Top 10 causes of sudden and severe abdominal pain

Sudden or severe abdominal pain can be brought upon by a variety of reasons. Dr Nisreen Nakhoda enlists the top 10 possible causes of severe abdominal pain.

Abdominal pain is a common complaint of many people, yet it’s difficult to diagnose, as there are many organs in the abdomen; solid organs like spleen, kidney and liver; hollow organs like the entire gastro-intestinal tract and the urinary bladder; and major blood vessels, viz., the abdominal aorta and the inferior vena cava. In this article we will cover abdominal causes of sudden severe abdominal pain or what is medically termed as acute abdomen, which is a surgical emergency. In any of the conditions mentioned below, if prompt medical treatment is unavailable, there is a big chance of the patient losing his life.

Top 10 causes of sudden and severe abdominal pain

Acute cholecystitis: This is an acute inflammation of the gallbladder due to gallstones causing obstruction, or chemical irritation. The patient complaints of agonising pain in the right upper part of the abdomen where the gall bladder is located. Fever is a usual symptom but may not be present in the elderly and in persons taking steroids or NSAIDs (Nonsteroidal anti-inflammatory drugs). Nausea and vomiting are the other features.
Acute appendicitis: This is a common and important condition in which a small rudimentary organ called the appendix, attached to the beginning of the large intestine gets inflamed due to lack of blood supply. It is an extremely painful condition and pain is maximum in the right lower abdomen.
Acute pancreatitis: The pancreas is an important organ located in the upper abdomen towards the back. Gallstones and excessive alcohol intake are two major factors responsible for 90% cases of acute pancreatitis. In this condition, there is excruciating pain in the upper abdomen along with nausea and repeated episodes of vomiting.
Perforated peptic ulcer: A long-standing or untreated peptic ulcer in the stomach or duodenum (first part of the small intestine) may perforate (the ulcer goes through the thickness of the wall causing a hole). This releases the partially digested food matter into the abdominal cavity leading to peritonitis. Peritonitis means inflammation of the peritoneum which is a bag in which most of the abdominal organs are located. Perforation of any part of the intestine too can cause peritonitis. Injury due to a sharp instrument like when a person is stabbed with a knife can cause intestinal perforation.
Intestinal obstruction: The intestinal passage may be blocked due to any mass like a tumour, polyp or trichobezoar. The obstruction can be partial or total. If the intestine gets totally obstructed, food cannot pass through, and this may lead to perforation or infection and inflammation of the bowel.
Gastro-intestinal haemorrhage: This refers to severe bleeding into the peritoneal cavity. It could be due a ruptured aneurysm of the abdominal aorta (aneurysm is a defective part of the blood vessel where the wall becomes thinned predisposing to rupture) or due to bleeding vessels as a result of portal hypertension (the blood in the portal veins close to the liver flows at high pressure – seen in liver cirrhosis and liver failure).
Acute intestinal ischaemia: The blood supply to a part of the intestine stops, due to this the intestinal tissue dies and has to be surgically removed. the healthy ends of bowel are then connected to maintain a patent bowel with adequate blood supply to the entire bowel. This is a major abdominal surgery.
Rupture of the spleen: The spleen is located in the left upper part of the abdomen, just below the ribs. A sharp or blunt injury to the area can cause the spleen to rupture and split. This will lead to excessive haemorrhage into the abdomen and may be fatal.
Renal or ureteric colic: When a kidney stone moves from the kidney into the ureter (a narrow tube connecting the kidney to the urinary bladder), the stone gets stuck in the narrow canal and causes intense pain called as ureteric colic. The pain is agonising, unbearable and the person keeps shifting restlessly in an attempt to minimise the pain.
Acute urinary retention: This refers to the sudden inability to pass urine; it is extremely painful and the person feels like his bladder is about to burst. It may occur in a young healthy male or in an old person who already has chronic urinary retention. Prostate enlargement or narrowing of the urethra are probable causes.