Stomach pain and vomiting
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Understanding Stomach Pain and Vomiting: Causes and Diagnostic Insights
Stomach pain and vomiting are common symptoms that can arise from a variety of medical conditions. This article synthesizes research findings to provide a comprehensive understanding of these symptoms, their potential causes, and diagnostic approaches.
Acute Appendicitis: Pain Before Vomiting
One significant cause of stomach pain and vomiting is acute appendicitis. A classic diagnostic indicator is the sequence of symptoms, where pain precedes vomiting. This pattern has been shown to have a high sensitivity (95.8%) for diagnosing appendicitis, although its specificity is relatively low (16.6%)1. When combined with the Alvarado score, this symptom pattern can help rule out appendicitis in a significant number of patients without false negatives1.
Gastrointestinal Obstructions and Surgical History
Patients with a history of abdominal surgeries, such as C-sections, may experience symptoms like colicky abdominal pain, nausea, and vomiting due to potential bowel obstructions. High-pitched bowel sounds and the absence of stool passage are key diagnostic clues2. Imaging, such as abdominal x-rays, can reveal obstructions, which are critical for timely intervention.
Ingestion of Toxic Substances
Ingestion of toxic substances, such as cleaning agents, can lead to severe epigastric pain and vomiting. Diagnostic imaging, including CT scans and upper endoscopy, can reveal gas in the stomach and hepatic portal veins, as well as erythema and erosion in the esophagus and stomach3. These findings are crucial for diagnosing and managing the ingestion of harmful substances.
Pediatric Considerations: Acute Abdominal Pain
In children, acute abdominal pain accompanied by nausea and vomiting can be indicative of various conditions, including appendicitis and other gastrointestinal issues. Detailed clinical evaluation and imaging are essential for accurate diagnosis and treatment4.
Functional Gastroduodenal Disorders
Functional gastroduodenal disorders, such as functional dyspepsia and cyclic vomiting syndrome, are characterized by chronic symptoms without an identifiable organic cause. These conditions include symptoms like epigastric pain, early satiation, postprandial fullness, and chronic nausea and vomiting5. Differentiating these functional disorders from organic diseases is crucial for appropriate management.
Cyclical Vomiting and Abdominal Migraine
Cyclical vomiting syndrome and abdominal migraine are episodic conditions marked by intervals of complete health between episodes. These conditions share many clinical features but require different therapeutic approaches. Accurate diagnosis often involves ruling out other potential causes through a combination of clinical evaluation and diagnostic testing8.
Severe Epigastric Pain and Pancreatitis
Severe epigastric pain radiating to the back, accompanied by nausea and vomiting, can be indicative of acute pancreatitis. Elevated levels of amylase and lipase, along with imaging findings, support the diagnosis. This condition often requires prompt medical intervention to manage symptoms and prevent complications7.
Trichobezoar and Gastric Masses
In rare cases, progressive vomiting and abdominal pain can result from trichobezoars, which are masses of ingested hair. These can cause gastric and intestinal obstructions, as seen in an 11-year-old girl with a history of trichophagia. MRI scans and surgical intervention are necessary for diagnosis and treatment10.
Conclusion
Stomach pain and vomiting are symptoms with a broad differential diagnosis, ranging from acute appendicitis and gastrointestinal obstructions to functional disorders and toxic ingestions. Accurate diagnosis relies on a combination of clinical history, physical examination, and appropriate imaging studies. Understanding the underlying cause is essential for effective management and treatment of these symptoms.
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Most relevant research papers on this topic
Is "pain before vomiting" useful?: Diagnostic performance of the classic patient history item in acute appendicitis.
"Pain before vomiting" is useful for identifying acute appendicitis in patients with abdominal pain and vomiting, with a sensitivity of 95.8% and specificity of 16.6% when combined with the Alvarado score.
Rigorous JournalAbdominal Pain, Nausea, and Vomiting
A 38-year-old woman presents to the emergency department with abdominal pain, nausea, and vomiting, and has no other medical problems.
Case ReportYoung Woman With Epigastric Pain and Vomiting
Unintentionally ingesting a cleaning agent from a refrigerator can cause epigastric pain and vomiting, with gas in the stomach and hepatic portal veins.
Case ReportAcute abdominal pain and vomiting in a 10-year-old girl.
A 10-year-old girl presented with severe abdominal pain and vomiting, requiring immediate medical attention.
Case ReportGastroduodenal Disorders
Functional gastroduodenal disorders are chronic symptoms in the gastroduodenal region without a clear organic cause, such as organic gastrointestinal or systemic disease.
Rigorous Journal
Highly CitedMan with abdominal pain
Multiple radiopaque densities in the stomach were found in a 33-year-old man with a history of developmental delay, schizophrenia, and other conditions.
Case ReportSevere Epigastric Pain with Nausea and Vomiting
A 41-year-old woman with severe epigastric pain, nausea, and vomiting may have a bacterial infection.
Case ReportAbdominal migraine and cyclical vomiting.
Cyclical vomiting and abdominal migraine are distinct conditions with different responses to therapies, and careful evaluation is crucial for accurate diagnosis and treatment.
Chest Pain After Vomiting
Chest pain after vomiting in an obese, alcoholic male may be due to a pleural effusion, a condition in which fluid accumulates in the chest due to excessive eating and drinking.
Case Report[A girl with abdominal pain and progressive vomiting].
A large trichobezoar was removed from the stomach in an 11-year-old girl with a history of trichophagia, causing abdominal pain and vomiting.
Case Report