Colitis will produce more diarrheic symptoms, with more accurate limitation of pain and tenderness on pressure, while sigmoiditis and proctitis will cause characteristic stools, in addition to the localized pain which they produce. A chronic colitis may cause backache, sometimes quite sharp, while the same may be produced by a well-marked condition of enteroptosis.
The more chronic forms of enteric disorders cause irregularly recurring pains, having definite relation to errors in diet, exercise, excitement, and environment. The membranous form of colitis nearly always produces abdominal pain, referred along the course of the transverse and descending colon. The complaint of pain and the condition of the stools will be found to have a close relationship. Fecal impaction rarely produces sharp pain until it proceeds to the degree of actual obstruction, but does cause feelings of discomfort and distention, especially in the right iliac region, with more or less tenesmus.
Lead poisoning produces severe abdominal pain, distention, and tenderness, with vomiting and alternating constipation and diarrhea, which may lead to confusion, especially as a subject of lead poisoning may be a sufferer from one or the other acute abdominal conditions. Of course, in its chronic forms the characteristic line upon the gums and the nature of the occupation would aid in diagnosis.
Tuberculosis of the intestines and peritoneum produces more or less colicky pain, especially in children, with enlarged mesenteric nodes; while in consumptive patients recurring abdominal pains, with alternating constipation and diarrhea, would suggest secondary intraperitoneal involvement.
The possibility of abdominal pain being caused by parasites, especially by tapeworms, should not be overlooked.
The intestinal ulcerations produce nearly always continual pain, associated with localized tenderness on pressure. The higher in the intestinal canal the ulcer be located the more regularly will it produce pain from one to two hours after eating, while the lower the location of the ulcer the more likely are we to find recognizable blood in the evacuations. During typhoid any sudden onset of abdominal pain associated with bladder irritability, and often with pain in the penis, may be regarded as indicating perforation.
In appendicitis the pain is usually first referred to the more central portion of the abdomen, later becoming localized in the right iliac fossa. Frequently the overlying muscles will be already in a condition of spasm before this pain is localized beneath them. In this disease, no matter where pain may be referred, the tenderness will usually be felt and the resulting tumor detected in significant position. Constant mild pain and tenderness in McBurney’s region are usually indicative of a chronic catarrhal and more or less obstructive appendicitis. In the chronic and relapsing forms the pain is intermittent, but tenderness is nearly always significantly located.
Strangulated hernias, when external, will usually attract attention by their presence without reference to pain, even though the latter be referred to some relatively distant part. Whatever might be characteristic of strangulation will more or less quickly merge into symptoms of intestinal obstruction, but no case presenting local indications should escape detection. Internal strangulations nearly always defy accurate detection before operation.
Intestinal obstruction from any cause, when acute, produces early sharp and severe abdominal pain, sometimes localized vaguely, but nearly always becoming general, and so quickly followed by muscle spasm with distention and the soreness of vomiting, that, with the accompanying general disturbances, it lends little aid in accurate diagnosis.
Acute pancreatitis of either clinical type produces a pain which is central and agonizing and is quickly followed by collapse, with abdominal rigidity. The resulting pain and tenderness are usually confined to the upper abdomen and may be expected at least to attract attention to this part of the belly.