belly of the beast

My stomach hurts. Sounds simple. The abdomen is full of hollow tubes with multilayer walls, lots of blood vessels, solid organs, and even reproductive structures. By convention, the abdomen is divided into four parts called quadrants, right upper and lower and left upper and lower. Any and all of the anatomical structures in the abdomen can go on the fritz and give one a belly ache. Constipation, nervous or acid stomach all sound benign but may represent a life threatening emergency.
The ER doc's investigation always begins with the most urgent and dangerous diagnosis: has an artery or vein sprung a leak. The body's main artery, the aorta, after exiting the heart and making a left handed loop descends south into the abdomen. It gives off branches to the liver, intestines, kidneys, spleen, spine and other stuff. The abdominal aorta itself is the number one concern as a source of vascular disaster causing abdominal pain.
Some causes of abdominal pain are described as colic. No, not the cranky baby type of colic. Biliary and renal colic can be the real 10/10 pain. Having stones or sludge exiting one's gall bladder can feel like a knife being twisting in the right upper quadrant of the abdomen. Kidney stones passing from the kidney to the bladder via the ureters is often described as stabbing, tearing pain in either flank or abdominal half. The tricky part for the ER staff is that the leaking aorta can feel just like a kidney stone. The former can kill in a matter of minutes, while the later justs make you wish you were dead, to end the horrific pain.
Problems involving the solid organs of the abdomen are usually more subtle in their presentation. Hepatitis, an infection of the liver, is heralded by dark urine, right upper quadrant pain and maybe even a resemblance to a lemon as you become jaundiced. Pyelonephritis, an infection of the kidney developes over time with flank ache, fever, chills, and nausea and vomiting. Enlargement of the spleen, which can accompany mononucleosis, causes a dull achy fullness in the left upper quadrant. Pancreatitis is especially unpleasant. The pancreas produces digestive enzymes that when carried by the pancreatic duct to the small intestine, aid in digestion of our food. The problem is that when damaged by infection, toxic exposure (often good old alcohol), vascular compromise or injury, those enzymes start digesting the pancreas itself.
A plumbers nightmare is the 10 meters or so of hollow tubing that include the stomach and small and large intestines. Coiled, full of trillions of bacteria, susceptible to inflammatory, vascular and infectious disease galore, all crammed into one's abdomen. Appendicitis, Crohn's disease, diverticulitis, colitis are all causes of mild to life threatening infections in the abdomen.
The complex meandering of the intestines can lead to blockages from twisting of adhesions (scar tissue, often from prior surgery to fix one of the diseases we have mentioned). There was nothing more humbling to your intrepid B.O.N.E.R. doc than being the victim of a bowel obstruction. Having the stuff that should come out my rectum backing up into my stomach and thence into a vomit bag, is miserable. This unpleasant experience can be temporarily treated by having a hard plastic tube rammed through a nostril, gagging you as the nurse passes this NG (nasogastric) tube into your stomach.
My stomach hurts. The differential diagnoses are seemingly without end. The clock is ticking. The patient is miserable. The stalwart ER doc, armed with his scanners, ultrasound machines, and hospital lab, takes a careful history, performs a thorough exam (sticking something into any available body opening that leads towards the abdomen), and tries to come up with the correct diagnosis and treatment.
Help!! Give your ER doc a hand by answering the usual questions concerning pain. When did it start? How has it progressed? What is the quality and intensity? Does the pain radiate and to where? Anything make the pain less or more intense? Any relation to the time of day or the eating of a meal?
Lots of anatomy, sometimes unpredictable pain patterns, time is critical. No problem, come to the ER with your bellyache.