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Overlooked Etiology of Chronic Abdominal Pain

Carnett’s sign may be a useful diagnostic tool

A PPM Brief

A recent review1 took a look at Carnett’s sign, a specialized physical examination technique that can be used to help verify that patients’ abdominal pain is originating from the wall of the abdomen rather than the abdominal viscera. Due to the host of possible differential diagnosis of chronic abdominal pain (CAP), it is important to determine if the source of pain is visceral or parietal.

A positive Carnett’s sign is considered after palpation of the abdomen while in the tense position is the same or similar to the tenderness of the abdomen in the resting position. “The diagnosis of CAWP can be made when the patient presents with well-localized pain over a small part of the abdomen, exhibits a positive Carnett’s sign, and has a good response to TPI,” the study authors concluded.

Carnett’s sign may be a useful diagnostic tool. (Source: 123RF)

Chronic abdominal wall pain (CAWP) is an often underrecognized etiology of chronic abdominal pain (CAP), most prevalent within middle-aged individuals and women. CAWP, also referred to as anterior cutaneous nerve entrapment syndrome, is associated with pain that occurs due to entrapment of the cutaneous branches of the sensory nerves that supply the abdominal wall. CAWP is often mistaken for visceral abdominal pain. Physicians may not consider CAWP as the cause of CAP, and often prescribe acid suppression therapy for dyspepsia or gastroesophageal reflux disease instead. CAWP is localized to two locations: right upper quadrant and superior to the umbilicus.

Diagnosis of CAWP is made using a comprehensive patient history, physical examination, and response to a trigger point inject. Patient history should include the chronicity, onset, and description and intensity of symptoms. Patients with CAWP often have a history of abdominal surgeries, with the pain being localized around the scar. Although, most patients go through a manifold of diagnostic measures ranging from extensive laboratory, imaging, and procedural work-up.

Treatment options for CAWP range from reassurance, activity modification, over-the-counter analgesic agents, and trigger point injections (TPI) using an anesthetic agent. Reassurance may be the most important component in a patient’s management plan. With painful and often disabling symptoms, it is important to remind the patient that these symptoms are typically non-progressive.

-Reporting by Cornelius Muntazar

Last updated on: April 2, 2019
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