Tag Archives: Abdominal pain

What are the symptoms and manifestations of irritable bowel syndrome?

Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder characterized by recurrent abdominal pain linked to altered bowel habits, without detectable structural or biochemical abnormalities. Symptoms fluctuate over years, often beginning in adolescence or early adulthood, and can significantly impair quality of life while sparing life expectancy.

Cardinal features

Abdominal pain or discomfort: crampy, aching, or sharp, usually located in the lower abdomen; episodes last minutes to hours and are relieved by defecation.
Change in bowel frequency: patients may experience >3 loose stools daily or <3 stools weekly; the pattern can alternate within the same individual.
Change in stool form: using the Bristol scale, types 6–7 (mushy/watery) during diarrhea spells and types 1–2 (hard/lumpy) during constipation spells are typical.
Sensation of incomplete evacuation: persistent urge after bowel movement, leading to repeated visits to the toilet.
Visible abdominal distension: objectively measured increase in girth by evening, often accompanied by tight clothing.

Subtypes based on predominant habit

IBS-D: >25 % of bowel movements loose and <25 % hard.
IBS-C: >25 % hard and <25 % loose.
IBS-M (mixed): both loose and hard stools >25 % of the time.
IBS-U: insufficient criteria for above categories.

Associated non-colonic symptoms

Upper GI: early satiety, nausea, epigastric burning overlapping with functional dyspepsia.
Genitourinary: frequent urination, urgency, dyspareunia.
Gynecologic: dysmenorrhea intensifying IBS pain mid-cycle.
Fatigue, headache, and sleep disturbances: independent of stool pattern.

Symptom triggers

Food: fatty meals, caffeine, sorbitol, onions, garlic, beans, wheat, milk (via either lactose or FODMAP effect).
Stress: examinations, job interviews, or personal conflicts can precipitate flares within hours.
Hormonal: many women report worsening perimenstrually.
Post-infectious: 10 % of acute gastroenteritis cases evolve into IBS through low-grade inflammation and altered microbiota.

Red flags that exclude IBS
Age >50 at first onset, nocturnal pain awakening from sleep, bloody stools, unintentional weight loss, anemia, elevated inflammatory markers, or family history of colorectal cancer, celiac disease, or inflammatory bowel disease—these mandate further investigation.
Daily-life impact
Symptoms often peak during working hours; fear of incontinence leads to avoidance of long commutes or social events, creating a cycle of anxiety and heightened gut sensitivity.

Summary table

Domain	Common presentation	Tip for patients
Pain	Lower-crampy, post-prandial	Heat pad, peppermint oil capsules
Stool	Alternating loose/hard, urgency	Keep 2-week diary to identify triggers
Bloating	Visible distension by evening	Reduce carbonated drinks, chew slowly
Non-gut	Tired, poor sleep, frequent urination	Regular exercise improves both gut and sleep
Alarm signs	Blood, night pain, weight loss	Seek immediate medical review

What Are the Symptoms of Acute Appendicitis?

Acute appendicitis results from luminal obstruction followed by bacterial overgrowth and rapid inflammation. Cardinal features in chronological order are:

Migratory pain
Vague periumbilical or upper-abdominal discomfort migrates to the right lower quadrant within 4–6 h and intensifies with movement, coughing or palpation.
Gastro-intestinal upset
Anorexia, nausea and often vomiting; loose stools or constipation may mislead toward gastroenteritis.
Fever
Low-grade 37–38 °C early, rising >38.5 °C as inflammation advances; elderly or immunocompromised patients may remain afebrile.
Peritoneal signs
Maximal tenderness at McBurney point, rebound pain, guarding and hypo-active bowel sounds indicate parietal peritoneal irritation.
Systemic toxicity
Tachycardia, malaise, thirst; high fever with pallor or hypotension suggests gangrene or perforation with sepsis.
Special populations
Pregnancy displaces the appendix upward, shifting pain to the right upper quadrant; infants present with irritability, refusal to feed and high fever.

Perforation risk rises sharply after 48 h; any sustained abdominal pain with fixed right-lower-quadrant tenderness warrants urgent evaluation.

Feature	Typical Findings
Pain onset	Periumbilical → right lower quadrant
Quality	Dull early, later sharp, worsened by cough
GI symptoms	Anorexia, nausea, vomiting, ± diarrhea
Fever	Low → moderate, may exceed 38.5 °C
Peritoneal signs	Tenderness, rebound, guarding at McBurney
Alarm signs	High fever, hypotension, diffuse pain (perforation)
Imaging	US/CT: enlarged appendix >6 mm

What Are the Symptoms of Peritonitis?

Peritonitis is an acute inflammation of the peritoneum triggered by bacterial, chemical or physical insults. It progresses rapidly and may become life-threatening within hours. Key manifestations include:

Abdominal pain
The earliest and most prominent symptom—persistent, sharp, and diffuse; movement, coughing or palpation intensifies the discomfort.
Peritoneal signs
Tenderness, rebound pain and guarding give the abdomen a board-like rigidity, reflecting parietal peritoneal irritation.
Nausea & vomiting
Initially reflex, later bilious or feculent if paralytic ileus supervenes.
Fever & rigors
Temperature often >38 °C with chills as systemic inflammation ignites.
Abdominal distension
Gas and fluid accumulate when peristalsis ceases, sometimes compromising respiration.
Cessation of flatus & stool
Absent bowel sounds confirm adynamic ileus.
Dehydration & thirst
Fluid loss from vomiting, third-spacing and fever produces dry mucosa and oliguria.
Systemic toxicity & shock
Endotoxaemia may lead to septic shock: pallor, cold clammy extremities, tachycardia, hypotension, confusion, culminating in multi-organ failure.
Dialysis-fluid changes (in CAPD patients)
Cloudy effluent with fibrin flecks or strands and catheter-site erythema.

Because fulminant deterioration is common, any patient with sudden severe abdominal pain plus fever, guarding or haemodynamic instability requires immediate evaluation and empiric therapy.

Key Aspect	Typical Findings
Pain onset	Sudden, severe, continuous, worsened by motion
Physical signs	Tenderness, rebound, board-like rigidity
GI function	Nausea, vomiting, absent flatus/stool, silent abdomen
Temperature	≥38 °C, often with chills
Circulatory	Tachycardia, hypotension → septic shock
Respiratory	Shallow breathing due to pain/diaphragmatic splinting
Urinary output	Oliguria from hypovolaemia or sepsis
Emergency marker	Combination of acute abdomen + fever/shock mandates urgent laparotomy/IV antibiotics

What Are the Symptoms of Retroperitoneal Hematoma?

The clinical presentation of retroperitoneal hematoma is often nonspecific. Mild cases may show only vague discomfort, while severe cases can quickly progress to hemorrhagic shock. Main manifestations include:

Abdominal pain – the most frequent symptom, usually steady and dull, located in the upper, lower or flank abdomen and sometimes radiating to the back .
Low-back pain – caused by direct compression or irritation of lumbar muscles and nerves .
Abdominal distension & decreased bowel sounds – due to paralytic ileus secondary to hematoma compression or irritation .
Hypovolemia & shock – the retroperitoneal space can conceal >2 L of blood; patients may suddenly develop pallor, tachycardia, hypotension and even collapse .
Nerve compression – femoral neuropathy with anterior thigh pain, numbness or weakness when the hematoma extends into the iliac fossa .
Urinary symptoms – hematuria, dysuria or acute urinary retention if the kidneys, ureters or bladder are involved .
Peritoneal irritation signs – muscular guarding, rebound tenderness and absent bowel sounds when the hematoma is large or ruptures into the peritoneal cavity .
Late complications – infection, multiple organ dysfunction or re-bleeding may appear if the hematoma is not promptly managed .

Because of this variability, any patient with lumbar-abdominal trauma, pelvic/spinal fracture, persistent abdominal-flank pain, unexplained shock or paralytic ileus should be evaluated for retroperitoneal hematoma, preferably by emergency CT.

Aspect	Key Points
Most common symptom	Abdominal pain (46–68 %)
Typical location	Flank, lower abdomen, back
Alarm signs	Tachycardia, hypotension, pale skin, oliguria
Neurological sign	Femoral nerve palsy (thigh pain/weakness)
Imaging of choice	Contrast-enhanced CT
Major risk	Occult hemorrhagic shock, mortality 35–42 %

What Are the Symptoms of Intestinal Obstruction?

The classic picture of intestinal obstruction is “pain, distension, vomiting, and absence of stool/gas.”

Abdominal pain: forceful peristalsis in the proximal bowel causes colicky pain every 5–15 min; persistent severe pain suggests ischemia or perforation.

Distension: gas and fluid accumulate proximal to the blockage, inflating the abdomen; low obstructions produce greater swelling and visible peristaltic waves.

Vomiting: high obstructions provoke early, frequent emesis—first gastric, then bilious or feculent; low obstructions delay vomiting.

Obstipation: complete obstruction abolishes flatus and stool; residual distal content may be passed early.

Auscultation reveals hyperactive, high-pitched, metallic bowel sounds; peritoneal signs or systemic toxicity warn of strangulation or perforation.

Key Symptom	Description
Colicky abdominal pain	Intermittent cramps every 5–15 min
Abdominal distension	More marked in distal obstruction
Vomiting	Early & bilious (high), late & feculent (low)
Obstipation	No flatus or stool in complete obstruction
Hyperactive bowel sounds	High-pitched, metallic on auscultation
Peritoneal signs	Persistent pain, guarding → possible strangulation

What Are the Symptoms of Appendicitis?

Almost every acute appendicitis begins with abdominal pain: initially dull or vague around the umbilicus; in roughly 70-80% of adults it migrates to the right lower quadrant (McBurney point) within 6-8 h and is worsened by coughing, walking, or pressure. Sudden spread suggests possible perforation.

Nausea, vomiting, and loss of appetite accompany the pain; vomitus is usually gastric, and children may vomit more often.

Temperature is usually low-grade (37-38℃); with suppuration or perforation it may exceed 38.5℃ and be accompanied by chills and malaise.

Altered bowel motility causes constipation or diarrhea; a pelvic appendix may irritate the rectum, producing tenesmus and urinary frequency.

When inflammation reaches the peritoneum, rebound tenderness and guarding appear; board-like rigidity with absent bowel sounds signals diffuse peritonitis.

An inflammatory mass or abscess may be palpated in the right lower quadrant with local warmth, indicating peri-appendiceal abscess.

Specific signs include Rovsing (right lower pain on left-side compression), psoas (pain on hip extension), and obturator (pain on hip flexion–internal rotation) signs.

Elderly patients feel less pain and may appear only mildly ill despite gangrene; in pregnancy the appendix is displaced upward, so pain is higher than the classic McBurney point.

Key Symptoms/Signs	Typical Presentation
Migrating RLQ pain	Umbilical → McBurney point, movement/cough ↑
Nausea & vomiting	Anorexia, gastric vomitus
Low-grade fever	37-38℃, rises if perforation
Bowel changes	Constipation or diarrhea
Peritoneal signs	Rebound, guarding, rigidity
Inflammatory mass	Palpable, warm, tender
Specific maneuvers	Rovsing, psoas, obturator positive
Atypical variants	Elderly: subtle; Pregnancy: higher pain

What Are the Symptoms of Intestinal Fistula?

An intestinal fistula is an abnormal passage between the bowel and another organ or the skin, allowing digestive fluid, food residue, or stool to leak, producing a spectrum of clinical manifestations.

The most common symptom is abdominal pain, usually persistent or colicky, located in the segment where the fistula arises.

Diarrhea is frequent, with watery or pasty stools caused by loss of digestive fluid and reduced absorptive surface.

Fever indicates accompanying infection, presenting as remittent or sustained high temperature, often with chills.

Rapid weight loss with fatigue and poor appetite results from malabsorption and hyper-catabolism.

When the tract opens into the bladder, pneumaturia, fecaluria and recurrent urinary tract infections occur; when into the vagina, passage of gas, fluid or stool is noted.

A cutaneous opening on the abdominal wall or perineum drains feculent fluid continuously, causing local pain, erosion, and excoriation.

In the acute postoperative phase sudden severe abdominal pain, guarding, tachycardia and hypotension may signal diffuse peritonitis or sepsis.

#	Symptom / Sign	Description
1	Abdominal pain	Persistent or colicky, localized to the involved segment
2	Diarrhea	Frequent watery or pasty stools from fluid loss & poor absorption
3	Fever	Remittent or sustained high temperature with chills; implies infection
4	Weight loss & fatigue	Rapid loss plus anorexia due to malabsorption & hyper-catabolism
5	Pneumaturia / fecaluria	Gas or stool in urine when fistula opens into bladder
6	Recurrent UTI	Repeated urinary infections from bacterial contamination
7	Vaginal passage of gas/stool	Noted when tract communicates with vagina
8	Cutaneous drainage	Continuous feculent fluid from abdominal/perineal opening
9	Skin erosion & excoriation	Local pain, redness, breakdown caused by effluent
10	Acute post-operative signs	Sudden severe pain, guarding, tachycardia, hypotension → possible peritonitis/sepsis

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Tag Archives: Abdominal pain

What are the symptoms and manifestations of irritable bowel syndrome?

What Are the Symptoms of Acute Appendicitis?

What Are the Symptoms of Peritonitis?

What Are the Symptoms of Retroperitoneal Hematoma?

What Are the Symptoms of Intestinal Obstruction?

What Are the Symptoms of Appendicitis?

What Are the Symptoms of Intestinal Fistula?

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