Abdominal Pain: When It's More Than Indigestion
Abdominal pain is one of the most common reasons for medical visits in the UAE. While most cases are benign (indigestion, gastritis, constipation), certain patterns indicate a surgical condition that requires prompt evaluation.
Red Flags That Require Urgent Assessment
Seek same-day surgical consultation if you have:
- Severe pain that wakes you from sleep
- Pain with fever above 38°C
- Abdominal rigidity (stomach feels board-like)
- Pain with inability to pass gas or stool for 24+ hours
- Vomiting blood or passing black stools
- Pain after abdominal trauma
- Sudden severe pain in a known hernia site
Pain Location Guide
| Location | Possible Surgical Causes | Other Causes to Rule Out |
|---|
| Right upper | Gallstones, liver abscess | Hepatitis, pneumonia |
| Left upper | Splenic issues, gastric ulcer | Pancreatitis, cardiac |
| Right lower | Appendicitis, ovarian cyst | UTI, ectopic pregnancy |
| Left lower | Diverticulitis, sigmoid volvulus | Constipation, IBS |
| Central/periumbilical | Small bowel obstruction, early appendicitis | Gastritis, IBS |
| Generalised | Peritonitis, bowel perforation | Gastroenteritis |
Appendicitis: The Most Common Surgical Emergency
Classic presentation:
- Pain starts around the navel
- Migrates to right lower abdomen over 12-24 hours
- Worsens with movement, coughing, or walking
- Loss of appetite, nausea
- Low-grade fever
Important: Not everyone presents classically. Women, elderly patients, and pregnant women may have atypical symptoms. When in doubt, get assessed.
Treatment: Laparoscopic appendicectomy (keyhole surgery, usually home next day)
Bowel Obstruction
Warning signs:
- Cramping abdominal pain that comes in waves
- Abdominal distension (bloating)
- Vomiting (especially if bile-stained or faecal)
- Complete inability to pass gas or stool
- Previous abdominal surgery (adhesions are the #1 cause)
This is an emergency - do not wait. Delayed treatment can lead to bowel death and perforation.
Diverticulitis
Common in adults over 40, especially with low-fibre diets:
- Left lower abdominal pain (usually)
- Fever and elevated white blood cells
- Change in bowel habits
- Tenderness on examination
Mild cases: Antibiotics and dietary modification
Severe/recurrent cases: May require surgical resection
Dubai-Specific Considerations
- Dehydration worsens constipation and can trigger diverticular flares
- Spicy food doesn't cause surgical conditions but can worsen symptoms
- Stress can mimic surgical pain (but never assume - always get checked)
- Travel and dietary changes common in Dubai can trigger gallbladder attacks
- Ramadan fasting can unmask gallstone symptoms
What Happens at a Surgical Consultation
- Detailed history (pain character, duration, associated symptoms)
- Physical examination (tenderness, guarding, bowel sounds)
- Blood tests (infection markers, organ function)
- Imaging (ultrasound, CT scan if indicated)
- Decision: observation, medical management, or surgery
- If surgery needed: same-day or scheduled based on urgency
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