From the Guidelines
Diagnostic tests for lower abdominal pain should begin with a thorough medical history and physical examination, followed by laboratory tests including complete blood count, urinalysis, and pregnancy test for women of childbearing age, and imaging studies such as abdominal ultrasound and CT scans, as recommended by the most recent guidelines 1. The selection of diagnostic tests depends on the patient's symptoms, medical history, physical examination findings, and suspected diagnoses.
- Laboratory tests may include:
- Complete blood count
- Urinalysis
- Pregnancy test for women of childbearing age
- Blood tests such as C-reactive protein and erythrocyte sedimentation rate to check for inflammation
- Imaging studies may include:
- Abdominal ultrasound, which is non-invasive and can detect gallstones, appendicitis, ovarian cysts, and kidney stones
- CT scans, which provide more detailed images and are particularly useful for diagnosing conditions like diverticulitis, appendicitis, and bowel obstructions
- Transvaginal ultrasound for women with suspected gynecological causes
- Additional tests may include:
- Stool analysis for gastrointestinal infections
- Colonoscopy for inflammatory bowel disease or colorectal cancer
- Laparoscopy for direct visualization of abdominal organs The goal of these diagnostic tests is to identify the underlying cause of pain and guide appropriate treatment, as supported by recent studies 1. It is essential to note that the choice of diagnostic tests may vary depending on the patient's specific situation and the availability of resources, and should always prioritize the patient's morbidity, mortality, and quality of life as the primary outcome 1.
From the Research
Diagnostic Tests for Lower Abdominal Pain
The diagnosis of lower abdominal pain involves a range of tests, including:
- Computed tomography (CT) scans 2, 3, 4
- Ultrasonography 2, 3, 4
- Magnetic resonance imaging (MRI) 2, 3
- Laboratory testing, such as pregnancy tests for women of reproductive age 3
- Faecal tests, including quantitative faecal immunochemical tests (FIT) for haemoglobin (f-Hb) and quantitative faecal calprotectin (f-C) point-of-care (POC) testing 5
Imaging Tests
Imaging tests are crucial in diagnosing the cause of lower abdominal pain. The choice of imaging test depends on the suspected diagnosis. For example:
- Ultrasonography is preferred when ovarian pathology is suspected 3
- CT scans are indicated when appendicitis or diverticulitis is suspected 2, 4
- MRI can be helpful in pregnant women when acute appendicitis is suspected, if ultrasonography results are nondiagnostic 3
Laboratory Tests
Laboratory tests can help confirm a diagnosis. For example:
- Pregnancy tests are essential for women of reproductive age 3
- Faecal tests, such as quantitative f-Hb, can be used as a rule-out test for significant colorectal disease (SCD) 5
Triage Strategy
A triage strategy is necessary to select patients who would benefit most from endoscopy. A single quantitative f-Hb result, without any clinical information, could be sufficient to decide whom to refer for endoscopy 5