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Signature ✍️
- “Postprandial” abdominal pain” refers to abdominal pain that is strikingly worse ~30 to ~120 minutes after eating, which may or may not be accompanied by other GI symptoms (e.g. bloating, nausea, early satiety)
- “Recurrent” abdominal pain is defined as intermittent pain occurring over 3+ months
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DDx 🏳️🌈
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- “Raw” (pain >>> nausea)
- Peptic ulcer disease
- Gastritis
- Allergic (pain > nausea)
- Non-eosinophilic food allergy
- Eosinophilic gastroenteritis
- Dysmotility (pain <<< nausea)
- Gastroparesis DDx
- Functional dyspepsia
- Obstruction (variable pain/nausea)
- Gastric outlet vs. other proximal obstruction***
- Paraduodenal hernia
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- Biliary
- Colic → Cholecystitis (image ⊕)***
- Functional gallbladder disorder (image ⊖)
- Pancreatic
- Chronic pancreatitis
- Both (Convergence)
- Sphincter of Oddi dysfunction
- Retained CBD stone***
- Ampulloma
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- Subacute
- Young ↔ Elderly: venous mesenteric ischemia***
- Chronic
- Young: median arcuate ligament syndrome (MALS)
- Elderly: chronic mesenteric ischemia (”stable intestinal angina”)
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- Anterior cutaneous nerve entrapment syndrome (ACNES)
*** = life-threatening
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Principles❗️
Postprandial Abdominal Pain: “Digestive Stress Test” 🏃♀️💨
- GI Lumen ⭕ : stressors include ↑ hydrochloric acid secretion, ↑ wall edema, ↑ motility, & ↑ accommodation
- HPB Axis 🟢 : stressors include ↑ gallbladder contraction, ↑ pancreatic enzyme secretion, & obstruction at the convergence point (sphincter of Oddi)
- Vascular 🔴 : ischemia is a result of ↑ postprandial splanchnic blood flow (arterial stenosis vs. poor venous outflow)
- Abdominal Wall Syndrome 😵 : pain is a result of contraction of abdominal musculature, which further impinges entrapped nerve
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References 📚
- “Digestive stress test” analogy by @CPSolvers
