish the cause.

Fundamentals
and Generalities
in Medical
Management of
ABDOMINAL
PAIN
pain?

Fundamentals
and Generalities
in Medical
Management of
ABDOMINAL
PAIN
pain?
SPECIFIC DISEASE SURGICAL / POTENTIALLY SURGICAL / NON-SURGICAL
W
X
Y
Z
• Surgical – outright surgical
• Non-surgical – non-surgical at all times (no operation)
• Potentially surgical – surgical only when needed

Fundamentals
and Generalities
in Medical
Management of
ABDOMINAL
PAIN
pain?
Examples of OUTRIGHT SURGICAL ABDOMEN
• Acute surgical abdomen
• Complete intestinal obstruction
• Peritonitis secondary to ruptured intestines
• Resectable tumors
Surgical Treatment:
• Drainage of
infections
(abscesses)
• Removal (-ectomy
such as
cholecystectomy)
• Repair (-rrhapy
such as
gastrorrhaphy)

Fundamentals
and Generalities
in Medical
Management of
ABDOMINAL
PAIN
pain?
Examples of POTENTIALLY SURGICAL ABDOMEN
• Asymptomatic gallstones
• Asymptomatic diverticulitis
• Incomplete intestinal obstruction
• Asymptomatic benign tumors

Fundamentals
and Generalities
in Medical
Management of
ABDOMINAL
PAIN
pain?
Examples of OUTRIGHT NON-SURGICAL
ABDOMEN
• Gastroenteritis
• Food ingestion
• Cirrhosis
• Hepatitis
Non-Surgical Treatment:
• Medicines
• NO medicines (watchful waiting;
natural support management; etc.)

Fundamentals
and Generalities
in Medical
Management of
ABDOMINAL
PAIN
pain?
BRCA Process in selecting cost-effective treatment
modality.

Fundamentals
and Generalities
in Medical
Management of
ABDOMINAL
PAIN
Contents of ABDOMINAL PAIN
pain?
• What are the causes of abdominal pain?
abdominal pain?
pain?
Summary
Take Away

Fundamentals
and Generalities
in Medical
Management of
ABDOMINAL
PAIN
Be always in touch with reliable medical
information on fundamentals and
generalities in medical management of
ABDOMINAL PAIN.
Knowledge is power; it gives power.
Use the 4Ks of Patient Empowerment:
Kaalaman, Kakayanan, Karapatan and
Kapangyarihan
to gain greater control over decisions in
medical management of ABDOMINAL
PAIN.
Take Away in
relation to
Patient
Empowerment

Empowerment
objective - for
understanding of
the FUNDAMENTALS
and GENERALITIES in
the MEDICAL
MANAGEMENT of
ABDOMINAL PAIN.
Health Disorder
Course–
Fundamentals
and
Generalities in
Medical
Management
of
ABDOMINAL
PAIN
March 26, 2022
1400H - 1500H
Via Zoom

ROJoson PEP TALK: Abdominal Pain - An Overview

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ROJoson PEP TALK: Abdominal Pain - An Overview