Abdominal Pain

Scope of the problem

Anatomic Essentials
Visceral Pain
Parietal Pain
Referred Pain
 History
Where is your pain? Has it always been there?
Does the pain radiate anywhere?
How did the pain begin (sudden vs. gradual onset)? How
long have you had the pain?
What were you doing when the pain began?
What does the pain feel like?
On a scale of 010, how severe is the pain?
Does anything make the pain better or worse?
Have you had the pain before?
 History (continued)
Associated symptoms
Gastrointestinal
Genitourinary
Gynecologic
Cardiopulmonary
Past medical
 Physical Examination -
Directed
General appearance
Vital Signs
Abdomen
Inspection
Auscultation
Percussion
Palpation
 Physical Examination -
Directed
Pelvic
Genital
Back
Rectal
Head-to-toe
 Differential Diagnosis
Appendicitis Pancreatitis
Biliary colic, cholecystitis, Pelvic Inflammatory
cholangitis Disease (PID)
Bowel obstruction Perforated peptic ulcer
Diverticulitis Ruptured or leaking
Ectopic pregnancy abdominal aortic
Gastroenteritis aneurysm (AAA)
Intussuception Testicular torsion
Mesenteric Ischemia Ureteral colic
Ovarian torsion Volvulus
 Diagnostic Testing
Laboratory Studies
CBC
Urinalysis
Pregnancy
Amylase/Lipase
Other
Electrocardiogram
Diagnostic Testing - continued
Radiologic Studies
Plain Films
Ultrasound
Computed Tomography
 General Treatment Principles
Volume repletion
Pain relief
Antibiotics
Other
 Special Patients
Elderly
Pediatric
Immune compromised
 Disposition
Surgical consultation
Serial evaluation
Discharge
 Pearls, Pitfalls and Myths
Do not restrict the diagnosis solely by the
location of the pain.
Consider appendicitis in all patients with
abdominal pain and an appendix,
especially in patients with the presumed
diagnosis of gastroenteritis, PID or UTI.
Do not use the presence or absence of
fever to distinguish between surgical and
medical causes of abdominal pain.
The WBC count is of little clinical value in
the patient with possible appendicitis.
Any woman with childbearing potential
and abdominal pain has an ectopic
pregnancy until her pregnancy test comes
back negative.
Pain medications reduce pain and suffering
without compromising diagnostic
accuracy.
An elderly patient with
abdominal pain has a high
likelihood of surgical disease.
Obtain an ECG in elderly
patients and those with cardiac
risk factors presenting with
abdominal pain.
A patient with appendicitis by
history and physical
examination does not need a CT
scan to confirm the diagnosis;
they need an operation.
The use of abdominal
ultrasound or CT may help
evaluate patients over the age of
50 with unexplained abdominal
or flank pain for the presence of
AAA.