Abdominal pain classification

Resident Survival Guide

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Abdominal pain can be classified into three categories: acute abdomen, recurrent, and chronic functional. Abdominal pain is traditionally described by its chronicity (acute or chronic), progression over time, nature (sharp, dull, colicky), characterization of the factors that worsen or alleviate pain, and distribution of the pain.

Acute abdomen refers to a sudden, severe pain in the abdomen that is less than 24 hours in duration. It is in many cases an emergency condition requiring urgent and specific diagnosis, and the treatment usually involves surgery.

Acute abdomen is occasionally used synonymously with peritonitis. This is not incorrect; however, peritonitis is the more specific term, referring to inflammation of the peritoneum. It is diagnosed on physical examination as rebound tenderness, or pain upon removal of pressure rather than application of pressure to the abdomen. Peritonitis may result from several diseases, notably appendicitis and pancreatitis.

Vascular disorders are more likely to affect the small bowel than the large bowel. Arterial supply to the intestines is provided by the superior and inferior mesenteric arteries, SMA and IMA respectively, both of which are direct branches of the aorta.

As with other difficult to diagnose chronic medical problems, patients with recurrent abdominal pain (RAP) account for a very large number of office visits and medical resources in proportion to their actual numbers. RAP can be classified under the Rome II criteria as one of the following:^[1]

• Abdominal migraine
• Aerophagia
• Functional abdominal pain
• Functional dyspepsia
• Irritable bowel syndrome

Chronic functional abdominal pain (CFAP) is the ongoing presence of abdominal pain for which there is no known medical explanation.

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