Internal Medicine

Abdominal pain and fever

introduction

Abdominal pain and fever can appear individually as symptoms or together. Abdominal pain usually indicates infection or damage to the gastrointestinal tract or other areas of the abdomen. Depending on the cause, the pain can occur in the upper or lower abdomen, on the right or left side. Abdominal pain, especially in children, can also occur as part of a cold or flu and is often accompanied by a fever.

What are fever and abdominal pain?

Abdominal pain can have a variety of causes. They often occur as part of a viral infection or when eating spoiled food. Viral infections in particular, which are associated with fever, can be associated with abdominal pain. However, a combination of abdominal pain and fever appears possible if another causal disease occurs (e.g. appendicitis / appendicitis).

In addition to abdominal pain and fever, other cardinal symptoms occur in appendicitis, which are also very often associated with abdominal pain. These include gas, constipation, loss of appetite, nausea and vomiting.

Common occurrence of abdominal pain and fever

The common occurrence of abdominal pain and fever can have various causes. In some cases it is just a flu-like infection that is accompanied by abdominal pain. It can also be an indication of Pfeiffer's glandular fever, which initially expresses itself similarly to a flu-like infection, but also has an impact on the spleen and a much longer course of the disease. However, the additional occurrence of fever often indicates an inflammation in the abdomen.

One possible cause is acute appendicitis. This can affect both children and adults. In contrast to the fever in the context of a flu-like infection, which usually precedes the abdominal pain, in appendicitis it often only occurs after the abdominal pain. The abdomen is very sensitive to pressure in appendicitis and the pain is often mainly in the right lower abdomen. If the inflammation is acute, those affected tend to crouch and every movement is painful. Additional symptoms are often nausea and constipation. If appendicitis is suspected, a doctor should be consulted immediately, otherwise it can lead to the appendix bursting. Bacteria and stool residues can then get into the free abdominal cavity and lead to peritonitis, which can be life-threatening.

Read more on this topic at: Appendicitis

Abdominal pain and fever can also occur with an infection of the urinary tract, an inflammation of the kidney pelvis or urine congestion in the kidney due to kidney stones. Abdominal pain usually occurs as colic and can radiate into the back or genitals. Holding back urine can also cause abdominal pain and fever. This mainly affects men in whom the urine flow is impeded by a greatly enlarged prostate.

Another possible cause of abdominal pain and fever is food poisoning. These usually come with diarrhea.
Leukemia can also be indicated by abdominal pain and fever. General tiredness and swollen lymph nodes are also symptoms.

Causes of fever and abdominal pain

Abdominal pain and fever can occur together in a variety of ways. The simplest form of common occurrence is a viral infection, which causes an increase in body temperature and can subsequently be accompanied by abdominal pain.

Appendicitis is very often associated with complaints in the area of the abdominal tract. Abdominal pain, gas, nausea and vomiting are typical. In addition, if the course is fulminant, it can lead to an acute abdomen, which is an internal emergency. However, since the symptoms often do not occur together and are often very acute, the diagnosis is not easy. However, a crucial clue for the doctor is the addition of a fever. In this case, the symptom complex of abdominal pain and fever can be an indication of appendicitis (inflammation of the appendix).

Read more on this topic at: Appendicitis

When making a diagnosis, it is crucial that the fever only occurs after the abdominal pain. This difference contributes to the differential diagnosis of bacterial or viral infections. Here the fever typically develops before the onset of abdominal pain. Appendicitis also occurs more frequently in children (peaks between the ages of 10 and 20 years) than in adults. The symptoms often begin in the middle of the abdomen or the lower left side of the abdomen and then migrate towards the lower right half of the abdomen.

The ingestion of spoiled food (e.g. seafood) can also lead to a combined occurrence of abdominal pain and fever.

In addition, the common occurrence is typical in an acute flare-up of inflammatory bowel disease (IBD). The two clinical pictures of IBD are Crohn's disease and ulcerative colitis. In addition to massive abdominal pain and a rapid rise in fever, severe episodes of diarrhea and vomiting can occur.

Read more on this topic at: Crohn's disease and Ulcerative colitis

Theoretically, it is also possible that a parasitic infestation of the gastrointestinal tract develops combined symptoms of abdominal pain and fever. The development of a fever is often based on a strong reaction of the immune system to the pathogen. The combined occurrence of postoperative wound complications is also conceivable. Here, a surgical wound can e.g. inflame and cause abdominal pain. If the pathogens spread into the peritoneum, a fulminant, very painful peritonitis can develop. If bacterial pathogens get into the bloodstream via the wound, they can trigger a fever by releasing exo- and endotoxins.

Celiac disease is an increasingly prominent disease (gluten sensitive enteropathy). Gluten-sensitive enteropathy is now considered a "widespread disease" and affects around 1% of the population. Here it comes from a certain protein fragment from wheat products (Gliadin) to an autoimmunogenic reaction in the gastrointestinal mucosa with subsequent abdominal pain and diarrhea. Fever can also occur in acute cases.

Read more on this topic at: Celiac disease

Concomitant symptoms

The accompanying symptoms can vary widely with the underlying condition. They can provide important information for establishing the diagnosis and the extent of the symptoms correlates in many cases with the severity of the underlying disease. The abdominal pain is often accompanied by:

Fever, abdominal cramps, diarrhea, nausea, vomiting
Spasmodic defensive tension in the abdominal wall, hardening of the abdomen
Loud bowel noises or bowel noises that are completely silent
Diarrhea and constipation (also possible alternately) with flatulence
fresh or old blood in the stool, black tarry stool possible
The pain is referred to the groin, back, or chest

Back pain

It is not uncommon for the stomach pain to radiate to the back and spine. The spatial proximity can lead to abdominal diseases exerting pressure on the spine and thus initially noticeable as back pain.

In particular, diseases of the spleen, liver, pancreas, but also the large intestine and rectum can exert pressure on the spine from the front and cause apparent back pain. In the case of long-lasting back pain without a correlation to the spine, diseases of the abdominal organs should be excluded.

Read more on the topic: If abdominal pain comes along with back pain, what can it be?

treatment

The therapy following the diagnosis depends on the underlying disease. A pure therapy of lowering the fever and the administration of analgesics does not always contribute to a solution of the underlying problems, but usually rather leads to a pure improvement of the symptoms. Underlying diseases such as IBD must be effectively treated with specific medication and, if necessary, surgically (here e.g. with immunosuppressants). However, it is important to narrow down the symptoms of abdominal pain and fever. The antipyretic and pain reliever drug paracetamol and non-steroidal anti-inflammatory drugs (such as ASA) are used particularly frequently. In addition, antidiarrheal drugs (e.g. loperamide or racecadotril) can be used if severe diarrhea occurs. If the abdominal pain manifests itself with severe cramps, antispasmodic medication can be used (e.g. butylscopolamine or metamizole).

Read more on this topic at: Abdominal pain - what to do

These home remedies can help!

There are different approaches that can be used to self-treat if you have a fever and you cannot see a doctor directly. A diet with light foods plays an important role. Since the body needs a lot of energy for the increased function of the immune system, this should be taken in the form of food. Light foods include fruits, vegetables, lettuce, and chicken or vegetable broth. In addition to adequate nutrition, it is extremely important to drink enough fluids. Tea drinks such as herbal tea or rose hip tea are very suitable. But fruit juices containing vitamin C also have a positive influence on fever. The need for drinking is significantly increased in a feverish state. Therefore, especially with newborns and small children, it is important to ensure that they drink enough. Warm drinks such as teas can extract additional heat from the body through sweat production.

Existing abdominal pain can also be treated with certain home remedies. In addition to avoiding substances that could potentially irritate the gastrointestinal tract (such as alcohol, fatty foods, etc.), there are also tried and tested home remedies. Caraway seed oil e.g. can be taken with water in the form of 3-6 drops with food. Some nuts and certain spices such as fennel and anise also counteract abdominal pain. Warming teas with a combination of the spices fennel, anise and caraway can also be used against stomach ache. However, adding heat (e.g. through teas or hot water bottles) does not generally make sense for all types of abdominal pain. In addition, the gastrointestinal tract reacts very positively to the consumption of bitter substances (e.g. rocket, Chinese cabbage, radicchio). It is also possible to use a hay flower bag as a warming bag.

Read more on this topic at: Home remedies for stomach ache

homeopathy

Homeopathic remedies can be used if abdominal pain occurs at a mild intensity or only temporarily. In addition to this intake, a gentle diet, plenty of fluids and, if necessary, heat treatment should be carried out. Various substances are contained in the globules used for abdominal pain. For example, Colcynthis is used for colic-like cramps. Staphisagria can also be used for colicky stomach and stomach pain and a feeling of emptiness in the stomach. Arsenicum Album, on the other hand, works well for burning stomach pains, watery diarrhea and vomiting that can hardly be stopped. Other substances used are Phosphorus, Bryonia alba and Lycopodium. However, in the event of massive abdominal pain in combination with a fever, a doctor should be consulted promptly.

How is the diagnosis made?

The diagnosis is made by looking at the symptoms present. A distinction must be made between the pure occurrence of abdominal pain and fever, which often arises in the context of viral or bacterial infections, from the occurrence of both symptoms together with other phenomena in a different causal disease. As mentioned above, these are flatulence with muscle tension in the abdomen, diarrhea, nausea with vomiting and, in some cases, radiating to the back. Here in particular, a detailed explanation of possible pathologies is essential. If IBD (Chrohn's disease or ulcerative colitis) is suspected, an ultrasound examination and a stool sample can often help.

The spectrum of diagnostics extends from the anamnestic determination of all symptoms to wiretapping (Auscultation), Scanning (Palpation) and tapping (percussion) of the abdomen as well as blood tests (especially for inflammation values in the case of infections or IBD), ultrasound examination (detection of potentially existing inflammatory infiltrates) or an X-ray of the abdomen. The collection of inflammation values (especially CRP and ESR) play an important role, especially in the diagnosis of IBD. In addition to stool samples, special localized tissue biopsies can also be used for diagnostics. Tissue biopsies play e.g. plays a role in celiac disease and can draw attention to this disease through the subsequent histological examination. The course of the fever should also be assessed during the diagnosis. This can manifest itself differently in the course of the curve for the various causative diseases.

When do I have to see a doctor?

In principle, it is not possible to establish precise limits for visiting a doctor in the event of abdominal pain. The patient concerned should assess the intensity of the pain himself and, if the pain persists or if the stomach pain increases, he should definitely consult a doctor for clarification.

In the case of a fever, however, there are certain rules of thumb as of when a doctor should be consulted. For babies up to and including the 3rd month of life you should consult a pediatrician if the body temperature is 38 degrees Celsius or more. In the case of small children, it is stated that a doctor should be recruited if the fever has lasted for more than one day. With older children, on the other hand, the question of when to go to the doctor with a fever is answered differently. The rough rule of thumb here is that the child should be examined by a doctor if the body temperature is 39 degrees Celsius or if the child has a fever that has persisted for more than three days or occurs repeatedly. Adults should see a doctor if they have a fever that goes on for more than two or three days, or keeps coming back.

If a combination of abdominal pain and fever occurs, a visit to a doctor should not be waited too long. In addition to harmless causes, there can also be serious illnesses behind this complex of symptoms.

Duration

The occurrence of abdominal pain together with fever can vary greatly in intensity and duration. In the case of relatively harmless infections (e.g. gastroenteritis) there is a relatively quick improvement through drug therapy. If, however, there is a more serious illness behind this combination of symptoms (e.g. IBD), the symptoms can persist over a long period of time or recur at certain intervals.

Special features in children

Children very often suffer from abdominal pain or general complaints of the gastrointestinal tract. Fever is also more common in childhood than in adults. The reason for this is the development of the immune system's function against invading pathogens. Therefore, a detailed diagnosis is very important, especially in children. Appendicitis or a urinary tract infection are not uncommon diseases in childhood or adolescence and can both lead to both abdominal pain and fever. They should be diagnosed and treated as quickly as possible, as there is a risk of the pathogen spreading. By staying in certain places (e.g. kindergarten or nature), children are also particularly at risk for parasitic worm diseases. These, too, can lead to abdominal pain and fever after a certain latency period.

Abdominal pain and fever in the toddler

Abdominal pain often occurs in connection with other disease symptoms, especially in toddlers. Not infrequently also as part of a cold. Due to the general malaise, the child mostly projects the pain into the center of the body. Abdominal pain and fever are not uncommon in toddlers, but if you have a fever you should always consult a pediatrician in order to rule out possible inflammation.

As a rule, stomach pain and fever in toddlers are flu-like infections that are caused by viruses and are harmless. Bacteria are rarely the trigger. Not only when the pathogen affects the gastrointestinal tract, but also when the upper respiratory tract is affected by the infection, this leads to abdominal pain in the child. However, there is also a risk that the abdominal pain is a sign of pneumonia.

Read more on this topic at: Pneumonia in the baby

However, if the child's abdomen is extremely sensitive to pressure or the abdominal pain occurs specifically in the right lower abdomen, appendicitis is suspected and you should see a pediatrician immediately.

Read more on this topic at: Appendicitis in the child

Abdominal pain, fever, and diarrhea

Add to the stomach ache and the fever diarrhea added, there is a suspicion that it is a Food poisoning acts. Abdominal pain usually comes on suddenly and is accompanied by fever, diarrhea and sometimes vomiting. If the diarrhea is very fluid and passed out frequently, it exists Risk of dehydration. It is important, much to drink and, if necessary, to take additional electrolyte solutions to compensate for the loss of minerals.

In most cases, the symptoms go away on their own after a few days. However, depending on which pathogen triggered them, they can also be dangerous. Contamination with salmonella, for example in poultry, can lead to typhoid fever, which can take a serious course. An infection with salmonella is notifiable in Germany.

Clostridia can include can be found in canned foods and cause food poisoning. Depending on the subspecies, these bacteria can lead to tetanus (Tetanus), Gas burn, or damage to the bowel.
An infection with Shigella also leads to very severe diarrhea. This can lead to damage to the intestinal mucosa in the further course.

If food poisoning is suspected, a Consulted a doctor to prevent a serious course of the disease and initiate appropriate therapy in good time.

Abdominal pain, fever, and vomiting

Abdominal pain, fever, and vomiting can all affect one Food poisoning indicate. Often there is also diarrhea. Food poisoning can be caused by different pathogens are caused, count among them Salmonella, Shigella and Clostridia.
The vomiting is a Protective mechanism of the bodyto get rid of contaminated food. It should be a Consulted a doctor because some pathogens can lead to serious disease courses. An infection with Salmonella is also notifiable.

Abdominal pain, fever and sore throat

A sore throat is generally a sign of one Upper respiratory tract infection. If there is a fever, this indicates this bacterial pathogens (Streptococci). Abdominal pain is often an accompanying symptom in children, but not in adults. If so, this may be a sign of a incipient pneumonia and should be examined by a doctor.

Abdominal pain, fever, and cough

When abdominal pain and fever along with to cough caution is required. Here is the Pneumonia is suspected. This is triggered by bacteria and can develop from a flu-like infection if it is not cured properly. Not treated pneumonia can cause pneumonia serious course assume, so if you suspect you should immediately Consulted a doctor and possibly with the Antibiotic therapy to be started.

Abdominal pain, fever and headache

Abdominal pain and headache are very non-specific symptoms. However, if they are accompanied by a fever, this usually indicates an infection of the gastrointestinal tract caused by viruses or bacteria. As a rule, it is viruses that cause such infections. These are then usually quite harmless and subside by themselves after a few days. However, if bacteria are the cause, it is often necessary to take an antibiotic.

The symptom complex of abdominal pain, fever and headache can also indicate appendicitis. Then the abdomen is usually very sensitive to pressure, especially in the right lower abdomen.

Read more on this topic at: Fever, dizziness and headache such as Fever and headache

Abdominal pain, fever and body aches

Abdominal pain, fever, and body aches are typical symptoms of one viral infectionaffecting the gastrointestinal tract. The person concerned feels weak and the stomach pain often causes it Loss of appetite. The infection usually subsides on its own after a few days. A symptomatic treatment with pain relievers may be necessary if the headache is too severe or having antipyretic agentsif the fever rises too high.