Mechanisms and Sources of Abdominal Pain
impaired passage of solid foods or liquids from
Visceral pain
• hollow organs (intestines) become
distended/contract forcefully /when the
capsules of solid organs (liver ,spleen) are
stretched. Poorly defined or localized and
intermittently timed. Dull, aching, burning,
cramping, or colicky
Parietal pain
• parietal peritoneum becomes inflamed, as
in appendicitis or peritonitis. This type of
pain tends to localize more to the source
and is characterized as a more severe and
steady pain.
Referred pain
• occurs at distant sites that are innervated
at approximately the same levels as the
disrupted abdominal organ. This type of
pain travels, or refers, from the primary site
- highly localized at the distant site.
Gastrointestinal Symptoms
Nausea
• Often described as “feeling sick to my stomach,”
may progress to retching and vomiting.
Retching
• describes involuntary spasm of the stomach,
diaphragm, and esophagus that precedes and
culminates in
Vomiting
• forceful expulsion of gastric contents out of the
mouth.
Regurgitation
• not actually vomit but raise esophageal or
gastric contents without nausea or retching,
called
Anorexia
• lack of appetite.
Dysphagia / Odynophagia
• patients may report difficulty swallowing from
the mouth to the stomach, or dysphagia.
Change in Bowel Function
Diarrhea
• Increased water content of the stool results in
diarrhea (stool volume greater than 200 grams in
24 hours)
Constipation
• should be present for at least 12 weeks of the
prior 6 months with at least two of the following
conditions: fewer than 3 bowel movements per
week; 25% or more defecations with either
straining or sensation of incomplete evacuation;
lumpy or hard stools; or manual facilitation
Abnormalities
 Hernia- occurs when an organ pushes through an
opening in the muscle or tissue that holds it in
place
 Ascites, edema- tense, glistening skin
 Purple striae - associated with Cushing’s diseases
 Cullen's sign - superficial edema and bruising in
the subcutaneous fatty tissue around the
umbilicus
 Grey Turner sign- refers to bruising of the flanks,
the part of the body between the last rib and the
top of the hip. The bruising appears as a blue
discoloration, and is a sign  of retroperitoneal
hemorrhage, or bleeding behind the peritoneum,
which is a lining of the abdominal cavity.
 Visible venous pattern (dilated veins) is
associated with liver disease, ascites and
venacaval obstruction
 Loud bruit over aortic area (possible aneurysm);
Others
• LIVER SIZE - 6 to 12 cm in the midclavicular line; 4 to 8 cm
at the midsternal line
• Borborygmi  is the sound that gas makes as it moves
through the intestines. It's often called "stomach
growling" or "stomach rumbling." 
• Normal Bowel sound consist of clicks and gurgles and 5-
30 per minute. An occasional borborygmus (loud
prolonged gurgle) may be heard.
• Abnormal bowel sound
Hypoactive bowel sounds are considered as one every three to five
minutes, and this can indicate diarrhoea, anxiety, or gastroenteritis.
Increased (hyperactive) bowel sounds can sometimes be heard
even without a stethoscope. Hyperactive bowel sounds mean there
is an increase in intestinal activity. This may happen with diarrhea or
after eating

• Murphy’s sign is a name of the maneuver by which a

doctor tries to determine if your upper right abdominal
pain arises from (cholecystitis) acute gallbladder
inflammation
• Deep tenderness at Mc Burney's point, known as Mc
Burney's sign, is a sign of acute appendicitis.

• If palpation of the left lower quadrant of a person's

abdomen increases the pain felt in the right lower
quadrant, the patient is said to have a positive Rovsing's
sign
• Aaron's sign - clinical sign of referred pain in epigastrium
when pressure is applied is also known as
• Blumberg’s sign- client has rebound tenderness when he
or she perceives sharp, stabbing pain as the examiner
releases pressure from the abdomen.
• Pain in the RLQ (Psoas sign) is associated with irritation of
the iliopsoas muscle due to an appendicitis.
•