From the Guidelines
The initial workup for a male presenting with abdominal pain should begin with a thorough history and physical examination, followed by targeted laboratory and imaging studies, with CT abdomen and pelvis being the preferred initial imaging modality. This approach is supported by the American College of Radiology (ACR) Appropriateness Criteria for acute nonlocalized abdominal pain, which recommends CT abdomen and pelvis as the initial imaging study 1. The history and physical examination should include details about the pain characteristics, associated symptoms, and relevant medical history, as well as vital signs, abdominal inspection, auscultation for bowel sounds, percussion, and palpation to assess tenderness, guarding, or rebound tenderness.
Some key points to consider in the workup of abdominal pain in males include:
- Laboratory tests such as complete blood count, comprehensive metabolic panel, urinalysis, and lipase should be performed to evaluate for infection, inflammation, and organ dysfunction 1
- Imaging studies should be tailored to the suspected diagnosis, with ultrasound being useful for gallbladder and appendix evaluation, and CT scan providing a comprehensive assessment of abdominal organs and potential pathologies 1
- The ACR Appropriateness Criteria recommend CT abdomen and pelvis as the initial imaging study for acute nonlocalized abdominal pain, due to its high sensitivity and specificity for detecting a range of pathologies 1
- Other imaging modalities, such as MRI, may be useful in certain situations, such as in pregnant patients or when CT is contraindicated 1
Overall, a systematic approach to the workup of abdominal pain in males, including a thorough history and physical examination, targeted laboratory tests, and imaging studies, can help identify common causes of abdominal pain and guide prompt and appropriate management. The use of CT abdomen and pelvis as the initial imaging modality is supported by the most recent and highest quality evidence, and should be considered the standard of care for acute nonlocalized abdominal pain 1.
From the Research
Initial Workup for Abdominal Pain in Males
The initial workup for a male presenting with abdominal pain involves a combination of laboratory tests and imaging studies to determine the underlying cause of the pain.
- The most common causes of abdominal pain include gastroenteritis, nonspecific abdominal pain, cholelithiasis, urolithiasis, diverticulitis, and appendicitis 2.
- Extra-abdominal causes such as respiratory infections and abdominal wall pain should also be considered.
Laboratory Tests
Recommended laboratory tests include:
- Complete blood count
- C-reactive protein
- Hepatobiliary markers
- Electrolytes
- Creatinine
- Glucose
- Urinalysis
- Lipase
- Pregnancy testing is not typically necessary for male patients, but may be considered in certain cases where the patient has a female reproductive system or is taking hormone therapy 2.
Imaging Studies
Imaging studies are chosen based on the location of pain and index of suspicion for specific etiologies.
- Computed tomography (CT) with intravenous contrast media is often chosen for generalized abdominal pain, left upper quadrant pain, and lower abdominal pain 2, 3.
- Ultrasonography is the study of choice for right upper quadrant pain 2.
- Point-of-care ultrasonography can aid in the prompt diagnosis of several etiologies of acute abdominal pain, including cholelithiasis, urolithiasis, and appendicitis 2.
Specific Conditions
Certain conditions, such as diverticulitis, may be suspected based on clinical presentation and laboratory results.
- Diverticulitis should be suspected in patients with isolated left lower quadrant pain, abdominal distention or rigidity, fever, and leukocytosis 4.
- Computed tomography with intravenous contrast is the preferred imaging modality for confirming the diagnosis and assessing for complications of diverticulitis 4.