From the Guidelines
Abdominal pain is a broad term that encompasses a wide range of pathologies, including pneumonia, hepatobiliary disease, complicated pancreatic processes, nephrolithiasis, gastrointestinal perforation or inflammation, bowel obstruction or infarction, abscesses, and tumor, among numerous other causes 1. Abdominal pain can manifest as discomfort or pain felt anywhere between the chest and groin regions, and can be sharp or dull, cramping, aching, or a sense of pressure in the abdomen.
Common Causes of Abdominal Pain
Some common causes of abdominal pain include:
- Gastrointestinal issues like indigestion, gas, constipation, diarrhea, food poisoning, gastritis, ulcers, inflammatory bowel disease, and irritable bowel syndrome
- Gynecological conditions in women, such as menstrual cramps, ovarian cysts, and endometriosis
- Urinary tract infections, kidney stones, appendicitis, gallstones, pancreatitis, or hernias The pain can vary in intensity from mild to severe and may be localized to specific areas of the abdomen or more generalized.
Importance of Location and Characteristics of Pain
The location of pain often provides clues about its cause, with upper abdominal pain potentially indicating stomach or liver issues, and lower abdominal pain suggesting intestinal or reproductive system problems. Pain characteristics, such as timing, duration, and accompanying symptoms like fever, vomiting, or changes in bowel habits, are important for diagnosis. Severe, sudden, or persistent abdominal pain, especially when accompanied by other concerning symptoms, requires prompt medical attention as it could indicate serious conditions requiring immediate treatment, as highlighted in the study by Pandharipande et al 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Definition and Causes of Abdominal Pain
Abdominal pain is a common presenting concern with a broad differential diagnosis, defined as nontraumatic abdominal pain lasting fewer than seven days 2. The most common causes of abdominal pain are:
- Gastroenteritis
- Nonspecific abdominal pain
- Cholelithiasis
- Urolithiasis
- Diverticulitis
- Appendicitis
Symptoms and Diagnosis
The clinical diagnosis of abdominal pain is based on history, physical examination, laboratory evaluation, and imaging 3. Classic symptoms of appendicitis, a common cause of abdominal pain, include:
- Vague periumbilical pain
- Anorexia/nausea/intermittent vomiting
- Migration of pain to the right lower quadrant
- Low-grade fever Pain location, history, and examination findings help guide the workup after ensuring hemodynamic stability 2.
Imaging and Treatment
Imaging studies are chosen based on the location of pain and index of suspicion for specific etiologies 2. Computed tomography with intravenous contrast media is often chosen for generalized abdominal pain, left upper quadrant pain, and lower abdominal pain. Ultrasonography is the study of choice for right upper quadrant pain. Treatment of abdominal pain depends on the underlying cause, with options including:
- Antibiotics for uncomplicated appendicitis 3, 4
- Appendectomy for complicated appendicitis or failed antibiotic treatment 5, 3, 4
- Surgical intervention for other causes of abdominal pain, such as small bowel obstruction 6
Special Considerations
Certain patient populations require special consideration, including:
- Pregnant patients, who should undergo timely surgical intervention to decrease the risk of complications 4
- Immunocompromised patients, who should also undergo timely surgical intervention 4
- Patients with high-risk CT findings, such as appendicolith or mass effect, who may require surgical management 3