Aetiological Study of Upper Abdominal Pain in Patients Admitted in the Department of Medicine, SSMC and Mitford Hospital, Dhaka, Bangladesh
Author(s): Haripada Roy, AKM Fazlul Kader, Abu Md. Towab, Monish Saha Roy, Goutom Chandra Bhowmik, Sushanta Barua, Arindam Majumder, Sudip Barua, Rabeya khatoon
Introduction:
Abdominal pain is an unpleasant experience commonly associated with tissue injury. The sensation of pain represents interplay of pathophysiologic and psychosocial factors. Pathophysiologic determinants of pain include the nature of the stimuli, type of the receptors involve, the organization of the neuroanatomic pathways from the site of injury to the central nervous systems and a complex interaction of modifying influences on the transmission.
Objective:
To assess the aetiological study of upper abdominal pain in patients admitted in the department of medicine, SSMC and Mitford hospital, Dhaka, Bangladesh.
Methods:
Patients admitted with upper abdominal pain in the medicine units of Medicine Department in SSMC and Mitford Hospital of 6 months from 1st July, 2011 to 31st December, 2011. A total of 100 cases were enrolled in the study. Data were recorded in preformed structured format and were analyzed by computer software SPSS (Statistical Package for social science) and the results are shown in tables & figures.
Results:
A total of 5280 patient got admitted during the study period in medicine units. Out of them 3250 were male and 2030 were female patients. Subjects presented with upper abdominal pain were 100 (1.89%) in number in whom 55 were male and 45 were female patients. Age ranged between 18 and 75 years with mean of 41.29 years. Out of 100 cases majority were nonsmoker, forty-five patients were smoker with a male and female ratio 7:2. Peptic ulcer disease topped the list. Thirty-six had peptic ulcer diseases (PUD). Of them 27 cases were male and 9 cases were female. In this study male patients were more in number with male and female ratio 3: 1. Out of 36 cases of peptic ulcer, 28 (77.78%) were detected to have duodenal ulcer and 8 (22.22%) were gastic ulcer. Male and female ratio is duodenal and gastric ulcer was 5: 2 and 7: 1 respectively. The ratio between duodenal and gastric ulcer was 3. 5:1. Non ulcer dyspepsia ranked second in order of frequency (20 cases = 20%). It was more common in females (13 cases = 65%) than in males (7 cases = 35%). Four patients were female and two were male. Two subjects were diagnosed as acute cholocystitis and 2 were female. One male and one female patient were diagnosed as chronic cholecytitis. Two patients were diagnosed on gastric cancinoma proved by histological examination of endosopically obtained biopsy specimens from the lesion. Two patients were male. In case of IBS, out of 18 patients, 10 patients (55.56%) had colicky abdominal pain. Majority of patient (40%) had burning type of abdominal pain, 17.3% of patient had colicky abdominal pain, most of them were patients of IBS (55.56%). Epigastric and / or right hypochondriac pain (66.67%) was more common in NUD. 51%, 22% and 14% patients had epigastric, simultaneous epigastric and right hypochondriac and simultaneous epigastric and periumbilical pain respectively. Majority of patients (66.67%) with IBS developed pain after taking food. Non ulcer dyspeptic patients (70%) developed pain mainly in empty stomach. 37%, 31% and 18% patients had pain in empty stomach, pain after meal and nocturnal pain respectively. 30 cases (83.33%) with PUD, seven cases (38.89%) with IBS and 16 cases (80%) with NUD, there was no radiation of pain. Majority of patient of IBS (44.44%) had radiation of pain to multiple sites.
Conclusion:
In conclusion it may be asserted that majority of patients with upper abdominal pain do not have peptic ulcer. Functional gut disorder is common cause of upper abdominal pain. A carefully taken history and its rational interpretation may help diagnosis. The simple means like explanation, reassurance and dietary advices may save a lot of antacids, H2 blocker and proton pump inhibitors in many cases.