Evaluation of the adult with abdominal pain
- Robert M Penner, BSc, MD, FRCPC, MSc
Robert M Penner, BSc, MD, FRCPC, MSc
- Assistant Clinical Professor
- University of Alberta, Canada
- Mary B Fishman, MD
Mary B Fishman, MD
- Associate Professor of Medicine
- Icahn School of Medicine at Mount Sinai
- Sumit R Majumdar, MD, MPH
Sumit R Majumdar, MD, MPH
- University of Alberta Medical School, Canada
- Section Editors
- Andrew D Auerbach, MD, MPH
Andrew D Auerbach, MD, MPH
- Section Editor - Hospital Medicine
- Professor of Medicine
- University of California, San Francisco
- Mark D Aronson, MD
Mark D Aronson, MD
- Editor-in-Chief — Primary Care (Adult); Hospital Medicine
- Section Editor — General Medicine
- Professor of Medicine
- Harvard Medical School
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 .
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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- - Acute versus chronic
- - Description
- - Associated symptoms
- - Other medical history
- Physical examination
- DIAGNOSTIC APPROACH TO ACUTE ABDOMINAL PAIN
- Urgent/emergent evaluation and/or surgical abdomen
- Nonurgent evaluation
- - Right upper quadrant pain
- - Epigastric pain
- - Left upper quadrant pain
- - Lower abdominal pain
- - Diffuse abdominal pain
- DIAGNOSTIC APPROACH TO CHRONIC ABDOMINAL PAIN
- Initial work-up
- Subsequent work-up
- SPECIAL POPULATIONS
- Older adults
- Sickle cell
- HIV patients
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS