When your belly hurts.(5-MINUTE CONSULT)(sudden onset of abdominal pain)

SEVERAL YEARS AGO, I received two middle-of-the-night phone calls within minutes of each other. Both calls were from men in their 40s. Each complained of abdominal pain, nausea, and vomiting, and each had undergone an appendectomy. There the similarities ended. The first caller also had diarrhea and a low-grade fever. The second caller didn't. Which one was sicker?

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You might think the one with more symptoms was in worse shape. But he was suffering from gastroenteritis, probably caused by a virus, and was feeling better the next morning. The other fellow turned out to have an intestinal obstruction caused by scar tissue from his appendix operation. He had to have emergency surgery.

Where's the pain?

Sudden onset of abdominal pain can be frightening for patients and a challenge for doctors. When pain is limited to one part of the belly, the diagnosis is easier but the cause might be more serious. Pain in the patient's right-upper abdomen can indicate gallstones or inflammation; in the mid-upper abdomen, stomach or pancreas problems; in the right-lower abdomen, an inflamed appendix; and in the left-lower abdomen, diverticulitis.

Problems of the small intestine, such as those experienced by my two patients, usually cause allover abdominal pain. Kidney pain typically begins in the back and can radiate to the abdomen.

In women the ovaries can cause pain by twisting or by forming cysts that occasionally rupture. Pregnancy adds even more possibilities.