Written by Dr.Md.Redwanul Huq (Masum)

Saturday, 03 March 2012 05:58

Causes of abdominal distension:

* Fat (physiological)

* Fluid (e.g. ascites, large ovarian cyst)

* Flatus (e.g. increased gas formation, intestinal obstruction)

* Feces (e.g. constipation)

* Fetus ( in female during pregnancy).

Causes of abdominal pain:

Abdominal causes:

1) Hepatic causes: Hepatitis, liver abscess, hepatoma

2) Gall bladder related cause: Cholecystitis, Empyema of gall bladder

3) Bile duct related cause: Biliary colic

4) Gastric causes: Peptic ulcer diseases, gastritis

4) Pancreatic cause: Acute and chronic pancreatitis, pancreatic pseudo cyst, carcinoma of head of pancreas

5) Renal cause: Pyelonephritis, Renal stone

6) Intestinal causes: Intestinal obstruction or perforation

7) Appendix related causes of abdominal pain: Acute or chronic appendicitis, appendicular abscess

8) Peritoneum related cause: Peritonitis

9) Uterus related cause: Fibroid uterus

10) Uterine tube related cause: Salpingitis

11) Ovary related cause: Large or twisted ovarian cyst

12) Ureteric cause: Uteretic infection or colic.

Extra-abdominal (thoracic) causes:

1) Cardiac cause: MI resulting epigastric pain

2) Pulmonary cause: Basal pneumonia.

Causes of Ascites:

Common causes of ascites are–

a) Chronic liver disease (CLD)

b) Nephrotic syndrome

c) CCF

d) Protein losing enteropathy (hypoalbuminemia).

Uncommon causes of ascites are–

a) Abdominal TB

b) Abdominal malignancy

c) Acute pancreatitis

d) Bacterial peritonitis.

Causes of bloody diarrhea:

Infectious causes:

1. Shigella dysenteriae
2. E. histolytica
3. Campylobacter jejuni
4. Cl. Difficile
5. Enterohaemorrhagic E. coli
6. Salmonella
7. Enteroinvasive E. coli
8. V. parahaemolyticus

Non infectious causes:

1. Inflammatory bowel disease
2. Diverticular disease
3. Ischemic colitis
4. Colonic or rectal carcinoma

Causes of bright rectal bleeding:

1. Hemorrhoids

2. Anal fissure

3. Colorectal polyps

4. Colorectal malignancy

5. Inflammatory bowel diseases

6. complicated diverticular disease

7. Ischaemic colitis.

Causes of central abdominal pain:-

i) Acute pancreatitis

ii) Intestinal obstruction

iii) Appendicitis.

Causes of chest pain due to abdominal causes:

1) Hepatic cause: Liver abscess

2) Gall bladder related cause: Cholecystitis

3) Gastric cause: Peptic ulcer disease.

Causes of diarrhea (watery):

Causes of diarrhea are-

1. Rota virus
2. Vibrio cholerae
3. Entero-toxigenic E. coli
4. Salmonella
5. Cryptosporidium
6. Entero-pathogenic E. coli

Causes of enlarged tender liver:

a) Hepatitis

b) Liver abscess

c) Hepatoma (HCC)

d) Congestive cardiac failure (CCF)

e) Cholengitis

f) Cholengio-hepatitis

g) Budd-chiarry syndrome (Thrombosis of hepatic vein).

Causes of haematemesis & melaena:

1) Bleeding PUD

2) Drugs (e.g. NSAIDs) induced,

3) Ruptured esophageal varices due to CLD,

4) Erosive gastritis,

5) Esophagitis,

6) Carcinoma of stomach

7) Bleeding disorder.

Causes of huge hepatomegaly:

a) HCC

b) Chronic malaria

c) Chronic kala-azar

d) Chronic myeloid leukemia (CML)

e) Congenital hemolytic anemia (Thalassemia).

Causes of huge hepato-splenomegaly or huge splenomegaly:

i) Chronic malaria

ii) Chronic kala-azar

iii) CML

iv) Lymphoma

v) Congenital hemolytic anemia (Thalassemia).

Causes of huge renomegaly:

a) Renal cell carcinoma,

b) Polycystic kidney disease

c) Hydronephrosis.

Causes of lump in right iliac fossa:

1) Appendicular lump or abscess,

2) Carcinoma of colon,

3) Tubercular mass ( Ileo-ceacal TB)

4) Right ovarian cyst or malignancy,

5) Amoeboma

6) Kidney malformation (Renomegaly) on right side

7) Fetus,

8) Dropped right kidney,

9) Huge hepatomegaly,

10) Huge splenomegaly.

Causes of non-tender hepatomegaly:

i) Chronic malaria

ii) Chronic kala-azar

iii) Leukemia

iv) Lymphoma

v) Congenital hemolytic anemia

vi) Enteric fever.

Causes of only hepatomegaly (No splenomegaly):

a) CCF

b) Viral hepatitis

c) Amebic liver abscess

d) HCC.

Causes of only splenomegaly (No hepatomegaly):

a) Cirrhosis of liver

b) Hypersplenism

c) Enteric fever

d) Infective endocarditis.

Causes of PUD

Most important causes are-

1.Helicobacter pylori infection

2.Non Steroidal Anti-Inflammatory Drugs (NSAIDs)

3.Smoking.

Other causes are-

1.Chemotherapy

2. Glucocorticoids (along with NSAIDs)

3. Clopidogrel

4. Bisphosphonates

5.Alcohol

6.Infection with Herpes simplex virus, Cytomegalovirus or Helicobacter heilmanni

7. Gut ischemia

8.Hypovolemia

9.Shock

10.Duodenal obstruction

11.Radiation therapy

12.Crohn’s disease

13.Zollinger Ellison Syndrome

14.Sarcoidosis.

Causes of upper abdominal pain:-

Abdominal causes:

1.Hepatitis

2.Liver abscess

3.Hepatoma

4.Cholecystitis

5.Gastric & duodenal ulcers.

Thoracic causes:

a) MI

b) Basal pneumonia.