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Acute pain represents a sudden occurrence of pain that does not last for a long period while chronic pain indicates an underlying problem that may become take the form of a disease.
Two approaches describe the assessment of Acute Abdominal Pain (AAP), the first one is based on a classification of the abdomen into systems and second is abdominal topography divided into four quadrants. Three types of abdominal pains according to systems are Visceral, parietal and referred. Visceral includes poorly localized pain in hollow or solid organs such as in Epigastric region (stomach, biliary tract, duodenum), Periumbilical (small bowel, appendix) and Suprapubic (colon, sigmoid) that may be due to stretching of fibers innervating the walls. Parietal pain involves localized pain in the parietal peritoneum. Referred pain develops at the different site distant from the pathological organ.
Based on the type of location three categories are designed for AAP, that are:
1. Intra-abdominal that develops within the abdominal cavity such as GI (Appendicitis, Diverticulitis, Pancreatitis, Biliary Tract Disease), Genitourinary (Renal Colic, Acute Urinary Retention / UTI), and Vascular systems (Mesenteric Ischemia).
2. Extra-abdominal that develops outer of the abdominal cavity such as cardiopulmonary, the abdominal wall including Hernia, psychic due to anxiety, or depression, toxic-metabolic, and neurogenic pain.
3. Nonspecific Abdominal pain or NSAP that develops because of various causes but those causes are not sufficiently described.
For differential diagnosis, a proper physical examination is required that should be included in the diagnosis, inspection for any scar or rash, palpation check, and Auscultation for hearing bowel sounds, or any other further hyperactivity.
Acute Abdominal Pain Causes in 20-year-old Male
In an early age, the leading causes of AAP are NSAP while the most common cause is Appendicitis and Diverticulitis (Kraemer et al., 2000). The inception of AAP is linked to the younger age that disappears with the increasing age (emedicine.medscape.com, 2016). The reasons of AAP may include lead, mercury or mushroom toxicity, accidental injury and electrical injury, Opoid withdrawal and several metabolic causes.
Chronic Abdominal Pain Causes in 20-year-old Male
Chronic Abdominal Pain (CAP) can continue for a long period or more than three months. For evaluating the condition, it is necessary to assess the vital signs such as fever or body rash, tachycardia, jaundice, and edema. Chronic problems may involve Dyspepsia, Hiccups, Lump in Throat, Rumination, Gas related issues, Inflammatory bowel disease, Diarrhea and constipation, Irritable bowel syndrome, Liver Disorders, Gallbladder and Pancreatic disorders, and Parasitic infections (giardiasis) (Kreis et al., 2007).
Rationale for differential diagnoses in 20-year-old male
The patient’s complaint indicates numerous possibilities, so it is necessary to have a differential diagnosis with a Patient-centered model of clinical reasoning. It will facilitate the efficient treatment plan for the patient. At the age of 20, most problems are simple but a minute fault can result in severe outcomes. The major steps in a differential diagnosis include historical clues, physical findings and ancillary results of the patient (Beirman, 2011).
Acute Abdominal Pain Causes in 50-year-old Male
In patients of 50 years, the leading causes of AAP include Biliary Tract Disease, NSAP, Appendicitis, diverticulitis and intestinal obstruction. At an elder age AAP can turn into fatal complication such as diverticulitis (Kraemer et al., 2000).
Chronic Abdominal Pain Causes in 50-year-old Male
In older adults CAP indicates the risks of cancer including colon, pancreatic, stomach, and pancreatic cancer. Other problems are Cholecystitis, pancreatitis, hepatitis, parasitic infections, peptic ulcers and Kidney and urinary tract disorders.
Rationale for differential diagnoses in 50-year-old male
Abdominal pain is a common complaint of older adult patients. Changes in the biliary system due to increasing age make older people more prone to acute cholecystitis, leading to the surgical requirement. Appendicitis in this age group shows higher mortality rate in comparison of the young populace because most of the time it results in perforation. Use of medicines, alcohol and gallstones elevate the risk of pancreatitis at this advanced age that is a leading reason for poor prognosis. According to a retrospective study morbidity and mortality in the older age group is two times higher. More than half of the cases of AAP at older age require immediate hospitalization and 20-30% need immediate surgery (Lyon & Clark, 2006).
References
Beirman, R. (2011). Cases in differential diagnosis for the physical and manipulative therapies.
Elsevier Australia.
Emedicine.medscape.com,. (2016). Abdominal Pain in Elderly Persons: Background,
Pathophysiology, Etiology. Retrieved 25 January 2016, from
http://emedicine.medscape.com/article/776663-overview#a6
De Dombal, F. T. (1994). Acute abdominal pain in the elderly. Journal of clinical
gastroenterology, 19(4), 331-335.
Lyon, C., & Clark, D. C. (2006). Diagnosis of acute abdominal pain in older patients. American
family physician, 74(9), 1537-1544.
Kraemer, M., Franke, C., Ohmann, C., Yang, Q., & Acute Abdominal Pain Study Group. (2000).
Acute appendicitis in late adulthood: incidence, presentation, and outcome. Results of a
prospective multicenter acute abdominal pain study and a review of the literature.
Langenbeck's archives of surgery, 385(7), 470-481.
Kreis, M. E., Koch, F., Jauch, K., & Friese, K. (2007). The Differential Diagnosis of Right
Lower Quadrant Pain. Deutsches arzteblatt-koln-, 104(45), 2645.
