From the Guidelines
Abdominal pain is a common clinical complaint due to the broad range of pathology that can produce it, including pneumonia, hepatobiliary disease, complicated pancreatic processes, nephrolithiasis, gastrointestinal perforation or inflammation, bowel obstruction or infarction, abscesses, and tumor, among numerous other causes. The abdomen contains numerous vital organs and structures that can develop various pathologies, creating many potential sources of pain 1. Pain can arise from inflammation, infection, obstruction, perforation, ischemia, or abnormal growth in any of these organs. According to a retrospective study of 8,710 visits to the emergency department, the most common indications for abdominopelvic CT scans included nononcologic emergencies, postoperative complications, oncologic emergencies, and intestinal obstruction 2. The study found that CT played an essential role in determining management, especially in instances where the positive result was not concordant with the initial diagnostic consideration.
The difficulty in making an accurate clinical diagnosis when patients present with nonlocalizing abdominal pain is further complicated by the presence of fever, which raises clinical suspicion of an intra-abdominal infection, abscess, or other condition that may need immediate surgical or medical attention 1. Imaging is especially helpful in the elderly with acute abdominal pain and fever, as many laboratory tests are nonspecific and may be normal despite serious infection [4-6]. The neutropenic patient is a diagnostic challenge as typical signs of abdominal sepsis may be masked, diagnosis may be delayed 7, and it is associated with a high mortality rate 8.
Some key points to consider when evaluating abdominal pain include:
- The broad range of potential causes, including gastrointestinal, urinary, reproductive, and vascular pathologies
- The importance of imaging, particularly CT scans, in determining management and diagnosis
- The challenges of diagnosing abdominal pain in certain populations, such as the elderly and neutropenic patients
- The need for quick, definitive diagnosis in cases where fever is present, as it can indicate a serious underlying condition. Given the complexity and variability of abdominal pain, a thorough evaluation, including imaging and laboratory tests, is essential to determine the underlying cause and develop an effective treatment plan 1.
From the Research
Causes of Abdominal Pain
Abdominal pain is a common clinical complaint due to its diverse causes, ranging from life-threatening conditions to benign ones. The causes of abdominal pain can be broadly categorized into:
- Organic diseases, such as inflammatory bowel disease, appendicitis, and diverticulitis 2, 3, 4
- Functional disorders, such as irritable bowel syndrome, which should be considered after organic pathology has been excluded 2, 4
Challenges in Diagnosing Abdominal Pain
Diagnosing abdominal pain can be challenging due to:
- The broad differential diagnosis, making it difficult to identify the underlying cause 2, 3
- The sometimes extensive and negative workup, which can be a burden to healthcare costs 2
- The need for a systematic approach to evaluate patients and initiate a management plan 2, 3, 5
Evaluation of Abdominal Pain
The evaluation of abdominal pain should start with:
- A detailed history and physical examination to identify alarm symptoms and symptom severity 2, 4
- Limited and adapted diagnostic investigations, based on clinical features and symptom severity 2, 5
- Consideration of all aspects of the patient's presentation, including history, physical examination, laboratory testing, and imaging 6
Commonly Missed Diagnoses
Some frequently missed conditions that cause abdominal pain include: