Common Diseases

When Abdominal Pain strikes....

Abdominal pain is such a commonly occurring symptom that it is sometimes difficult to judge when it is due to a serious problem requiring immediate medical attention.

However the pain itself may be a most useful pointer to the underlying disease and in that respect, we must admit that pain serves as an important protective mechanism and forms a key to early diagnosis and timely treatment.

Dr. Sarojini A. Parameswaran Consultant, Gastroenterology, Apollo Hospitals, Chennai, gives a brief account on abdominal pain, and discusses the causes and also when it is absolutely essential to rush to the emergency.

Types of Abdominal Pain:

Visceral pain is experienced when pain receptors in the abdominal organs are stimulated. The pain is usually dull, difficult to pinpoint to a particular location and is felt in the midline. It is generally described as cramping, gnawing or burning and is often accompanied by sweating, nausea and vomiting. The person suffering from visceral pain is often restless and constantly moves about in an attempt to relieve the discomfort. An example is the pain of intestinal obstruction.

Somatoparietal pain arises from irritation of the lining of the abdominal cavity (peritoneum). It is more intense and more precisely localized than visceral pain; and is aggravated by movement, coughing or sneezing; so that the sufferer lies absolutely still in order to reduce the pain. Another characteristic feature of peritoneal irritation is a relief spasm of the abdominal musculature, localized to the involved area. An example of this kind of pain is that caused by irritation of the peritoneal lining by acid gastric juice due to a perforated peptic ulcer.

Referred pain is felt in areas far away from the diseased organ due to the nerve supply arising from the same spinal segments. Pain arising from the gallbladder, for instance may be felt in the right upper back or shoulder. There are some characteristics of abdominal pain such rapidity of onset, location duration and intensity that can give the physician as well as the patient some idea about the cause.

  • Pain that is of sudden onset severe and well localized is likely due to an intra abdominal catastrophe such as a perforation.
  • Pain is self-limiting and subsides in disorders such as gastroenteritis.
  • Pain in the upper abdomen above the naval can be from pancreatitis of from a performed peptic ulcer.
  • Pain in the right upper portion of the abdomen could be from the gallbladder or liver.
  • Pain originating in the small intestine is felt around the umbilicus.
  • Pain can also spread from its original site to another as in appendicitis, where it starts around the umbilicus and then spreads to the right lower portion of the abdomen.
  • Although it is hard to be objective about the pain intensity due to variations in the pain threshold among individuals, the severity of pain is loosely related to the magnitude of the disease process.
  • The character of the pain (dull aching spasmodic, crampy or severe boring) can also suggest its origin.

Causes of abdominal pain:

Acute Appendicitis:

This usually begins with vague pain around the umbilicus and nausea. Within 6 to 8 hours, the pain moves to the right lower portion of the abdomen and tenderness (ie, severe pain when this area is pressed) occurs along with low-grade fever.

Acute Cholecystitis:

This is an inflammation of the gallbladder usually secondary to gallstones and is characterized by pain in the right upper abdomen, which radiates to the right upper back and shoulder. Accompanying symptoms include nausea, vomiting, low-grade fever with chills and obvious jaundice; it could be due to stones in the bile ducts with infection.

Acute Pancreatitis:

This usually begins with acute-onset upper abdominal pain that rapidly increases in severity and radiates to the back or left shoulder. It is a constant unrelenting pain which is often reduced by sitting up and leaning forward. There is associated nausea, vomiting, abdominal bloating and 'tightness' with inability to pass wind or motion. In severe cases there may be a rapid heart rate, drop in blood pressure and breathing difficulty. The common causes of acute pancreatitis are alcoholism and gallstones and hence a history of chronic alcohol intake or a recent binge, or a known of gallstones will be useful.

Performed Duodenal Ulcer:

As already mentioned, the pain is sudden, sharp, intensely severe and present initially over the upper abdomen and later spreads to the entire abdomen. Movement increases the pain and there may be an increase in heart rate and difficulty in breathing. Fever and drop in blood pressure may happen within a few hours.

Acute Small Intestinal Obstruction:

This produces crampy pain around the naval associated with abdominal distension and vomiting of copious amounts of bilious material, restlessness, fever, increase in heart rate and sometime audible intestinal rumbles.

Acute Gastroenteritis:

This is characterized by cramps around the navel, with diarrhea, sometimes with blood and mucus, with or without vomiting and fever. Most cases are self-limiting or respond rapidly to antibiotics and fluid replacement. There may be a history of other family members or friends affected at the same time. Gynaecological causes, such as endometriosis, twisted ovarian cyst or ruptured tubal pregnancy and urological causes such as kidney stones should not be overlooked.

Abdominal pain can also originate from disorders involving extra abdominal organs and systemic illnesses. Examples include acute myocardial infarction (heart), pneumonia (lung), disc prolapse, spinal cord tumors (nervous system), metabolic (renal failure diabetes), toxic (lead poisoning), infections (herpes zoster) and muscle contusions or haematomas.

It is therefore extremely important to consult the nearest physician or the Emergency Department when one has abdominal pain with any of the characteristics described above. Even if the cause of the pain turns out to be innocuous, it is better to err on the side of caution than to land up with an abdominal catastrophe!

OBESITY - A Cops Nightmare

It is not uncommon for a policeman to be portrayed as a "pot belled" unfit individual...

Yet we all know that the Physical fitness selection process of the police force is only second to the Military! The reason for some of this these young fit recruits becoming "Pot Belled" is the mismatch of the food intake and the energy expenditure in the form of physical exercise. Sure the long hours of work, inadequate rest and lack to access to healthy food also compounds the weight gain problem. This article is aimed at creating awareness about this difficult disease.

Obesity one of the deadliest diseases taking epidemic proportions in our country. Affecting up to five per cent of the country's population it is going to become a serious social problem in the days to come. Obesity and associated medical conditions have been taking their toll on Indians like elsewhere in the world. India is following the trend of other developing countries that are steadily becoming more obese. The access to unhealthy cheap processed food and the adoption of sedentary lifestyle amongst the urban middle-class has lead to the growth of this disease at an exponential rate.

According to statistics, the prevalence of overweight adults among urban population is more than 30%. This is ironically the situation in India even as the poorest of poor battle hunger and starvation.

Obesity is commonly calculated using BMI. An adult with a BMI of 28 or greater is clinically obese. It has been established that the percentage body fat content of Indians is very high as compared to a Western Individual. A simplest way to calculate ideal body weight is to minus 100 from ones height in centimeters (For example if a person's height is 150 cms, then his/her ideal body weight should be below 50kgs. i.e., 150cms - 100).

Obesity is related to excess intake of calories by an individual than over an extended period of time. These "extra" calories are stored in the body as fat. Although there are several factors that may lead to this energy imbalance in obese individuals, the main contributors are behavior, environment and genetics.

Genes: Genetics plays a major role in ones predisposition for obesity. Upto 80% of severely obese individuals have a genetic tendency.

Behavioral Factors: Parents and immediate family have a major impact in a child's behavior molding which in turns determines healthy eating and exercising habits.

Environmental factors: In today's fast-paced urban environment, it is easy to adopt unhealthy lifestyle habits. Access to play areas and parks in the neighborhood has major impact in promoting healthier lifestyle.

There are more than 30 medical conditions that are associated with obesity. Individuals who are obese are at risk of developing one or more of these serious medical conditions, causing poor health or, in severe cases, early death. The most prevalent obesity-related diseases include Diabetes, High blood pressure, High cholesterol, Heart disease, Stroke, Gallbladder disease, Reflux Disease (GERD), Osteoarthritis, Sleep apnea, respiratory problems and some forms of cancers.

Individuals affected by obesity often face obstacles far beyond health risks. Emotional suffering may be one of the most painful parts of obesity. Society often emphasizes the importance of physical appearance. As a result, people who are obese often face prejudice or discrimination at school, in social situations and work place, which have serious consequences for their personal and psychological well being. The consequences of this discrimination can seriously impact an individual's quality of life and only further intensify the negative stigma associated with obesity.

Obesity treatment strategies vary from person to person. Beginning treatment early is an essential part of success. There are several methods for treating obesity, such as behavior modification, physical activity, medically managed weight-loss and surgical treatment.

While plenty of diets and slimming products claim to offer quick fixes, obesity is not something that can be cured or brought under clinical control within a few weeks or months. Treatment such as diet and exercise may need to continue for years. Weight-loss plans from a dietician are an effective way to lose weight, but a greater challenge is to achieve a way of life that maintains weight and reduces the chances of putting it back on. This can only be achieved sensible eating and regular exercise habits. With Obesity (Bariatric) surgery options that are available today one can hope that severely obese people will permanently benefit and have a better quality of life by getting rid of obesity and associated disorders.

Dr. Ravindran Kumeran, FRCS
Laparoscopic Obesity Surgeon

Author can be contacted at
Obesity Helpline: +91 9841041141


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