Dariusz Litera
Abdominal pain is one of the most common complaints patients report to doctors. It's estimated that up to 10% of primary care visits are related to this problem. Unfortunately, despite the onset of pain, as many as 40% people don't seek medical help promptly, which can lead to delayed diagnosis of serious conditions. Do you sometimes ignore this symptom, especially when it's not very severe? Today, your doctor is surgeon Dr. Adam Kuźmiński. Welcome, doctor.

Dr. Adam Kuźmiński
Good morning. What are the most common causes of abdominal pain and when should we be concerned?

Dr. Adam Kuźmiński
Let's remember one thing: pain is our friend. It's a symptom that tells us something is wrong in our body, that something bad is happening. The abdominal cavity is so innervated that the pain we experience may not necessarily originate there. It could be something quite common, such as an inferior wall heart attack. And this is a very dangerous situation, because ignoring this pain can 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 a very difficult one to diagnose. Therefore, I would always advise consulting a doctor, who will order the simplest test, an ECG.

Dariusz Litera

Then we'll at least rule out the heart attack. But as for the stomach, we'll probably need a bit longer to diagnose it.

Dr. Adam Kuźmiński
Yes, we live in the 21st century, and we have a whole range of different diagnostic tests, from imaging to laboratory studies. Each of these tests contributes to our diagnosis and allows for a 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 a patient can tell us a lot about abdominal pain. This can confirm the symptoms of an 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 perspective, it's irritation of the nerve endings and the peritoneum. When does this happen? When there's inflammation in the abdominal cavity, the peritoneum becomes irritated by this "inflamed" organ. The surgeon places his hand on the abdomen, presses gently, and immediately feels muscle tension. Tension in the rectus abdominis muscles. This is one of the many symptoms of an 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 resembles a caged lion. They pace, fidget, and can't sit still. When asked where the pain is, they can't pinpoint the location. Their stomach simply hurts. They pace. They sit down. They sit down. They pace all the time. They can't find a better position. That's one type of patient.

The second type of patient is the one who lies curled up in a ball. Don't touch me. You can't touch me. Where does it hurt? I'll point to that exact spot. And this is the patient we're most worried about.

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 could also be acute cholecystitis.

Dr. Adam Kuźmiński
May be.

Dariusz Litera
And this is all it can be?

Dr. Adam Kuźmiński
Virtually everything in the abdominal cavity that becomes inflamed. These two types of patients represent two types of pain. One type of pain is called visceral pain. This is pain associated with dilatation of the tubular organs, such as intestinal distention, dilatation of the bile ducts, and dilatation of the ureters, which is related, for example, to the movement of stones or deposits, or increased 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 pain that usually subsides after administering antispasmodics. And such a patient is given antispasmodics in the emergency room. He's diagnosed. You have gallstones, for example, bile duct stones. Goodbye.

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

Dariusz Litera
So, there's an immediate, life-threatening situation, and we need to act quickly as a medical team. We have an acute abdomen, and this could be a symptom, as the doctor said, of almost any acute inflammatory condition of the abdominal organs?

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

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

Dr. Adam Kuźmiński
Every chronic pain begins at some point with a sudden onset of pain. This is obvious. Chronic pain is a condition that requires double our vigilance, because it's the information our body constantly transmits: Something's wrong, something's changed, something's wrong with me. Do something about it.

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

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

Dariusz Litera
How can the location of pain initially indicate its cause? That is, can a doctor determine more precisely based on its location and location?

Dr. Adam Kuźmiński
Not always. The location of abdominal pain is very deceptive. Sometimes, what a patient feels can lead us down very wrong paths. It's generally believed that epigastric pain is pain associated with some stomach condition, or pain, for example, under the right hypochondrium, is associated with gallbladder disease. This is related to the location of these organs, and that's obvious. But for example, if we have appendicitis, the pain in early inflammation begins in the epigastrium. Only as the situation progresses, the inflammation develops, does this pain initially become visceral pain. Only later, when the gallbladder becomes inflamed and touches the peritoneum, does inflammation develop in this area, and we progress to somatic pain. So, first, we have pain in the epigastrium, which slowly descends towards the right iliac fossa, where the underlying disease occurs.

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

Dr. Adam Kuźmiński
This is a very difficult question. I have many patients who postpone seeing a doctor, and then it gets really bad. Then we have a lot of problems. Then the procedures we perform are fraught with a very large number of possible complications, because adhesions form, because the entrance to the abdomen is difficult, and so on. We live in the 21st century, so we have access to a multitude of painkillers and antispasmodics, and unfortunately, these are over-the-counter medications, meaning we can take them without any supervision. Don't delay. Generally, don't delay seeing a doctor. The most important thing in all of this is a diagnosis. If we know what we have, what's wrong, we can do it.

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 genetically related diseases, but on what hurts now. So if we know, we have a diagnosis, and this pain persists. We can use painkillers, we can alleviate these pain symptoms, because we know what's wrong with us.

Dariusz Litera
But first we need to find out.

Dr. Adam Kuźmiński
That's the way it is, and that's where diagnostics come in. And this is where the entire diagnostic process that we must conduct is very important to us.

Dariusz Litera
What are the most common mistakes patients make? As the doctor said, we have a whole range of over-the-counter medications we can purchase and use. It's just that we probably overuse them a bit, and as the doctor said, there are problems with patients who come to the doctor when it's already very late and the disease has progressed.

Dr. Adam Kuźmiński
And there are two problems here. On the one hand, patients take too many medications, mixing different medications that are actually the same drug, just in different forms and under different brand names, thus accumulating the dose of the drug.

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 has to process all this, right? And the second type of patient is those who use homeopathic doses of these medications, which won't help, and the liver has to process all this anyway.

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 abdominal pain?

Dr. Adam Kuźmiński
This is an issue we could discuss for hours, as it's related to our overall lifestyle. In today's fast-paced world, our meals are too irregular. We live under enormous stress.

Dariusz Litera
We sit on one side.

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

Dariusz Litera
What preventive measures should we take to ensure that abdominal pain only indicates a potential disease?

Dr. Adam Kuźmiński
It's impossible to answer this question. If we led a truly healthy lifestyle, introduced physical exercise, regular meals, and something virtually impossible these days—a stress-free life. That's utopia. Then perhaps a stomach ache would mean something is seriously wrong.

Dariusz Litera
Do women or men come to a surgeon's office with abdominal pain more often?

Dr. Adam Kuźmiński
The ratio of men to women is essentially the same. However, we have a bigger problem with women, because women, as the weaker sex, endure pain longer. Therefore, they don't pay attention to it. Men are more sensitive to these ailments and see a doctor sooner, which sometimes saves their lives. When it comes to illnesses, a large number of illnesses are gender-related. Gallstones are a female disease, stomach ulcers are a male disease. Here, the ratio of women to men is the same.

Dariusz Litera
Doctor, abdominal pain as a symptom is no longer somatic, but psychosomatic, because here we're 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 turns out there's no somatic basis for them to feel it.

Dr. Adam Kuźmiński
There are such patients. We need to realize that we have two nervous systems. One system is responsible for our emotions, and the other nervous system is responsible for not having to remember to inhale, exhale, inhale, exhale, and so on. And it is precisely disturbances in this autonomic system that can cause various strange symptoms in a patient. These can be symptoms related to intestinal peristalsis. They can be associated with various strange pains that pass, that reappear, correlated with emotions, or even without any correlation. These patients often go to a doctor, a primary care physician, or even paramedics because the pain is so intense and causes such significant distress for these patients. They actually feel it. It's not a situation where the patient is hysterical, or has a headache, or so on. No. They actually hurt. You have to go through the entire diagnostic procedure to determine that someone has a problem like globus hystericus. You can't neglect anything, you can't underestimate anything. And the golden rule is to always trust the patient.

Dariusz Litera
Dr. Adam Kuźmiński, a surgical specialist, said in the podcast "WHAT DOES YOUR DOCTOR SAY?" Thank you very much, doctor.

Dr. Adam Kuźmiński
Thank you very much.