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Cardiovascular Medicine

Painful Conditions

Bowel Disorders

Gallbladder Disorders

Hernia

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Abdominal Pain Evaluation

Aka: Abdominal Pain Evaluation
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  1. See Also
    1. Acute Abdominal Pain
    2. Acute Abdominal Pain Causes
    3. Abdominal Pain in Older Adults
  2. History
    1. Abdominal Pain characteristics
      1. Time of onset
      2. Pain localization and radiation
      3. Palliative and provocative factors
    2. Associated Symptoms
      1. Nausea or Vomiting
      2. Fever
      3. Anorexia
      4. Diarrhea or Constipation
      5. Bloody stool
      6. Dysuria
    3. Past Medical History
      1. Abdominal surgery, procedures or trauma
        1. Consider Small Bowel Obstruction
      2. Cholelithiasis
      3. Diverticulitis
      4. Cardiovascular disease
        1. Consider Mesenteric Ischemia
        2. Consider Abdomnal Aortic Aneurysm
        3. Consider referred cardiac ischemia pain
      5. Diabates Mellitus (Diabetic Ketoacidosis)
      6. Human Immunodeficiency Virus (HIV)
      7. Sickle Cell Anemia
      8. Inflammatory Bowel Disease
    4. Social History
      1. Tobacco Abuse
        1. Consider Mesenteric Ischemia
        2. Consider Abdominal Aortic Aneurysm
      2. Alcohol Abuse
        1. Consider Pancreatitis
        2. Consider Gall Bladder disease
    5. Medications
    6. Recent Travel (Parasitic infection)
    7. Review of Symptoms
      1. Pharyngitis (may mimic surgical Abdomen)
      2. Genitourinary
        1. Menstrual History
        2. Obstetrical history
        3. Urinary Symptoms (Dysuria, Hematuria, frequency)
  3. Examination
    1. General appearance
      1. Acutely or chronically ill appearing patient
      2. Malnourished patient
      3. Positioning
        1. Retroperitoneal irritation: Thighs flexed
        2. Peritonitis: Lie very still
        3. Bowel Obstruction or Nephrolithiasis: Restless
    2. Back Exam
      1. Flank Ecchymosis
      2. Costovertebral Angle tenderness (flank tenderness)
    3. Cardiopulmonary examination
      1. Assess for Myocardial Infarction
      2. Assess for Cardiac arrhythmia
      3. Arterial Pulses
        1. Femoral pulse
        2. Pedal pulses (dorsalis pedis and posterior tibial)
    4. Abdominal examination
      1. Pearls
        1. Do not test rebound tenderness by rapid release
        2. Stethoscope applies pressure and observe response
      2. Observation
        1. Distention, Asymmetry or Peristalsis
        2. Scars from prior abdominal surgeries, trauma
        3. Hernia (and signs of incarceration)
        4. Reduced chest excursion (due to guarding)
      3. Auscultation
        1. Borborygmi: Consider Bowel Obstruction
        2. Silent: Consider surgical Abdomen
      4. Palpation
        1. Maximal tenderness
        2. Pulsatile masses (Abdominal Aortic Aneurysm)
        3. Abnormal fullness
        4. Muscle tone
    5. Genitourinary examination
      1. Examine for Femoral Hernia
      2. Rectal exam in all patients with Abdominal Pain
        1. Pain on palpation
        2. Occult or frankly bloody stool
      3. Pelvic exam in all women
  4. Labs
    1. Urinalysis
    2. Complete Blood Count (CBC)
      1. Leukocytosis lags other findings in elderly
    3. Electrocardiogram
    4. Pulse oximetry
    5. Serum Phosphate (increased in Mesenteric Ischemia)
    6. Liver Function Tests
    7. Blood Cultures
    8. Amylase
      1. Pancreatitis (Lipase preferred)
      2. Bowel Obstruction
      3. Bowel perforation or peptic ulcer perforation
      4. Mesenteric Ischemia
    9. Lipase Indications
      1. Pancreatitis
      2. Bowel Obstruction
      3. Duodenal Ulcer
    10. Arterial Blood Gas
  5. Imaging: Protocol
    1. Directed imaging where specific cause is suggested
    2. Initial non-specific radiology studies
      1. Chest XRay findings
        1. Abdominal free air
        2. Congestive Heart Failure
        3. Pneumonia
      2. Kidney, Ureter, Bladder plain XRay (KUB) findings
        1. Small Bowel Obstruction
        2. Incarcerated Hernia
        3. Appendicitis
        4. Large Bowel Obstruction
        5. Diverticulitis
        6. Volvulus
        7. Mesenteric Ischemia
    3. Second-line studies where diagnosis unclear
      1. See available studies below for specific indications
      2. Abdominal CT is most broadly useful study
        1. "Workhorse" of Acute Abdomen evaluation
        2. Sucher (2002) Semin Laparosc Surg 9(1):3-9
      3. Right upper quadrant Ultrasound
        1. First-line study if biliary tract disease suspected
      4. Angiography or MR angiography
        1. Indicated for Mesenteric Ischemia
      5. Upper Endoscopy
        1. Indicated if Peptic Ulcer Disease suspected
  6. Imaging: Available studies
    1. Chest XRay
      1. Assess for cardiopulmonary process
      2. Identifies 50-90% of perforated viscus
        1. Free air under diaphragm
        2. Increased sensitivity
          1. Left lateral decubitus XRay
          2. XRay after 500 ml air given via Nasogastric Tube
    2. Abdominal XRay (KUB) Indications
      1. Bowel perforation
      2. Bowel Obstruction
      3. Abdominal Aortic Aneurysm
      4. Volvulus
      5. Nephrolithiasis
      6. Abdominal Trauma
      7. Mesenteric Ischemia
      8. Cholelithiasis
    3. Abdominal Ultrasound Indications
      1. Cholecystitis
      2. Appendicitis (lower efficacy than CT)
      3. Abdominal Aortic Aneurysm (hemodynamically unstable)
    4. Abdominal CT Indications
      1. Appendicitis
      2. Diverticulitis
      3. Bowel Obstruction
      4. Pancreatitis
      5. Abdominal Aortic Aneurysm (hemodynamically stable)
      6. Mesenteric Ischemia
    5. Angiography or MR Angiography Indications
      1. Mesenteric Ischemia

Abdominal Pain (C0000737)

Definition (NCI) Painful sensation in the abdominal region.
Definition (NCI) A disorder characterized by a sensation of marked discomfort in the abdominal region.
Definition (MEDLINEPLUS)

Your abdomen extends from below your chest to your groin. Some people call it the stomach, but your abdomen contains many other important organs. Pain in the abdomen can come from any one of them. The pain may start somewhere else, such as your chest. Severe pain doesn't always mean a serious problem. Nor does mild pain mean a problem is not serious.

Call your healthcare provider if mild pain lasts a week or more or if you have pain with other symptoms. Get medical help immediately if

  • You have abdominal pain that is sudden and sharp
  • You also have pain in your chest, neck or shoulder
  • You're vomiting blood or have blood in your stool
  • Your abdomen is stiff, hard and tender to touch
  • You can't move your bowels, especially if you're also vomiting
Definition (MSH) Sensation of discomfort, distress, or agony in the abdominal region; generally associated with functional disorders, tissue injuries, or diseases.
Concepts Sign or Symptom (T184)
MSH D015746
ICD9 789.00, 789.0
ICD10 R10.9
SnomedCT 207205003, 207230000, 158498003, 158512003, 139313005, 21522001
English Abdominal Pains, ABDOMINAL PAIN NOS, ABDOMINAL PAIN, PAIN ABDOMINAL, Pains, Abdominal, Abdominal pain NOS, Abdominal Pain, [D]Abdominal pain (context-dependent category), [D]Abdominal pain NOS (context-dependent category), Abdo pain, Pain abdo, Abd. pain, [D]Abdominal pain, [D]Abdominal pain NOS, Abdomen pain, abdominal pain (symptom), abdominal pain, [D]Abdominal pain (situation), [D]Abdominal pain NOS (situation), Pain, Abdominal, Pain abdominal, Gut pain, ABDOMEN PAIN, Abdmnal pain unspcf site, PAIN, ABDOMINAL, Unspecified abdominal pain, Abdominal Pain [Disease/Finding], Pain;abdominal, gut pain, abdomen pain, abdominal pains, Bellyache, Abdominal pain, AP - Abdominal pain, Abdominal pain (finding), abdominal; pain, abdominalgia, pain; abdominal, Abdominal pain, unspecified site
French DOULEUR ABDOMINALE, Douleur abdominale SAI, Douleur intestinale, Douleur abdo, Douleur abdo., Douleur abd., Douleur abdominale, Douleur de l'abdomen
Portuguese DOR ABDOMINAL, Dor abdominal NE, Dor intestinal, Dor abdominal, Dor Abdominal
Dutch darmpijn, buikpijn NAO, pijn abdominaal, abdominaal; pijn, pijn; abdominaal, abdominale pijn, Buikpijn, Pijn, buik-
German Schmerz abdominal, Bauchschmerz, abd. Schmerz, Abdominalschmerzen NNB, Schmerz abdo, abdo. Schmerz, ABDOMEN SCHMERZHAFT, Abdominalschmerz, Abdominalschmerzen, Bauchschmerzen
Italian Dolore intestinale, Dolore addominale NAS, Dolore addominale
Spanish Dolor de barriga, Dolor abdominal NEOM, [D]dolor abdominal, SAI (categoría dependiente del contexto), [D]dolor abdominal (categoría dependiente del contexto), [D]Abdominal pain NOS, Abdominal pain, [D]Abdominal pain, ABDOMEN, DOLOR, [D]dolor abdominal, SAI, [D]dolor abdominal, SAI (situación), [D]dolor abdominal, [D]dolor abdominal (situación), dolor abdominal (hallazgo), dolor abdominal, Dolor abdominal, Dolor Abdominal
Japanese 腸管痛, 腹痛ＮＯＳ, 腹痛, ﾌｸﾂｳ, ﾁｮｳｶﾝﾂｳ, ﾌｸﾂｳNOS
Swedish Buksmärta
Czech břicho - bolest, Břišní bolest NOS, Střevní bolest, Bolest břicha
Finnish Vatsakipu
Russian BRIUSHNAIA POLOST', BOLI, ABDOMINAL'NAIA BOL', АБДОМИНАЛЬНАЯ БОЛЬ, БРЮШНАЯ ПОЛОСТЬ, БОЛИ
Croatian ABDOMINALNA BOL
Polish Ból brzucha
Hungarian Hasi fájdalom, Abdominalis fájdalom k.m.n., Bél fájdalom, Abdominalis fájdalom, Hasfájdalom
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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