Main complaints and history taking
When the intestines are affected, patients traditionally present with five main groups of complaints. These include abdominal pain, abdominal distension (meteorismus), increased stool frequency (diarrhea), delayed defecation (constipation), as well as the appearance of various pathological inclusions in the feces (mucus, blood).
Since pain syndrome is the leading symptom, the physician needs to conduct a deep detailing of it across three vectors:
- Localization: determining the initial point of discomfort and the presence of pain migration (shifting).
- Intensity: subjective assessment of the severity of pain sensations.
- Chronology: the nature of onset (sudden or gradual), duration of the attack, as well as daily, weekly, or monthly dynamics.
In addition, when taking the medical history, factors influencing symptom severity must be specified. It is important to find out what exactly relieves or worsens the condition (food intake, alcohol, medications such as antacids, changes in body position, stress). It is necessary to establish the connection of pain with physiological functions—urination, defecation, and in women, with the phase of the menstrual cycle. The chronology of the appearance of any concomitant symptoms in relation to the onset of pain is also recorded.
Pathogenetic classification of pain
Depending on the mechanism of development and the localization of the lesion, three main types of abdominal pain are distinguished.
1. Visceral pain Arises due to spasm or excessive distension of the walls of hollow organs (intestines, bile ducts), as well as stretching of the capsules of parenchymal organs. By character, it can be dull, burning, sharp, or constricting. The patient is extremely restless and cannot find a place to stay. When the attack is of high intensity, pronounced autonomic accompaniments join: nausea, vomiting, skin pallor, and heavy sweating.
2. Somatic (parietal) pain Develops with direct irritation of the leaflets of the parietal peritoneum. This pain is constant and aching in nature and often exceeds visceral pain in strength. It has a clear localization strictly corresponding to the affected area. The main feature of the patient's behavior is the desire to lie absolutely motionless, since coughing or the slightest change in posture sharply increases suffering.
3. Referred pain (irradiation) Caused by the transmission of nerve impulses to body parts that share a common innervation with the affected organ. Notably, the pain syndrome can radiate to the abdominal cavity in primary pathology of extra-abdominal structures (diseases of the spine, pelvic or thoracic organs).
Intestinal colic and flatulence syndrome
One of the most frequent variants of abdominal syndrome is intestinal colic (colica intestinalis). It is based on excessive contractile activity and spasm of the smooth muscles of the intestinal wall. This spasm is provoked by local irritation—for example, accumulated gases or intestinal contents.
Colic occurs in attacks and is most often localized in the umbilical region, although other options are possible. The list of main causes (etiology) includes:
- Inflammatory processes in the intestines.
- Helminthic invasions (helminthiases).
- Formation of fecal impactions.
- Nervous system disorders.
The attack is often associated with bowel function, can occur at the time of defecation, or be accompanied by tenesmus—extremely painful, yet false urges to use the restroom.
Flatulence syndrome represents pronounced abdominal distension due to the pathological accumulation of gases. During the diagnostic search, it is fundamentally important to identify the connection of this symptom with specific food products. For example, if bloating occurs after consuming milk or dairy products, this directly indicates lactase deficiency.
Briefly: answers to topical questions
What specific diseases of extra-abdominal organs can cause referred pain in the abdominal cavity?
Referred pain in the abdominal cavity can occur with pathologies of the chest organs, spine, and pelvis. Conditions capable of causing such irradiation include:
- Pleural lesions — irritation of the diaphragmatic part of the peritoneum leads to the appearance of pain mimicking the clinical picture of an "acute abdomen".
- Pericarditis — the inflammatory process can spread from the pericardium to the adjacent visceral pleura, forming pleural pain with subsequent irradiation into the abdomen.
What pathological admixtures, apart from blood and mucus, can be detected in feces in intestinal diseases?
During macroscopic examination of feces, pathological admixtures, in addition to blood and mucus, include:
- Pus.
- Parasites.
- Undigested food residues.
It is easy to distinguish the two main types of pain by behavior: with visceral pain, the patient tosses and turns (cannot find a comfortable position), while with somatic pain, the patient lies still (movement is painful).
Class and exam questions
What is the main difference in patient behavior between somatic and visceral pain?
In visceral pain, the patient is restless and constantly changes posture in search of relief. In somatic (parietal) pain, any movement or coughing intensifies suffering, so the patient tries to lie absolutely motionless.
What is tenesmus?
Tenesmus refers to agonizing, false, and painful urges to defecate. They very often accompany attacks of intestinal colic.
Can the abdomen hurt if the abdominal cavity organs are healthy?
Yes, referred pain exists. Due to shared innervation, impulses can radiate into the abdomen in diseases of the chest, pelvis, or spine.
What does the association of flatulence with milk indicate?
A clear association between abdominal distension and the consumption of milk or dairy products is a classic sign of lactase deficiency.
What else to study on this topic
- Pathogenetic mechanisms of diarrhea and constipation development
- Types of pathological admixtures in feces and their diagnostic value
- Detailed characteristics of intestinal inflammatory processes
- The effect of antacids and other medications on gastrointestinal function
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