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Evaluation of the adult with abdominal pain in the emergency department

John L Kendall, MD, FACEP
Maria E Moreira, MD
Section Editor
Robert S Hockberger, MD, FACEP
Deputy Editor
Jonathan Grayzel, MD, FAAEM


Abdominal pain continues to pose diagnostic challenges for emergency clinicians. In many cases, the differential diagnosis is wide, ranging from benign to life-threatening conditions. Causes include medical, surgical, intraabdominal, and extraabdominal ailments. Associated symptoms often lack specificity and atypical presentations of common diseases are frequent, further complicating matters.

The elderly, the immunocompromised, and women of childbearing age pose special diagnostic challenges. Elderly and diabetic patients often have vague, nonspecific complaints and atypical presentations of potentially life-threatening conditions leading to time consuming workups [1,2]. The immunocompromised patient may suffer from a wide range of ailments, including unusual and therapy-related conditions. Pregnancy leads to physiologic and anatomic changes affecting the presentation of common diseases. (See "Approach to abdominal pain and the acute abdomen in pregnant and postpartum women" and "Evaluation of abdominal pain in the HIV-infected patient".)

This topic review will discuss how to assess the adult patient presenting to the emergency department (ED) with abdominal pain, and provide a synopsis of important diagnoses to consider. Detailed discussions of specific diagnoses are found separately.


Abdominal pain comprises 5 to 10 percent of emergency department (ED) visits [3-6]. Despite sophisticated diagnostic modalities, undifferentiated abdominal pain remains the diagnosis for approximately 25 percent of patients discharged from the ED and between 35 and 41 percent for those admitted to the hospital [4,7-9]. Approximately 80 percent of patients discharged with undifferentiated abdominal pain improve or become pain-free within two weeks of presentation [9].

Older patients with abdominal pain have a six- to eightfold increase in mortality compared to younger patients [1,10]. The elderly (ie, patients over 65 years of age) account for 20 percent of ED visits, of which 3 to 4 percent are for abdominal pain [1,10,11]. About one-half to two-thirds of these patients requires hospitalization, while one-third requires surgical intervention [2,5,12-14]. Some studies suggest the elderly sustain increased mortality when their diagnosis is not determined in the ED [15].


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Literature review current through: Sep 2016. | This topic last updated: Sep 29, 2016.
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