Abdomen Capsular Distention And Metabolic Disturbances

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Capsular distention

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Distention of the well-inverted capsule surrounding digestive organs is potential source of aching abdominal pain.

Hepatic capsular distention leads to upper quadrant pain occurs in hepatitis, CHF, fatty infiltration ( hepatic steatosis) and subcapsular hematoma.

Splenic capsular distention pain may occur secondary to blunt trauma. Localize pain to left upper quadrant. With subdiaphragmatic peritoneal irritation. Pain radiate to ipsilateral shoulder. With splenic trauma, there is a period of many hours that passes before peritoneal signs develop.

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Metabolic disturbances

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Ketoacidosis presents with severe abdominal pain in some cases accompanied by vomiting and elevated WBC.

Cholecystitis in diabetic May be the precipitant.

Porphyria: sometimes stimulates bowel obstruction because of cramping abdominal pain and hyperperistalsis that may occur.

Symptoms: severe colicky pain, maybe localized or generalized. Vomiting and diarrhea also common. Fever and leukocytosis may be present. On examination, the abdomen is soft. Proximal muscle pain and range of neuropsychiatric symptoms accompanied abdominal pain.

Lead poisoning: may also be accompanied by abdominal pain which is typically wandering, poorly localized, colicky and rigid abdomen.
Encephalopathy, peripheral neuropathy and anemia are associated features. Urine coproporphyrin test is more reliable than serum lead level which can be normal.

Angioneurotic edema: caused by C' esterase inhibitor deficiency. May result in abdominal pain. If diagnosis suspected, check serum level of C4 which is low in C' esterase inhibitor.

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Nerve injury

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Nerve injury from encroachment or irritation causes pain. The source of pain maybe intraabdominal example pancreatic cancer or pancreatitis or inflamed splenic nerves. It may be extraabdominal example herpes zoster.

Abdominal Wall Pathology: traumatic injury to the musculature of the wall produces pain that is constant, aching and exacerbate by movement or pressure in abdomen.

Referred Pain:
1) chest sources: pulmonary infarction and pneumonia of Lower lobes are among the chest problem that present with upper abdomen pain. Nausea and vomiting maybe principal manifestation of acute inferior myocardial infarction.

Ovarian cancer and other pelvic sources: benign and malignant ovarian masses are sources of abdominal complaints. In addition to causing pelvic pain and urinary urgency, such pelvic pathology is associated with increase abdominal girth and bloating.