Abdominal Pain

   There are two forms of cholecystitis: acute and chronic. Acute involves inflammation of the gallbladder that results in abdominal pain during a specific episode. Chronic cholecystitis involves inflammation of the gallbladder with a greater duration. Damage to the gallbladder can lead to a scarred and thickened organ, which can ultimately lead to inability of the gallbladder to store and release bile.^8,13,14

   The patient with cholecystitis may report having eaten a meal that included fried, greasy, spicy or fatty food. There is often acute, crampy pain in the right upper quadrant that tends to last more than six hours. The discomfort may also radiate to the right shoulder and may increase with inspiration. Murphy's sign refers to increased pain and interruption of inspiration during palpation of the right upper quadrant. The patient may experience fever, chills, nausea and vomiting, as well as symptoms similar to a myocardial infarction, such as epigastric discomfort that radiates to the shoulders.^8,13,14

DIVERTICULITIS

   The large intestine is a tube-like structure that stores and eliminates waste material. As an individual ages, pressures within the colon result in bulging sacs in the wall of the bowel. When this out-pouching occurs in the bowel wall, it is called a diverticulum. When there is more than one bulging area, they are called diverticula. The presence of diverticula in the colon is referred to as diverticulosis.^15,16

   When a diverticulum becomes inflamed it is called diverticulitis. The patient with diverticulitis may have few or no symptoms. If they are present, symptoms may be vague and can include nausea, vomiting, diarrhea, chills and abdominal pain. The pain often begins in the hypogastric area (below the umbilicus) and then becomes more prominent in the lower left quadrant. The patient may develop a fever, tenderness over the left lower quadrant and rebound tenderness.^15,16 Diverticulitis may result in perforation of a diverticulum or local abscess formation.

INTESTINAL OBSTRUCTION

   Intestinal obstruction can be caused by either mechanical or neurologic conditions and may occur within the small or large bowel. Mechanical causes include adhesions from previous surgeries, entrapment of intestine within a hernia, tumors, or twisting of the intestine. Neurologic causes are a result of alterations in peristaltic wave action of the intestinal wall. This results in backup of gas, secretions and intestinal contents. In either mechanical or neurological intestinal obstruction, the patient often experiences a crampy discomfort that is located in the periumbilical or suprapubic area. Abdominal distention, nausea and vomiting may result. Abdominal distention may result from the section of bowel that fills with intestinal contents.^8,17

   Other causes of intestinal obstruction include medication, intraperitoneal infection, impaired abdominal blood supply, kidney or thoracic disease, and metabolic abnormalities.^8,17

PANCREATITIS

   The pancreas is a large gland located behind the stomach. It secretes enzymes through the pancreatic duct into the small intestine to assist in digestion of food and releases insulin and glucagons into the bloodstream. These hormones help the body to metabolize glucose from food.^8,18

   Pancreatitis is acute or chronic inflammation of the pancreas. In acute cases, onset tends to be rapid and may last for several days. Symptoms tend to develop quickly, with mild to severe upper abdominal pain often centered in the mid-epigastric area. The pain often radiates to the back and/or the chest, may be consistent for several hours, and may increase with eating or alcohol use. The patient may curl into fetal position or bend forward for relief. Symptoms will typically include nausea and vomiting. The patient's abdomen may be swollen and tender.^8,18

   Chronic pancreatitis generally develops gradually and can persist for years. These cases often develop as the result of continuous damage to the pancreas. In addition, the pancreas and surrounding tissue may sustain extensive damage before symptoms develop. Once symptoms occur, they are usually intermittent initially and become constant over time. The patient will often experience nausea, vomiting, fever and weight loss. Oily and malodorous stool may develop from poor digestion.^8,18

RENAL COLIC