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Evaluation of the adult with abdominal pain

Robert M Penner, BSc, MD, FRCPC, MSc
Mary B Fishman, MD
Sumit R Majumdar, MD, MPH
Section Editors
Andrew D Auerbach, MD, MPH
Mark D Aronson, MD
Deputy Editor
H Nancy Sokol, MD


Abdominal pain can be a challenging complaint for both primary care and specialist physicians because it is frequently a benign complaint, but it can also herald serious acute pathology.

Clinicians are responsible for trying to determine which patients can be safely observed or treated symptomatically and which require further investigation or specialist referral. This task is complicated by the fact that abdominal pain is often a nonspecific complaint that presents with other symptoms [1].

This topic reviews a diagnostic approach to nontraumatic abdominal pain in adults. The causes of abdominal pain and its pathophysiology, the evaluation of the adult with abdominal pain in the emergency department, and the evaluation of abdominal pain related to trauma is discussed elsewhere. (See "Causes of abdominal pain in adults" and "Evaluation of the adult with abdominal pain in the emergency department" and "Traumatic gastrointestinal injury in the adult patient".)


Abdominal pain is a common problem. Most patients have a benign and/or self-limited etiology, and the initial goal of evaluation is to identify those patients with a serious etiology that may require urgent intervention. A history and focused physical examination will lead to a differential diagnosis of abdominal pain, which will then inform further evaluation with laboratory evaluation and/or imaging.

History — The history of a patient with abdominal pain includes determining whether the pain is acute or chronic and a detailed description of the pain and associated symptoms, which should be interpreted with other aspects of the medical history.


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Literature review current through: Sep 2016. | This topic last updated: Feb 22, 2016.
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  1. Fleischer AB Jr, Gardner EF, Feldman SR. Are patients' chief complaints generally specific to one organ system? Am J Manag Care 2001; 7:299.
  2. Yamamoto W, Kono H, Maekawa M, Fukui T. The relationship between abdominal pain regions and specific diseases: an epidemiologic approach to clinical practice. J Epidemiol 1997; 7:27.
  3. Heikkinen M, Pikkarainen P, Eskelinen M, Julkunen R. GPs' ability to diagnose dyspepsia based only on physical examination and patient history. Scand J Prim Health Care 2000; 18:99.
  4. Thomson AB, Barkun AN, Armstrong D, et al. The prevalence of clinically significant endoscopic findings in primary care patients with uninvestigated dyspepsia: the Canadian Adult Dyspepsia Empiric Treatment - Prompt Endoscopy (CADET-PE) study. Aliment Pharmacol Ther 2003; 17:1481.
  5. Böhner H, Yang Q, Franke C, et al. Simple data from history and physical examination help to exclude bowel obstruction and to avoid radiographic studies in patients with acute abdominal pain. Eur J Surg 1998; 164:777.
  6. Eskelinen M, Ikonen J, Lipponen P. Usefulness of history-taking, physical examination and diagnostic scoring in acute renal colic. Eur Urol 1998; 34:467.
  7. Trowbridge RL, Rutkowski NK, Shojania KG. Does this patient have acute cholecystitis? JAMA 2003; 289:80.
  8. Becker SL, Vogt J, Knopp S, et al. Persistent digestive disorders in the tropics: causative infectious pathogens and reference diagnostic tests. BMC Infect Dis 2013; 13:37.
  9. Gu Y, Lim HJ, Moser MA. How useful are bowel sounds in assessing the abdomen? Dig Surg 2010; 27:422.
  10. Eskelinen M, Ikonen J, Lipponen P. Contributions of history-taking, physical examination, and computer assistance to diagnosis of acute small-bowel obstruction. A prospective study of 1333 patients with acute abdominal pain. Scand J Gastroenterol 1994; 29:715.
  11. Drossman DA, Li Z, Andruzzi E, et al. U.S. householder survey of functional gastrointestinal disorders. Prevalence, sociodemography, and health impact. Dig Dis Sci 1993; 38:1569.
  12. Talley NJ, Zinsmeister AR, Van Dyke C, Melton LJ 3rd. Epidemiology of colonic symptoms and the irritable bowel syndrome. Gastroenterology 1991; 101:927.
  13. de Dombal FT. Acute abdominal pain in the elderly. J Clin Gastroenterol 1994; 19:331.
  14. Thuluvath PJ, Connolly GM, Forbes A, Gazzard BG. Abdominal pain in HIV infection. Q J Med 1991; 78:275.
  15. Parker LJ, Vukov LF, Wollan PC. Emergency department evaluation of geriatric patients with acute cholecystitis. Acad Emerg Med 1997; 4:51.
  16. Lyon C, Clark DC. Diagnosis of acute abdominal pain in older patients. Am Fam Physician 2006; 74:1537.