Abdominal pain is the chief complaint in 5%-10% of patients presenting to emergency departments and one of the top 10 outpatient complaints. Accurate diagnosis can be difficult, because the array of possible problems associated with abdominal pain is wide. For this reason, a detailed history, thorough physical examination, and laboratory and radiologic evaluations are necessary.
- Determine acute versus chronic.
- Quality, location, and radiation of pain.
- Associated symptoms.
The history is one of the most important components in the evaluation of abdominal pain and can help direct the subsequent workup. The first priority is to determine whether the pain is acute or chronic. The sudden or severe onset of abdominal pain, particularly pain associated with hemodynamic changes, leads toward an emergent evaluation and intervention.
A thorough and accurate history requires effective communication skills on the part of the clinician. Physicians are more likely to collect the full history when implementing the "engage, empathize, educate, and enlist" method. Patients should be allowed to tell their story, which usually takes 1 or 2 minutes and often answers the questions regarding onset, intensity, location, and frequency of the problem that can help focus the physical examination.
It is important to determine onset of pain to help in determinig the cause of abdominal pain as well as the need for emergent referral. Abdominal pain can be categorized as acute, subacute, or chronic. Generally, 3 months of symptoms are considered chronic, while acute and subacute are more subjectively determined. Acute pain is often associated with problems causing peritoneal irritation as from appendicitis, or ruptured abdominal organ. Many of these problems require emergency management and consultation with a surgeon. In the family medicine office, many other issues present with a more gradual onset of abdominal pain and by abdominal pain that is chronic in nature (Table 30-1).
Table 30–1. Common Causes of Abdominal Pain by Location. |Favorite Table|Download (.pdf)
Table 30–1. Common Causes of Abdominal Pain by Location.
|Ruptured ovarian cyst|
|Sickle cell crisis|
|Abdominal wall pain—multiple causes|
|Ruptured aortic aneurysm|