Abdominal pain

“ It should be noticed whether the abdomen is normal or whether it is distended and hard.
Strength or weakness is indicated to some extent by the way the patient moves, and by his ability to walk, stand, sit, hold up his head, feed himself, or turn in bed without assistance. The position he habitually takes is sometimes significant; in heart affections, for instance, he may be unable to lie down, in pleurisy he ordinarily lies on the affected side, and during abdominal pain he generally draws the knees up. ”

“ While the pain lessens or ceases as the abdominal affection advances, the purging, on the other hand, continues, often it increases. Purging, succeeding to constipation and to pain, and remaining after the subsidence of the pain, affords an infallible indication of abdominal disease. ”

“ The patients usually suffer from abdominal symptoms, varying from a colicky pain due to obstruction at a flexure or at the sigmoid, or to a flatulent distension of the stomach or intestine due to decomposition produced by the delay in evacuation of the contents, or to the presence of a pancreatitis or of gall-stones. ”

“ It is more common in women than in men, possibly due to lacing and the relaxations of the muscles of the abdomen from pregnancy. It may come from wounds, lifting too heavy articles, emaciation.
Symptoms.—They are often absent. There may be pain or dragging sensation in the loins, or intercostal neuralgia; hysteria, nervousness, nervous dyspepsia and constipation are common. The kidney can be felt. A dull pain is caused by firm pressure. Sometimes there are attacks of severe abdominal pain, with chill, fever, nausea, vomiting and collapse. The kidney becomes large and tender. ”

“ During the remissions sensations of distress, of burning, or of dull pain are experienced at the pit of the stomach; during the exacerbations, which may last several days, the pain becomes extremely acute and lancinating and extended in distribution. The ingestion of food and pressure upon the epigastrium have no constant effect upon the pain. Quick movements of the body from side to side often increase it and excite exacerbations. The suffering is greatest in the erect posture, and on this account the patient bends his body forward so as to relax the abdominal muscles. ”

“ Dyspeptic disturbances are rarely absent during the climacteric period. Most often we see disordered appetite, sluggish digestion, pyrosis, eructation, at times nausea and retching, and actual vomiting of a watery or bilious fluid. Occasionally, an abnormal sensation of hunger follows each meal, associated, however, with a feeling of distension of the stomach. A very distressing symptom is an excessive formation of gas within the intestine. At times such meteorism is extreme, and it then gives rise to very severe abdominal pain. ”

“ The contents of the stomach are first ejected, and this is followed by severe retching and vomiting of thin fluid of bilious appearance and bitter taste. The diarrhoea which accompanies or succeeds the vomiting, and is likewise of bilious character, is attended with severe griping abdominal pain, while cramps affecting the legs or arms greatly intensify the suffering. The effect upon the system is rapid and alarming, a few hours of such an attack sufficing to reduce the strongest person to a state of extreme prostration. ”

“ After a period which varies much in different cases, inflammation, suddenly or gradually, is set up, and all the symptoms of acute obstruction are presented, grafted on signs of chronic occlusion. We have pain, nausea, vomiting, great distension and tenderness of the abdomen, peristalsis plainly seen and felt if the abdominal wall is thin, the small, frequent, wiry pulse, clammy perspiration, prostration with hiccough, tendinous twitchings, and death, very like that following a case of external strangulated hernia. ”

“ Persons addicted to the use of tobacco or alcohol and to dissipations of various kinds may become predisposed to enteralgia. Idiosyncrasy is a predisposing cause.
Enteralgia is often secondary to ovarian, uterine, or other distant disease. Also, owing to intimate sympathetic relations, pain is often felt in the bowels as a result of disease situated in some of the solid abdominal viscera, as the liver, spleen, and pancreas. In the same way, organic affections of the brain and spinal cord, especially acute myelitis and spinal sclerosis and lesions of the vertebral bones, excite intestinal pain. ”

“ Pain of the abdomen upon pressure, and especially upon pressure in the epigastrium, is much less seldom absent than pain of which the patient spontaneously complains.
5. Pain, though it may usher in the abdominal affection, and may even be severe for the first few days, diminishes after a certain time and then ceases altogether, so that it is extremely rare, after the tenth day of fever, for instance, for the patient to complain of pain of the abdomen, even when the abdominal affection is the most intense. ”

“ In a general way, any abdominal pain that does not yield in 24 hours to rest in bed with application of external heat, should call for the advice of a physician. Any severe attack of vomiting or diarrhea, accompanied by temperature, and not immediately traceable to some indiscretion in diet, is cause for study, and if improvement does not soon show itself, a physician should be called. ”

“ Corpulent persons, and those indulging in over-stimulating diet, or in the habitual use of fermented drinks, are most liable to be troubled by them.
Symptoms. The patient is suddenly seized with excruciating pain in the right side. After a time it subsides, but is again renewed with as great severity as before. There is nausea, with vomiting, which is often excessive and severe. The pulse is sometimes slower than is natural, the extremities are cold, there is great exhaustion, together with perspiration and spasmodic contraction of the abdominal muscles. ”

“ DIAGNOSIS.—The acute variety is known by the seat of the abdominal symptoms, the pain, distension, and movement of gas not being in the stomach, but in the intestines. The pain is like colic; the abdomen is sensitive to the touch; tympanites is general and may be very great. If vomiting occurs, the symptoms continue after the stomach is empty. Diarrhoea may quickly come on, and is followed by relief. The fever may be quite high. There is no sleep, but restlessness, and in children delirium. They may also have convulsions. ”

“ In another case the patient, a man aged sixty-seven, was very liable to attacks of intermittent abdominal agony, in which one could hardly doubt that the pain was located in the colon, and was attended with paralytic distention of the bowel ”

“ During the throes of pain—for it is paroxysmal—the outline of the distended gut can be felt and seen through the abdominal walls if they are thin and free from fat. Unless the stricture is relieved the patient gradually dies from asthenia. Inflammation is often absent throughout, but enteritis or peritonitis may come on, or perforation and peritoneal extravasation ensue and hasten the fatal termination. ”

“ The assault is sudden and violent, with shivering, headach, especially in the temples and eyes, giddiness, nausea, sickness of the stomach, and vomiting of bile in large quantity, pains darting through the lower region of the abdomen, and reaching up to the stomach, with extreme sensibility and tenderness, on being pressed with the hand, or by coughing or vomiting: the pain is felt between the stomach and navel, and is higher than in the inflammation of the womb ”

“ The pain in the abdomen is constant, intense and burning in its character, felt most at the navel; the abdomen is extremely tender to pressure, and often bloated or tympanetic.
Thirst is intense, but cold drinks distress and vomit the patient. The pulse is small, feeble and frequent, and the bowels costive. This is a very dangerous disease. It is sometimes connected with inflammation of the stomach, then called gastro-enteritis. The tongue is then red and pointed, the nausea and vomiting are more violent and constant, the thirst burning and insatiable. ”

“ There is generally also severe pain at the pit of the stomach, trembling of the limbs, scanty urine, and collapse. Marks of violent inflammation are found after death in the stomach and along the intestinal canal. ”

“ Disturbance of the stomach with increase of saliva in the mouth as if emesis must occur, with stinging pains in the forehead and cold over the whole body, without thirst or feeling of heat following.
Hunger almost all the time.
Pain across the stomach as if a blow had been received.
The pain persists even after thirty-six hours.
On account of the severe pain in the stomach can only breathe slowly and carefully.
The pains in the stomach extend to the chest, causing oppression thereof, and then pass into the shoulders, with much belching and alternating pains in the throat and in the spine. ”

“ But we are liable to be misled by pain: gastric pain is not a characteristic symptom; subacute forms of the disease may exist without any fixed pain; the sensation is rather that of burning, uneasiness, and oppression of the epigastric region. The appetite, as a rule, is greatly impaired—indeed, the sense of hunger is rarely experienced—and nausea and vomiting frequently follow the ingestion of food. This is especially the case when catarrh of the stomach is associated with renal disease, portal congestion, or chronic alcoholism. ”

“ INTESTINAL COLIC. (Enteralgia) .—Causes.—Predisposing; poor general condition, worry, over-work, nervous disposition. Exciting causes; exposure, gas in the bowels, mass of feces, undigested or irritating food, cold drinks, green fruit, ice cream when a person is very warm.
Symptoms.—Intermittent pain usually in the umbilical (navel) region, moving from place to place, dull or sharp pain, relieved by pressure or bending forward. Abdomen is distended or drawn back. It lasts a few minutes or many hours, ending gradually or suddenly, after a passage of gas or movement of the bowels. ”

“ When the pain and chill come on, disturbances of the digestive organs ensue. When a large vein of the portal system is occluded, the remaining veins must be over-distended, and congestion of a part or of all of the digestive tract will be a result. An acute gastric catarrh is set up. The appetite is lost, the stomach becomes irritable, and vomiting is a usual incident. ”

“ Whatever may be the explanation, it is a fact that the type of trauma which results from fighting corresponds closely with that which causes the most shock in the experimental laboratory. Division of the intestines with a sharp knife causes no pain, but pulling on the mesentery elicits pain. Ligating the stump of the appendix causes sharp, cramp-like pains. Sharp division of the gall-bladder causes no pain, but distention, which is the gall-bladder's most common pathologic state, produces pain. ”

“ Lesions of any sort seated in the intestinal wall, as ulcers and neoplasms, induce paroxysmal pains.
SYMPTOMS.—The pain of enteralgia occurs in attacks which come on slowly and continue for a variable time—some hours or days. The pain is situated about the umbilicus, and is relieved by deep pressure, although at the same time there may be hyperæsthesia of the skin. The intensity of suffering ranges from a dull heavy pain to one which is acute and lancinating. Retraction of the abdomen is common, but there may be tympanites. ”

“ But this is not all; for in bilious complaints, when the stomach is most disordered, bitters never fail of making evil worse. The stomach is a delicate viscera, and should ever be the most cautiously dealt with. Whatever part of the human body is in exquisite pain, the stomach 226from the nervous consent always partakes, and is apt to be depraved in its functions; whence a nausea is liable to ensue; and in such a case any stimulants, particularly where bitters are concerned, is ever of evil tendency. ”

“ If this is not attended to, and several days, perhaps a week, pass by without the bowels being relieved at all, pain in the head, a foul tongue, and an increased degree of fulness and tension of the abdomen, are experienced. These symptoms are followed, in all probability, by thin watery evacuations, attended with pain, weight, and pressure about the lower bowel; they become frequent; and the female at last, finding that the bowels are not only open again, but even loose, takes chalk mixture. ”

“ When the contents of the bowel happen to be watery, the loose stool is spurted out with great force. In this disease diarrhoea alternates with constipation; the intestines become distended with quantities of gas and feces, which provoke frequent and severe attacks of colic; the appetite and digestion fail; the complexion becomes sallow; the patient emaciates; ulceration sets in, and the patient slowly sinks from exhaustion. Usually, these cases do not give rise to much pain, and what there is, is usually referred to the back, thighs, penis, or perineum. ”

“ If the bowels are morbidly influenced by this affection, there is constipation or diarrhea, griping pain, distension of the abdomen, piles, and pain just within the points of the hips, thus indicating irritation of The colon. If the brain or nervous system sensitively responds, there is [pg 571] headache, dizziness, disturbed sleep, depression of spirits, peevishness, capriciousness, lack of energy, irritability, and congestive symptoms. ”

“ Tightness at the stomach, in the evening.
Thirty-ninth day.—At five o’clock in the morning, violent sensation of hunger, with tensive and pressive pain at the stomach; when lying, the pain extends to the umbilical region. 315. The pain during a walk continues; pressure after eating; painful sensation of hunger. Acute pain at the stomach, with constant hunger. Frequent desire to urinate. The urine deposits a white sediment. At noon, pressive pain at the stomach, before and after eating. 320. Acute pain, like a stitch, at the anterior surface of the right lung, which hinders breathing. ”