Dariusz Litera
Abdominal pain is one of the most common complaints with which patients report to doctors.
It is estimated that up to 10% visits to Primary Health Care are related to this
Unfortunately, despite the appearance of pain, as many as 40% people do not seek help quickly
medical care, and this can lead to delayed diagnosis of serious illnesses.
ignore this symptom, especially if it is not too intense? Today your doctor is
Surgery specialist Dr. Adam Kuźmiński. Welcome, doctor.

Dr. Adam Kuźmiński
Good morning. What are the most common causes of abdominal pain and when should they raise our concern?
anxiety?

Dr. Adam Kuźmiński
Let's remember one thing: pain is our friend. So, it's the symptom that informs us
us that there is something wrong in our body, that something bad is happening. The abdominal cavity is
so innervated that the ailments we feel may not necessarily come from this cavity
abdominal. It may be something that is quite common, for example, an infarction of the lower wall
heart. And this is a very dangerous matter, because by ignoring this pain we lead to
death.

Dariusz Litera
But how do you recognize it? Is it a heart attack or perhaps some more severe indigestion?

Dr. Adam Kuźmiński
This is a very good question and very difficult to answer. Therefore, I would advise
always seek the opinion of a doctor who will order the simplest test, i.e. an ECG.

Dariusz Litera

Then we'll at least rule out the heart attack. But I think we'll be worried about the stomach.
they had to take a little longer to diagnose.

Dr. Adam Kuźmiński
Yes, we live in the 21st century and here we have a whole range of different types of diagnostic tests
imaging tests, through laboratory tests. Each of these tests contributes something to our
diagnosis and allows this diagnosis to be made very quickly. In most cases.

Dariusz Litera
First, the doctor usually checks the abdomen with his hand.

Dr. Adam Kuźmiński
Simply touching the patient can tell us a lot about abdominal pain.
way to confirm the symptoms of the so-called acute abdomen.

Dariusz Litera
I wanted to ask about it. What does it manifest itself in? What exactly is it?

Dr. Adam Kuźmiński
From a physiological, pathophysiological point of view, it is irritation of the endings
nerves, peritoneum. When does this happen? When we have some inflammation in the cavity
abdominal, the peritoneum becomes irritated by this "inflamed" organ in quotation marks. The doctor
the surgeon places his hand on the abdomen, presses gently on the abdomen and immediately feels the muscle tension.
Rectus abdominis muscle tension. This is one of the many symptoms of acute abdomen.

Dariusz Litera
And the patient is writhing.

Dr. Adam Kuźmiński
Well, not necessarily. We have two types of patients with abdominal pain. One type of patient
He looks like a lion in a cage. He paces, fidgets, and can't sit still. When asked where he is,
It hurts, he can't pinpoint the exact location. His stomach just hurts. He walks. He sits. He sits.
He walks all the time. He can't find a better position. This is one type of patient.

The second type of patient is the one who lies curled up in a ball. Don't touch me. I'm not allowed.
touch. Where does it hurt? I'll point to that exact spot with my finger. And we're more worried about this patient.

Dariusz Litera
So we are worried about his health.

Dr. Adam Kuźmiński
Because this is a symptom of acute abdomen.

Dariusz Litera
And this acute abdomen is actually acute appendicitis. It can be acute
inflammation of the gallbladder.

Dr. Adam Kuźmiński
May be.

Dariusz Litera
And this is all it can be?

Dr. Adam Kuźmiński
Basically, anything in our abdominal cavity that becomes inflamed. These two types
patients, there are two types of pain. One pain is called visceral pain. This is pain associated with
dilation of tubular organs, i.e. for example distention of the intestine, dilation of the ducts
bile ducts, dilation of the ureters, which is related, for example, to the movement
stones or deposits, or an increased amount of content in these ducts.

Dariusz Litera
So how does a lemon try to get through the plum hole?

Dr. Adam Kuźmiński
There's no lever, it has to hurt. And it's visceral pain. This is the pain that occurs after the administration of drugs.
antispasmodic drugs most often pass. And such a patient is given antispasmodic drugs in the emergency room.
You've been diagnosed with gallstones, perhaps choledocholithiasis. Goodbye.

The next day, further diagnostics. And he goes home. The second type of pain is related to
irritation of these nerve endings of the peritoneum, this is the so-called somatic pain. And here
we need to get to the heart of the matter and start treating the inflammation because without it we won't heal
patient. And delaying diagnosis and treatment for too long may result in the loss of the patient.

Dariusz Litera
This means there is a direct threat to life and we must act quickly as a medical team.
We have an acute abdomen and this may be a symptom, as the doctor said, of almost all
acute inflammation of the abdominal organs?

Dr. Adam Kuźmiński
Yes. And then straight to the operating table!

Dariusz Litera
And then the surgeons know what they're doing. They're saving the patient's life. Yes, but only if that pain is pain.
severe, but chronic. How do we distinguish chronic pain from acute pain?

Dr. Adam Kuźmiński
Every chronic pain starts with a sudden onset of pain. This is obvious. Chronic pain is
there are diseases that require our double vigilance, because this is the information that
our body constantly tells us that something is wrong, something has changed, something is sick, do something
something about it.

Dariusz Litera
And since pain is our ally, we have to react.

Dr. Adam Kuźmiński
Ignoring these symptoms may later lead to irreversible changes in our
body, to really big problems.

Dariusz Litera
How can the location of pain initially indicate its cause? That is, whether the doctor
based on the location of this place, determining exactly this place may be something more
to say?

Dr. Adam Kuźmiński
Not always. The location of abdominal pain is very deceptive. Sometimes what you feel
the patient can sometimes lead us down very wrong paths. It is generally believed that pain in
epigastrium, i.e. pain related to some stomach diseases, or pain for example under
right upper quadrant is associated with gallbladder disease. This is related to
the location of these organs, and this is obvious. But for example, if we have appendicitis
vermiformis, the pain in the case of early inflammation begins precisely in
epigastrium and only as the situation develops, the inflammation develops, this pain is initially
visceral pain, and only later, when this vesicle becomes inflamed and affects us
to the peritoneum, inflammation develops in this place and we progress to somatic pain.
So first we have pain in the upper abdomen, which slowly moves towards the right
iliac fossa and there we have the main disease.

Dariusz Litera
What can we advise people who do not experience acute pain, but such ailments,
which may become more severe?

Dr. Adam Kuźmiński
A very difficult question and a very difficult question. I have a lot of patients like that who
They put off going to the doctor and then it gets really bad. Then we have a lot of problems. Then
the procedures we perform are burdened with a very large number of possible complications because they create
adhesions occur because we have some difficult entrance to the abdomen and so on. We live in the 21st century, in
Therefore, we have access to a lot of painkillers and antispasmodics, and unfortunately
There are over-the-counter medications available, meaning we can take them without any supervision. Let's not delay.
Generally, don't delay a visit to the doctor. The most important thing in all this is
diagnosis. If we know what we are sick with, what is wrong.

Dariusz Litera
In the family history too?

Dr. Adam Kuźmiński
Well, yes, but let's focus on the pain, on this situation now. Not on the diseases associated with
genetics, only what hurts now. So if we know, we have a diagnosis and this pain all the time

It keeps recurring. We can use painkillers, we can alleviate these symptoms
painful, because we know what's wrong with us.

Dariusz Litera
But first we need to find out.

Dr. Adam Kuźmiński
That's right, and here's the diagnostics. And here's what's very important to us: the entire diagnostic process, which
we have to carry out.

Dariusz Litera
And what are the most common mistakes made by patients? As the doctor said,
we have a whole range of different types of over-the-counter remedies that we can purchase and use.
It's just that we probably overuse them a little bit and as the doctor said, there are these
problems with patients who come to the doctor when it is already very late and the disease has progressed
developed.

Dr. Adam Kuźmiński
And there are two problems here. On the one hand, patients take too many medications, mixing them
different specifics which are actually the same medicine, only in a different form, in a different
trade name, thus accumulating the dose of the medicinal substance.

Dariusz Litera
And sometimes they even irritate their digestive tract.

Dr. Adam Kuźmiński
That's another matter. Not only does it exercise the digestive system, but it also exercises the liver, which must do so.
to redo everything, right? And the second type of patient are those patients who use
homeopathic doses of these medicines that won't help, and the liver has to do all this anyway
redo.

Dariusz Litera
So we do not delay and we do not overdo it when taking medications on our own.

Dr. Adam Kuźmiński
Exactly.

Dariusz Litera
Doctor, how does lifestyle and diet generally affect the occurrence of pain?
belly?

Dr. Adam Kuźmiński
This is an issue we can talk about for hours because it is related to our
lifestyle in general. Nowadays, with this constant rush, our meals are too
not very regular. We live under great stress.

Dariusz Litera
We sit on one side.

Dr. Adam Kuźmiński
We live under a lot of pressure. We lack movement. Car, desk, car, desk, and that's it.
it all ends.

Dariusz Litera
What preventive measures should we take to make abdominal pain show up early?
only some disease that may appear?

Dr. Adam Kuźmiński
It's impossible to answer this question. If we were to lead a truly healthy lifestyle,
they introduced physical exercise, regular meals, and something that is actually
impossible in today's world, that is, a life without stress. This is utopia. Then maybe
abdominal pain would mean that something is wrong there.

Dariusz Litera
Do women with abdominal pain come to the surgeon's office more often in his practice?
gentlemen?

Dr. Adam Kuźmiński
The ratio of men to women is basically the same. Except that we have a bigger problem with
ladies, because women, as the weaker sex, endure pain longer. Therefore, they do not pay attention to this pain.
Men are more sensitive to these ailments and come to the doctor more quickly, and sometimes it is
It saves lives. When it comes to diseases, a large number of diseases are related to gender.
gallbladder is a female disease, stomach ulcers, a male disease. This is where women's attitude towards
men is the same.

Dariusz Litera
Doctor, abdominal pain as a symptom is no longer somatic, but psychosomatic, because here
we are touching on a completely different field of medicine. That is, there are people who experience severe pain and even
if we diagnose it for a very long time, it will turn out that there are no somatic grounds for
so that they feel it.

Dr. Adam Kuźmiński
There are patients like that. We need to be aware that we have two systems.
nervous system. One system is responsible for our emotions, and the other nervous system is
responsible for the fact that we don't have to remember to inhale, exhale, inhale, exhale, and so on.
it is the disorders in this autonomic system that can cause such various strange
symptoms in the patient. These may be symptoms related to intestinal peristalsis. These may be related to
various strange pains that pass, that reappear, correlated with
emotions, without this correlation. These patients often go to a doctor or a primary care physician, or
even paramedics, because the pain is so intense and causes such distress to these patients
big problem. They actually feel it. It's not a situation where the patient is hysterical, that the patient
They have a headache and so on. No. They actually hurt. You have to go through the whole procedure.
diagnostic to say that someone has a problem like globus hystericus. Nothing is allowed
neglect, nothing should be underestimated. And the golden rule is to always believe the patient.

Dariusz Litera
This was said in the podcast WHAT YOUR DOCTOR SAYS, by a surgical specialist, Dr. Adam Kuźmiński.
Thank you very much, doctor.

Dr. Adam Kuźmiński
Thank you very much.