Abdominal Pain Diagnosis
A Comprehensive Approach


Accurate abdominal pain diagnosis is required for any case of abdominal pain lasting more than an hour, or causing moderate to severe pain and affecting the normal function of the sufferer.

This will involve a diligent and thorough process of obtaining a detailed description or history of the pain from the patient, performing a focused physical examination and carrying out some blood and urine test if needed, possibly x-rays (radiography), ultrasound scan, CT scan and MRI as required.

Over half of the time, getting an accurate diagnosis of abdominal pain may proof impossible. This is because abdomen contains several organs and structures all packed within that confined space. Other structures in other regions like lungs and heart may also cause problems that may show up as abdominal pain.

The work before a physician aiming to come up with an abdominal pain diagnosis can be appreciated, if we take a look at the list of common causes of abdominal pain as listed below:

Abdominal Aortic Aneurysm
Abdominal-Migraine
Appendicitis
Biliary Colic
Bowel Cancer
Bowel Obstruction
Braxton Hicks
Carcinoid Tumour
Chance Fracture
Celiac Disease
Cholecystitis

Constipation
Crohn's Disease
Cystitis
Diverticulitis
Diabetic Keto Acidosis / Angina

Ectopic Pregnancy
Endometriosis
Endometritis
Fibroids
Food Piosoning
Gallstone Diseases
Gastroenteritis
Gonorrhoea
Hernia
Heart Attack
Hirschsprung's Disease
Indigestion
Intussusception
Irritable Bowel Syndrome
Kidney Stone

Loin Pain Haematuria Syndrome
labour Pain
Lactose Intolerance
Liver Cancer

Menstrual Pain
Merkels Diverticulitis
Mesenteric Infarction
Mid-Cycle Pain
Mini Heart Attack / Angina Miscarriage
Muscle Strain or Bruise
Myocardial Infarction
Non-specific Abdominal Pain
Ovarian Cancer
Ovarian Cyst
Pancreatic Cancer
Pancreatitis
Peptic Ulcer
Pneumonia
Porphyria
Primary Sclerosing Cholangitis
Pulmonary Embolism

Pyloric Stenosis
PID
Recurrent Abdominal Pain Syndrome
Rectus Sheath Haematoma
Ruptured Spleen

Miscarriage
Stomach Cancer
Trapped Wind
Trichobezoa
Ulcerative Colitis
Urinary Retention
Urinary Tract Infection
Volvulus

This list is by no means exhaustive. It represents just the more common causes of abdominal pain.

Abdominal pain diagnosis can pretty much be likened to finding a fish with a golden pebble in its tummy in a pool with many fishes.

It could be difficult, but with a systematic approach, this could be achieved.

We will divide the steps of diagnosis of abdominal pain along the above lines into the stages of History Taking, Physical Examination and Investigations.

A Detailed History

At first contact, many patients expect their doctor to be able to tell exactly what is wrong. No. Your doctor can only come to an accurate diagnosis if you are able to describe in detail, how you have been experiencing. This is the fist of the three steps described here.You should be prepared to describe the pain in terms of the following:

  1. Is the pain all over the abdomen (diffused) or in a particular part of the abdomen (localized)? A diffused abdominal pain will suggest problems like
    1. Constipation
    2. Bowel Ischaemia
    3. Leaking peptic ulcer
    4. Spontaneous Bacterial Peritonitis

  2. What part of the abdomen is the pain located if it is not diffused? Right, Left, upper or lower abdomen? Pain is usually fairly well localised to the region of the abdomen where the injured organ is located. An abdominal pain in the upper right abdomen for example could be due to
    1. Cholecystitis
    2. Biliary Colic
    3. Liver disease
    4. Peptic ulcer

  3. Time of onset.
  4. The severity of the pain(best measured on a scale of 0 to 10, with 0 being no pain, and 10 been the most severe pain ever)
  5. Duration of the pain when it comes on
  6. Does it spread from one point or part of the abdomen across to another point or area
  7. What are the things or activities that makes the pain worse or bring it on?

  8. Is there any positioning, activity or medication or indeed any other factor that help relieve the pain?
  9. Are there any other associated symptoms like nausea and vomiting, distension or swelling of the abdomen, loose stools, increased frequency of urination, pain on passing urine, fever or weight loss.

The Physical Examination

Abdominal pain diagnosis often requires that the doctor carries out what is referred to as a physical examination. It involves taking a trained look at the patient, performing some manoeuvre and then listening with the stethoscope.

It is often very important to carry out an examination of the rectum (back passage or anus) in many instances of abdominal pain in men and women.

Taking about women, a vaginal examination may be necessary, especially in cases of miscarriage or pelvic inflammatory disease.

Investigations

In most cases of abdominal pain, it may be necessary to carry out some blood and urine test, stool examination, endocscopy, biopsy, radiography and other scans to help come to an accurate abdominal pain diagnosis.





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