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Abdominal pain is the single most common reason for ED visits and constitutes 6.8% of all visits.1 Benign etiologies need to be sorted out from potentially life-threatening conditions on a daily basis. Appendicitis remains the most common surgical condition in ED patients seeking care for their abdominal pain. Overall, in spite of multiple laboratory tests and imaging modalities available, undifferentiated abdominal pain is often the final impression and it remains the most frequently given diagnosis to ED patients presenting with abdominal pain. Diagnostic possibilities and uncertainty can be even greater in females. This chapter reviews the diagnosis and treatment of pelvic/abdominal pain in the nonpregnant woman. Specific discussion of the pregnant woman with abdominal/pelvic pain is found in Chapter 104, Emergencies after 20 Weeks of Prenancy and the Postpartum Period. A detailed assessment of abdominal pain and diagnoses is located in Chapter 74, Acute Abdominal Pain.

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Table 100-1 lists corresponding spinal segments and the nerves of the pelvic organs.

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Table 100-1 Pelvic Organ Nerve Innervation
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The differential diagnosis of abdominal pain in the nonpregnant female is due to the proximity of the gynecologic and GI systems and overlapping symptoms among abdominal and pelvic disorders. Diagnostic precision is sometimes difficult because of the various mechanisms involved with pain perception and because of the fact that many common conditions present atypically. Not infrequently, patients are labeled as undifferentiated abdominal or pelvic pain once life-threatening etiologies are eliminated.

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History

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Define pain attributes, including pain quality, location, character, duration, radiation, exacerbating and relieving factors, particulars of the onset, and response to analgesics. Table 100-2 lists a variety of pain characteristics and examples of potential corresponding pathology. Obtain a detailed gynecologic, obstetric, and urologic history. It is unwise to eliminate the possibility of pregnancy by history alone. In one instance, 7% of patients with positive pregnancy tests gave a history of a normal last menstrual period and denied being pregnant.2 In contrast, claiming not to be sexually active when asked as part of a structured gynecologic questionnaire did have a 100% NPV for a positive pregnancy test in one study.3

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Table 100-2 Characteristics of Pain and Corresponding Examples

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