Summary
1. Thoracic pain occurs in eighty per cent of patients with pneumonia, while abdominal pain occurs in eight per cent of patients with this disease.
2. The occurrence of thoracic pain in pneumonia is a helpful symptom because it directs attention to the diseased organs, thereby aiding in their diagnosis; but the appearance of abdominal pain distracts attention from the disease giving rise to it, and so becomes a source of confusion.
3. Abdominal pain has little if any physiologic relationship to the pneumonia which produces it. It is a physiologic paradox.
4. Abdominal pain and other associated symptoms may be so pronounced as to completely mask the respiratory infection, and may simulate acute abdominal disorders, as acute appendicitis, acute cholecystitis, intestinal obstruction, etc.
5. The ability of referred abdominal pain and the associated symptoms to simulate acute appendicitis is annoyingly real at times; and laparotomies have been performed as a result of this mimicry.
6. The probable explanation for the production of referred abdominal pain lies in the toxemia which occurs in the disease.
7. The toxemia consists of two factors, a specific factor elaborated by the pneumococcus, and a non-specific factor resulting from the general fever process.
8. We regard the toxemia acting on the gastrointestinal tract as a responsible for the production of the symptoms of abdominal pain, meteorism, flatulence, nausea, vomiting, distention, constipation, etc.
9. The differential diagnosis between the acute abdominal crises and pneumonia is arrived at by a painstaking consideration of all the available clinical material.
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References
Chatard, J. A.: Lobar Pneumonia in the Johns Hopkins Hospital, 1889–1905. Johns Hopkins Hospital Reports, 1910, 15, 55.
Brown, T. R.: Abdominal Pain: Its Significance and Diagnostic Value. Ann. Int. Med., 1934, 8, 343.
Norris, G. W.: Lobar Pneumonia. Osler’s Modern Medicine, 1925, 1, 184.
Reiman, H. A.: The Pneumonias. W. B. Saunders Company, Philadelphia, 1938.
Gauss, Harry: The Interrelationship of Gastrointestinal and Renal Disease. Ann. Int. Med., 1936, 9, 1373.
Gauss, Harry: Gastrointestinal Symptoms of Pelvic Origin. Am. J. Dig. Dis., 1937, 3, 891.
Gauss, Harry: Gastrointestinal Symptoms from Cardiovascular Disease. Am. J. Dig. Dis., 1937, 4, 374.
Gauss, Harry: Gastrointestinal Symptoms in Anorectal Disease. Colorado Medicine, 1939, 36, 106.
Gauss, Harry: Gastrointestinal Symptoms in Disease of the Brain. J.A.M.A., 1939, 112, 501.
Gauss, Harry: Gastrointestinal Onset of Pulmonary Tuberculosis. Am. J. Dig. Dis., 1939, 6, 263.
Kolmer, J. A.: The General and Specific Treatment of Pneumonia. Texas State J. Med., 1938, 34, 460.
Griffiths, M. A. B.: Ptomaines extraites des urines dans quelque maladies infectienses. Compt. Rend. Acad. Sc., 1891, 113, 506.
Griffiths, M. A. b.: Recherches sur les ptomaines dans quelques maladies infectienses. Compt. Rend. Acad. Sc., 1892, 114, 506.
Dochez, A. R. and Avery, O. T.: Elaboration of specific soluble substances by pneumococcus during growth. J. Exper. Med., 1917, 26, 477.
Macleod’s Physiology in Modern Medicine. C. V. Mosby Company, St. Louis, 1938.
Best, C. H. and Taylor, N. B.: The Physiological Basis of Medical Practice. William Wood and Co., Baltimore, 1937.
Palmer, W. W.: Acidosis and Acid Excretion in Pneumonia. J. Exper. Med., 1917, 26, 495.
Elwyn, Herman: Some Present Day Concepts in Nephritis. Am. J. Med. Sc., 1930, 179, 149.
Pottenger, F. M.: Symptoms of Visceral Disease. C. V. Mosby Company, St. Louis, 1938.
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Gauss, H. Abdominal pain in pneumonia. Jour. D. D. 13, 73–77 (1946). https://doi.org/10.1007/BF03002754
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DOI: https://doi.org/10.1007/BF03002754