Abdominal Pain

Risk: Use of aspirin and other nonsteroidal anti-inflammatory drugs, alcohol, or tobacco can lead to abdominal pain, but because the pain is a symptom of a variety of underlying causes, risks related to demographics and lifestyle are difficult to anticipate.

Incidence and Prevalence: Males and females are affected equally and incidence varies with the underlying cause or diagnosis. All age groups are affected although incidence increases with advancing age (King). Annually, more than 13.5 million individuals are seen in primary care settings for abdominal pain (Flasar). Abdominal pain accounts for 10% of all emergency room visits (King).

History: The timing mode of onset and initial characteristics of pain are all key elements of the history. Abdominal pain can vary in location, mode of onset, progression, and character. The individual may complain of slow onset; dull poorly localized abdominal pain; or acute, sharp, and highly localized pain. Abdominal pain can spread or shift over time. Onset may be rapid (within seconds), rapidly progressive (within 1 to 2 hours), or gradual (over several hours or days). Pain can be constant, intermittent, vague, or crampy. The individual may describe it as "stabbing" or capable of "taking my breath away." The pain may radiate or be referred to the shoulder, the back or, in men, the testicles. The relationship of pain to food intake can offer valuable clues about causation. Individuals may also complain of fever, loss of appetite, nausea, vomiting, constipation, or diarrhea. In many cases, other symptoms are helpful in identifying the cause of abdominal pain. Besides the present condition, the history must include a detailed account of all existing medical conditions, medications, family history and occupational history.

Physical exam: Physical findings vary depending on the cause of the abdominal pain. The abdomen can be tense, rigid, generally or locally tender, and/or distended. Contractions may be visible, and bowel sounds may be diminished. Abdominal masses may be detected by deep touch (palpation). Pain with gentle pressure on the abdomen may intensify when the pressure is released (rebound tenderness). Other pertinent findings may include pale complexion (pallor), low blood pressure (hypotension), fever, rapid heartbeat, shallow breathing, sweating. A yellow tinge to the skin and whites of the eyes (jaundice) suggests liver involvement. Blood in the vomitus, stool, or urine (hematuria) suggests other diagnoses. Rectal and pelvic examinations may help identify the location and source of the pain. Vital signs (i.e., blood pressure, or heart rate) should be monitored; abnormalities in vital signs may indicate a more serious life-threatening condition.

Tests: Commonly ordered laboratory tests include blood studies such as a complete blood count, liver function panel, kidney function panel, pregnancy test, amylase, and lipase. Urinalysis may be done to look for infection, kidney dysfunction, or urinary tract disorders. The stool may be tested for occult blood, parasites, or other abnormalities. Diagnostic imaging studies may include plain chest and abdominal x-rays, contrast x-rays (upper and lower GI series), intravenous pyelogram (to look for kidney/urinary tract abnormalities), angiography, ultrasound, CT, and radionuclide scan. Endoscopy (colonoscopy, gastroduodenoscopy, proctosigmoidoscopy) may be indicated, as well as paracentesis (removal of excess abdominal fluid) and laparoscopy. In women, diagnostic laparoscopy may be done for suspected gynecologic causes because the technique allows both rapid diagnosis and immediate surgical intervention. In some cases, cardiovascular tests such as EKG or echocardiography may be done to help determine the cause of pain. Such tests are especially important if there is a history of atherosclerotic disease, or arrhythmias, as well as when the individual has certain risk factors.