From the Guidelines
The diagnostic workup for a 24-year-old female presenting with abdominal pain should start with a thorough medical history and physical examination to narrow down the differential diagnosis, and then transabdominal and transvaginal ultrasound should be used as the initial imaging techniques if the differential is primarily of gynecologic origin 1.
Initial Evaluation
- A thorough medical history to identify potential causes of abdominal pain, such as menstrual history, sexual history, and previous surgeries or medical conditions
- Physical examination to assess for tenderness, guarding, or rebound tenderness
Imaging Studies
- Transabdominal and transvaginal ultrasound as the initial imaging techniques if the differential is primarily of gynecologic origin 1
- CT with intravenous (IV) contrast if the differential diagnosis remains broad 1
- MRI without IV contrast or MRI without and with IV contrast may also be used for certain differential considerations 1
Considerations
- The most common causes of pelvic pain in women of reproductive age are ovarian cysts, uterine fibroids, pelvic inflammatory disease, and ovarian neoplasm 1
- Other etiologies of pelvic pain are attributable to urinary, gastrointestinal, and vascular systems 1 Note that the provided evidence is focused on postmenopausal women, but the general principles of diagnostic workup can be applied to a 24-year-old female, with consideration of the more common causes of pelvic pain in women of reproductive age.
From the Research
Diagnostic Workup for Abdominal Pain
The diagnostic workup for a 24-year-old female presenting with abdominal pain involves a comprehensive evaluation to determine the underlying cause of the pain. The following steps are recommended:
- Ensure hemodynamic stability
- Obtain a detailed history and physical examination to guide the workup 2
- Consider extra-abdominal causes such as respiratory infections and abdominal wall pain 2
- Recommended tests may include:
- Complete blood count
- C-reactive protein
- Hepatobiliary markers
- Electrolytes
- Creatinine
- Glucose
- Urinalysis
- Lipase
- Pregnancy testing 2
- Imaging studies are chosen based on the location of pain and index of suspicion for specific etiologies 2
- Computed tomography with intravenous contrast media for generalized abdominal pain, left upper quadrant pain, and lower abdominal pain
- Ultrasonography for right upper quadrant pain
- Point-of-care ultrasonography to aid in the prompt diagnosis of several etiologies of acute abdominal pain, including cholelithiasis, urolithiasis, and appendicitis 2
- Consider diagnoses specific to female patients, such as ectopic pregnancy, pelvic inflammatory disease, and adnexal torsion 2
Specific Considerations
In patients with chronic undiagnosed abdominal pain, a detailed history and physical examination are crucial to narrow down the broad differential diagnosis 3. The workup may also involve reviewing specific details of the patient's history and physical examination to identify key elements that can clue in the etiology of the abdominal pain 3. Additionally, functional causes of abdominal pain should be considered, and identifying these disorders can help avoid unnecessary testing 3.
Rare Causes
Rare conditions such as epiploic appendagitis should also be considered in the differential diagnosis, particularly in patients presenting with localized abdominal pain 4. A contrast-study computed tomography of the abdomen may be necessary to confirm the diagnosis 4.