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Table 37-1

Some Important Causes of Abdominal Pain

Pain Originating in the Abdomen

Parietal peritoneal inflammation

Bacterial contamination

Perforated appendix or other perforated viscus

Pelvic inflammatory disease

Chemical irritation

Perforated ulcer

Pancreatitis

Mittelschmerz

Mechanical obstruction of hollow viscera

Obstruction of the small or large intestine

Obstruction of the biliary tree

Obstruction of the ureter

Vascular disturbances

Embolism or thrombosis

Vascular rupture

Pressure or torsional occlusion

Sickle cell anemia

Abdominal wall

Distortion or traction of mesentery

Trauma or infection of muscles

Distension of visceral surfaces, e.g., by hemorrhage

Hepatic or renal capsules

Inflammation

Appendicitis

Typhoid fever

Neutropenic enterocolitis or “typhlitis”

Pain Referred from Extraabdominal Source

Cardiothoracic

Acute myocardial infarction

Myocarditis, endocarditis, pericarditis

Congestive heart failure

Pneumonia (especially lower lobes)

Pulmonary embolus

Pleurodynia

Pneumothorax

Empyema

Esophageal disease, including spasm, rupture, or inflammation

Genitalia

Torsion of the testis

Metabolic Causes

Diabetes

Uremia

Hyperlipidemia

Hyperparathyroidism

Acute adrenal insufficiency

Familial Mediterranean fever

Porphyria

C1-esterase-inhibitor deficiency (angioneurotic edema)

Neurologic/Psychiatric Causes

Herpes zoster

Tabes dorsalis

Causalgia

Radiculitis from infection or arthritis

Spinal cord or nerve root compression

Functional disorders

Psychiatric disorders

Toxic Causes

Lead poisoning

Insect or animal envenomation

Black widow spider bites

Snake bites

Uncertain Mechanisms

Narcotic withdrawal

Heat stroke