What is the workup for upper abdominal pain in a teenage female without fever, vomiting, diarrhea, or constipation?

Workup for Upper Abdominal Pain in a Teenage Female

Ultrasonography is the initial imaging study of choice for evaluating upper abdominal pain in a teenage female without fever, vomiting, diarrhea, or constipation. 1

Initial Diagnostic Approach

Laboratory Tests

• Complete blood count (CBC) to assess for leukocytosis, which may indicate infection or inflammation 2
• Liver function tests (LFTs) to evaluate for hepatobiliary disease 2
• Pancreatic enzymes (amylase and lipase) to rule out pancreatitis 2
• Renal function tests (BUN, creatinine) to assess kidney function 2
• Pregnancy test for all teenage females of reproductive age - this is critical before performing any imaging 1, 2

Imaging Studies

• Ultrasonography of the abdomen is the first-line imaging modality for upper abdominal pain 1
  • Reduces radiation exposure compared to CT, which is particularly important in younger patients 1
  • Highly effective for evaluating gallbladder pathology, liver abnormalities, and pancreatic conditions 1
  • Can also visualize gynecologic structures in female patients 1

Specific Considerations Based on Pain Location

Right Upper Quadrant Pain

• Ultrasonography is particularly valuable for right upper quadrant pain to evaluate:
  • Gallbladder pathology (cholelithiasis, cholecystitis) 1
  • Liver abnormalities 1
  • Hepatobiliary tract disease 2

Left Upper Quadrant Pain

• Ultrasonography can evaluate:
  • Splenic pathology 2
  • Pancreatic conditions 2
  • Left kidney abnormalities 2

Additional Imaging Considerations

• If ultrasonography is non-diagnostic and symptoms persist:

  • CT of the abdomen and pelvis with contrast may be considered as a second-line imaging study 1
  • MRI is an emerging alternative that avoids ionizing radiation, which is particularly important in teenage patients 1

• Conventional radiography (plain X-rays) has limited diagnostic value in evaluating upper abdominal pain and should not be routinely used 1

Special Considerations for Teenage Females

• Always consider gynecologic causes of upper abdominal pain in teenage females 3
• Pelvic pathology can sometimes present with referred pain to the upper abdomen 3
• In cases where gynecologic pathology is suspected, pelvic ultrasonography should be included 2

Common Pitfalls to Avoid

• Failing to obtain a pregnancy test before imaging studies in females of reproductive age 1, 2
• Relying solely on laboratory tests without appropriate imaging when indicated 2
• Using CT as first-line imaging due to radiation exposure concerns in younger patients 1
• Overlooking functional causes of abdominal pain, which are common in the pediatric and adolescent population 4, 3

By following this systematic approach with ultrasonography as the initial imaging modality, clinicians can effectively evaluate upper abdominal pain in teenage females while minimizing radiation exposure and maximizing diagnostic yield.