Abdominal pain: Difference between revisions

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''For pediatric patients see [[Abdominal pain (peds)]]. See also [[abdominal pain (geriatrics)]] and [[Abdominal pain in pregnancy]].''
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''For pediatric patients see [[Special:MyLanguage/Abdominal pain (peds)|Abdominal pain (peds)]]. See also [[Special:MyLanguage/abdominal pain (geriatrics)|abdominal pain (geriatrics)]] and [[Special:MyLanguage/Abdominal pain in pregnancy|Abdominal pain in pregnancy]].''
 
 
==Background==
==Background==
*Patients with immunosuppression often have delayed or atypical presentations
*Patients with immunosuppression often have delayed or atypical presentations
*[[Fever]] is not a reliable marker for surgical disease
*[[Special:MyLanguage/Fever|Fever]] is not a reliable marker for surgical disease
*Abdominal pain may be particularly misleading in elderly or diabetics
*Abdominal pain may be particularly misleading in elderly or diabetics
*Consider pain in any abdominal or pelvic region in a female of child-bearing age, including pre-teens, is an [[ectopic pregnancy]] until proven otherwise
*Consider pain in any abdominal or pelvic region in a female of child-bearing age, including pre-teens, is an [[Special:MyLanguage/ectopic pregnancy|ectopic pregnancy]] until proven otherwise


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{{Abdominal pain location}}
{{Abdominal pain location}}
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==Clinical Features==
==Clinical Features==
*Abdominal pain (see workup by location)
*Abdominal pain (see workup by location)
*May be associated with [[nausea]], [[vomiting]] or [[diarrhea]]
*May be associated with [[Special:MyLanguage/nausea|nausea]], [[Special:MyLanguage/vomiting|vomiting]] or [[Special:MyLanguage/diarrhea|diarrhea]]
*[[Fever]] may be present in pain from infectious etiology
*[[Special:MyLanguage/Fever|Fever]] may be present in pain from infectious etiology
 
 


==Differential Diagnosis==
==Differential Diagnosis==
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{{Abdominal Pain DDX Diffuse}}
{{Abdominal Pain DDX Diffuse}}
 
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{{Abdominal Pain DDX Epigastric}}
{{Abdominal Pain DDX Epigastric}}
 
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{{DDX RUQ}}
{{DDX RUQ}}
 
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{{DDX LUQ}}
{{DDX LUQ}}
 
<translate>
</translate>
{{Abd DDX RLQ}}
{{Abd DDX RLQ}}
 
<translate>
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{{LLQ DDX}}
{{LLQ DDX}}
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</translate>
{{Pelvic pain DDX}}
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{{Extra-abdominal sources of abdominal pain DDX}}
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{{Pelvic pain DDX}}


{{Extra-abdominal sources of abdominal pain DDX}}


==Evaluation==
==Evaluation==
*Pregnancy test in all females of childbearing age — this is mandatory
*Vitals: Tachycardia and hypotension suggest serious pathology (hemorrhage, sepsis, perforation)
*Point-of-care ultrasound: FAST exam (free fluid), RUQ (gallbladder), aorta (AAA), renal (hydronephrosis)
*Workup is by location:
*Workup is by location:
**[[RUQ pain]]
**[[Special:MyLanguage/RUQ pain|RUQ pain]]
**[[RLQ pain]]
**[[Special:MyLanguage/RLQ pain|RLQ pain]]
**[[Epigastric pain]]
**[[Special:MyLanguage/Epigastric pain|Epigastric pain]]
**[[LUQ pain]]
**[[Special:MyLanguage/LUQ pain|LUQ pain]]
**[[LLQ pain]]
**[[Special:MyLanguage/LLQ pain|LLQ pain]]
**[[Diffuse abdominal pain]]
**[[Special:MyLanguage/Diffuse abdominal pain|Diffuse abdominal pain]]
**[[Flank pain]]
**[[Special:MyLanguage/Flank pain|Flank pain]]
 
 


==Management==
==Management==
*'''Pain control:''' Do not withhold analgesia — multiple studies confirm it does not mask surgical findings<ref>Ranji SR, et al. Do opiates affect the clinical evaluation of patients with acute abdominal pain? JAMA. 2006;296(14):1764-74.</ref>
**[[Ketorolac]] 15-30 mg IV, [[acetaminophen]] 1g IV, or opioids for severe pain
*Antiemetics: [[Ondansetron]] 4 mg IV for nausea/vomiting
*IVF: Fluid resuscitation for dehydrated or hemodynamically unstable patients
*NPO: If surgical abdomen suspected
*Antibiotics: Early if infection suspected (sepsis, perforated viscus, appendicitis)
*Surgical consultation: Emergent for peritonitis, perforation, ischemic bowel, ruptured AAA, ruptured ectopic
*Treat underlying cause
*Treat underlying cause
*Multiple studies show [[pain medicine]] should not be withheld for fear of masking symptoms
 
 


==Disposition==
==Disposition==
*Depends on etiology
 
*The two most notoriously missed conditions are [[appendicitis]] and [[small bowel obstruction]].<ref>Macaluso CR and McNamara RM. Evaluation and management of acute abdominal pain in the emergency department. Int J Gen Med. 2012; 5: 789–797. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3468117/</ref>. When discharging patients with abdominal pain, clear instructions should be given for return if there are red flags.
*Admit: Surgical abdomen, hemodynamic instability, intractable pain/vomiting, inability to tolerate PO, suspected serious pathology requiring observation or further workup
*Discharge: Benign exam with improvement after treatment, reliable follow-up, clear return precautions (worsening pain, fever, vomiting, inability to tolerate PO)
*The two most notoriously missed conditions are [[Special:MyLanguage/appendicitis|appendicitis]] and [[Special:MyLanguage/small bowel obstruction|small bowel obstruction]].<ref>Macaluso CR and McNamara RM. Evaluation and management of acute abdominal pain in the emergency department. Int J Gen Med. 2012; 5: 789–797. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3468117/</ref>. When discharging patients with abdominal pain, clear instructions should be given for return if there are red flags.
 
 


==See Also==
==See Also==
*[[Abdominal Pain (Geriatrics)]]
 
*[[Abdominal Pain (Peds)]]
*[[Special:MyLanguage/Abdominal Pain (Geriatrics)|Abdominal Pain (Geriatrics)]]
*[[Abdominal Trauma]]
*[[Special:MyLanguage/Abdominal Pain (Peds)|Abdominal Pain (Peds)]]
*[[Abdominal pain in pregnancy]]
*[[Special:MyLanguage/Abdominal Trauma|Abdominal Trauma]]
*[[Pelvic Pain]]
*[[Special:MyLanguage/Abdominal pain in pregnancy|Abdominal pain in pregnancy]]
*[[Special:MyLanguage/Pelvic Pain|Pelvic Pain]]
 
 


==References==
==References==
<references/>
<references/>
[[Category:GI]]
[[Category:GI]]
[[Category:Misc/General]]
[[Category:Misc/General]]
[[Category:Symptoms]]
[[Category:Symptoms]]
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Latest revision as of 09:29, 22 March 2026

For pediatric patients see Abdominal pain (peds). See also abdominal pain (geriatrics) and Abdominal pain in pregnancy.


Background

  • Patients with immunosuppression often have delayed or atypical presentations
  • Fever is not a reliable marker for surgical disease
  • Abdominal pain may be particularly misleading in elderly or diabetics
  • Consider pain in any abdominal or pelvic region in a female of child-bearing age, including pre-teens, is an ectopic pregnancy until proven otherwise


Classification by Abdominal pain location

Side-by-side comparison of quadrants and regions.
Chart of commonly reported referred pain sites.
RUQ pain Epigastric pain LUQ pain
Flank pain Diffuse abdominal pain Flank pain
RLQ pain Pelvic pain LLQ pain


Clinical Features

  • Abdominal pain (see workup by location)
  • May be associated with nausea, vomiting or diarrhea
  • Fever may be present in pain from infectious etiology


Differential Diagnosis

Diffuse Abdominal pain


Epigastric Pain

RUQ Pain

Left upper quadrant abdominal pain


RLQ Pain

LLQ Pain

Acute Pelvic Pain

Differential diagnosis of acute pelvic pain

Gynecologic/Obstetric

Genitourinary

Gastrointestinal

Musculoskeletal

Vascular

Extra-abdominal Sources of Abdominal pain


Evaluation


Management

  • Pain control: Do not withhold analgesia — multiple studies confirm it does not mask surgical findings[2]
  • Antiemetics: Ondansetron 4 mg IV for nausea/vomiting
  • IVF: Fluid resuscitation for dehydrated or hemodynamically unstable patients
  • NPO: If surgical abdomen suspected
  • Antibiotics: Early if infection suspected (sepsis, perforated viscus, appendicitis)
  • Surgical consultation: Emergent for peritonitis, perforation, ischemic bowel, ruptured AAA, ruptured ectopic
  • Treat underlying cause


Disposition

  • Admit: Surgical abdomen, hemodynamic instability, intractable pain/vomiting, inability to tolerate PO, suspected serious pathology requiring observation or further workup
  • Discharge: Benign exam with improvement after treatment, reliable follow-up, clear return precautions (worsening pain, fever, vomiting, inability to tolerate PO)
  • The two most notoriously missed conditions are appendicitis and small bowel obstruction.[3]. When discharging patients with abdominal pain, clear instructions should be given for return if there are red flags.


See Also


References

  1. ↑ Norris DL, Young JD. UTI. EM Clin N Am. 2008; 26:413-30.
  2. ↑ Ranji SR, et al. Do opiates affect the clinical evaluation of patients with acute abdominal pain? JAMA. 2006;296(14):1764-74.
  3. ↑ Macaluso CR and McNamara RM. Evaluation and management of acute abdominal pain in the emergency department. Int J Gen Med. 2012; 5: 789–797. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3468117/
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