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Bloated Stomach – Causes of Abdominal Distension and Bloating

Stomach bloating is a visible enlargement of the abdomen and usually associated with gas or fluid. However, any mass in the abdomen may also result in a visible and palpable swelling which may feel soft, spongy, firm or hard and could be mistaken for fluid or gas.

Abdominal  distension is commonly referred to as a bloated stomach but the enlargement may not always be due to the stomach or associated with gas as is often the case with bloating. Any distension or bulging that is evident on only one part of the the abdomen may provide a clearer indication of the underlying cause along with other associated signs and symptoms.

Abdominal distension may be due to a number of reasons which are not always related to any disease. The most common causes of generalized abdominal bloating or a swollen stomach is due to the five F’s – flatus (gas), fat, fluid, feces (constipation), fetus (pregnancy).

Causes of a Bloated Stomach

Many diseases of any of the abdominal organs and structures can result in bloating that is evident as an increase in the abdominal diameter. However, a solid mass, enlarged organ or fluid or gas accumulation may present as a swelling at a specific area (quadrant) of the abdomen which is usually palpable and occasionally visible.

Right Upper Quadrant

  • Hepatomegaly (Enlarged Liver)
  • Causes
    • Alcoholic liver disease
    • Biliary cirrhosis
    • Primary hepatocellular carcinoma (liver cancer)
    • Autoimmune hepatitis
    • Viral hepatitis
    • Heart failure
  • Gallbladder
  • Causes
    • Gallstones
    • Cholangitis – inflammation of the gallbladder
    • Gallbladder cancer
  • Kidney (Right)
  • Causes
    • Polycystic kidney
    • Hydronephrosis – kidney stone, other causes of urinary outlet obstruction
    • Renal carcinoma (cancer of the kidney)
  • Colon
  • Causes
    • Feces – refer to Swollen Stomach for a list of causes
    • Colon cancer
    • Colitis
    • Diverticulosis

Left Upper Quadrant

  • Hepatomegaly
  • An enlarged liver can be detected in the LUQ  (moderate to marked enlargement)
  • Splenomegaly (Enlarged Spleen)
  • Causes
    • Infections, especially blood-borne infections
    • Lymphoma
    • Lymphatic leukemias
    • Hemolytic anemia
    • Polycythemia rubra vera
    • Myelofibrosis
    • Heart failure
    • Cirrhosis (liver)
    • Thromobosis in the portal or splenic vein.
    • Splenomegaly may also be present in a person with inflammatory immune-related disorders like rheumatoid arthritis and systemic lupus erythematosus (SLE).
  • Hepatosplenomegaly
  • An enlarged liver and spleen is known as hepatosplenomegaly.
  • Causes
    • Amyloidosis
    • Cirrhosis
    • Lymphoma
    • Myeloproliferative diseases
  • Left Kidney
  • Causes
    • Polycystic kidney disease
    • Hydronephrosis – kidney stone, other causes of urinary outlet obstruction
    • Renal carcinoma (cancer of the kidney)
  • Stomach
  • Cause
    • Stomach distension with food/drink due to delayed gastric emptying – pyloric stenosis, gastroparesis
    • Stomach cancer
  • Pancreas
  • Causes
    • Pancreatitis
    • Pancreatic cancer
    • Pancreatic pseudocyst
    • Pancreatic abscess
    • Cystadenoma (benign)
  • Colon
  • Causes
    • Feces
    • Colon cancer
    • Splenic flexure syndrome
    • Colitis
    • Diverticulosis
  • Aorta
  • May be more evident in the epigastric region.
  • Cause

Middle of the Abdomen

  • Epigastric Region
  • Causes mentioned above :
    • Stomach
    • Pancreas
    • Aorta
    • Colon
  • Umbilical Region
  • Causes :
    • Hernia
    • Crohn’s disease (small intestine)
    • Intestinal obstruction
  • Other causes mentioned above :
    • Colon
    • Stomach
    • Spleen (marked splenomegaly)
    • Liver (marked hepatomegaly)
  • Hypogastric (Suprapubic) Region :
  • Bladder
  • Causes :
    • Distended bladder due to outlet obstruction – bladder stone, prostate (mentioned below)/
    • Bladder cancer
  • Prostate
  • Various prostate diseases may affect bladder emptying thereby resulting in bladder distension.
  • Causes :
  • Uterus
  • Causes :
    • Fibroids
    • Uterine cancer

Right and Left Lower Quadrant

  • Appendix (right lower quadrant only)
  • Cause :
  • Small intestine
  • Causes :
    • Crohn’s disease
    • Lipoma
    • Intestinal obstruction
  • Colon
  • Causes :
  • Gynecological
  • Causes :
    • Ovarian cyst
    • Tumor of the ovary
    • Ectopic pregnancy

Other Causes

There are other causes that may not be related to the organs in the abdomen. It may affect the entire abdomen or it is isolated to one or more quadrants.

  • Abdominal wall
  • Causes :
    • Hernia
    • Lipoma
    • Trauma
  • Peritoneal Cavity
  • Causes :
    • Ascites
    • Peritoneal abscess
    • Peritonitis

References

  1. Abdominal Distension and Bloating. Patient.co.uk
  2. Swollen Abdomen. Medline Plus