Abdominal pain


 * Associate Editor(s)-In-Chief:

Overview
Abdominal pain can be one of the symptoms associated with transient disorders or serious disease. Making a definitive diagnosis of the cause of abdominal pain can be difficult, because many diseases can result in this symptom. Abdominal pain is a common problem. Most frequently the cause is benign and/or self-limited, but more serious causes may require urgent intervention.

Introduction
Abdominal pain is traditionally described by its chronicity (acute or chronic), its progression over time, its nature (sharp, dull, colicky), its distribution (by various methods, such as abdominal quadrant (left upper quadrant, left lower quadrant, right upper quadrant, right lower quadrant) or other methods that divide the abdomen into nine sections, and by characterization of the factors that make it worse, or alleviate it.

Due to the many organ systems in the abdomen, abdominal pain is a concern of general practitioners/family physicians, surgeons, internists, emergency medicine doctors, pediatricians, gastroenterologists, urologists and gynecologists. Occasionally, patients with rare causes can see a number of specialists before being diagnosed adequately (e.g., chronic functional abdominal pain)

Types and mechanisms

 * 1) The pain associated with the abdomen of inflammation of the parietal peritoneum (the part of the peritoneum lining the abdominal wall) is steady and aching, and worsened by changes in the tension of peritoneum caused by pressure or positional change. It is often accompanied by tension of the abdominal muscles contracting to relieve such tension.
 * 2) The pain associated with obstruction of a hollow viscus (as opposed to peritoneal and solid organ pain) is often intermittent or "colicky", coinciding with the peristaltic waves of the organ. Such cramps are exactly what is experienced with early acute appendicitis and gastroenteritis and are somewhat relieved by writhing and massage.
 * 3) The pain associated with abdominal vascular disturbances (thrombosis or embolism) can be sudden or gradual in onset, and can be severe or mild. Pain associated with the rupture of an abdominal aortic aneurysm may radiate to the back, flank, or genitals.
 * 4) Pain that is felt in the abdomen may be "referred" from elsewhere (e.g., a disease process in the chest may cause pain in the abdomen), and abdominal processes can cause radiated pain elsewhere (e.g., gall bladder pain&mdash;in cholecystitis or cholelithiasis&mdash;is often referred to the shoulder).

Diffuse Abdominal Pain

 * Abdominal aortic aneurysm
 * Appendicitis
 * Colitis
 * Gastroenteritis
 * Ileus
 * Inflammatory bowel disease
 * Intussusception
 * Leukemia
 * Mesenteric adenitis
 * Metabolic, toxic, bacterial causes
 * Pancreatitis
 * Peritonitis
 * Sickle cell crisis

Epigastric and upper quadrant

 * Aortic aneurysms
 * Basal pneumonia
 * Cholecystitis
 * Cholecystolithiasis
 * Chronic infections
 * Colon cancer
 * Diseases of the spine with pain radiating into the abdominal cavity
 * Dyspepsia
 * Gastric tumors
 * Gastritis
 * Gastroesophageal reflux disease (GERD)
 * Lamblia
 * Hepatic tumors
 * Congested liver
 * Irritable stomach
 * Kidney cancer
 * Lymphomas
 * Myocardial ischemia
 * Pancreatic tumors
 * Pancreatitis
 * Parasitosis of the liver
 * Peptic ulcer disease
 * Pleuritis
 * Postcholecystectomy syndrome
 * Pulmonary embolism
 * Pyelonephritis
 * Splenic cancer
 * Splenic infarction
 * Splenic rupture
 * Stomach emptying disorder
 * Tuberculosis
 * Tumors of the gall bladder and bile ducts
 * Ulcerative colitis

Right upper quadrant

 * Budd-Chiari syndrome (hepatic vein obstruction)
 * Cholecystitis
 * Choledocholithiasis
 * Hepatic abscess
 * Hepatic tumor
 * Hepatitis
 * Hepatomegaly
 * Ileus
 * Invagination
 * Mesenteric infarction
 * Mesogastrium
 * Pancreatitis
 * Peptic ulcer
 * Pleuritis
 * Pulmonary infarction
 * Renal pain
 * Sigmoid volvulus

Left upper quadrant

 * Basal pneumonia
 * Empyema
 * Gastritis
 * Gastroduodenal ulcers
 * Kidney cancer
 * Pancreatitis
 * Pericarditis
 * Pleuritis
 * Pulmonary infarction
 * Pyelonephritis
 * Renal pain
 * Spleen tumor
 * Splenic infarction
 * Splenic rupture
 * Splenomegaly

Left Lower Quadrant

 * Appendicitis
 * Adnexitis
 * Aortic aneurysm
 * Crohn's disease
 * Colitis
 * Colon carcinoma
 * Diverticulitis
 * Ectopic pregnancy
 * Endometriosis
 * Faeces
 * Gastritis
 * Gastroenteritis
 * Inflammatory bowel disease
 * Inguinal hernia
 * Intestinal obstruction
 * Mesenteric lymphadenitis or thrombosis
 * Middle pain
 * Nephrolithiasis
 * Ovarian cyst or torsion
 * Psoas abscess
 * Pyelonephritis
 * Renal pain
 * Salpingitis/Pelvic inflammatory disease
 * Seminal vesiculitis
 * Splenomegaly
 * Strangulated hernia
 * Volvulus

Pelvic/Hypogastric Region

 * Abdominal aortic aneurysm
 * Appendicitis
 * Bladder distention
 * Cystitis
 * Diverticulitis
 * Ectopic pregnancy
 * Endometriosis
 * Malignancy
 * Nephrolithiasis
 * Ovarian cyst
 * Ovarian torsion
 * Prostatitis
 * Salpingitis/Pelvic inflammatory disease
 * Strangulated hernia

Right Lower Quadrant

 * Adnexitis
 * Appendicitis
 * Caecal volvulus
 * Carcinoma
 * Colon
 * Caecum
 * Crohn's disease
 * Diverticulitis
 * Ectopic pregnancy
 * Faeces
 * Endometriosis
 * Endometritis
 * Hemorrhage or rupture of ovarian cyst
 * Inflamed ileal diverticulum
 * Inguinal hernia
 * Intussusception
 * Leaking aortic aneurysm
 * Middle pain
 * Ovarian cyst or torsion
 * Perforated ulcer
 * Psoas abscess
 * Renal calculus
 * Renal pain
 * Salpingitis/Pelvic inflammatory disease
 * Seminal vesiculitis
 * Terminal ileitis (Inflammatory bowel disease)
 * Uteral colic
 * Ureteral colic

Peritoneal

 * Chemical and nonbacterial peritonitis
 * Perforated peptic ulcer/biliary tree, pancreatitis, ruptured ovarian cyst, mittelschmerz
 * Bacterial peritonitis
 * Primary peritonitis (Pneumococcal, streptococcal, tuberculous; spontaneous bacterial peritonitis)
 * Perforated hollow viscus

Hollow visceral

 * Appendicitis
 * Cholecystitis
 * Peptic ulcer
 * Gastroenteritis
 * Gastritis
 * Duodenitis
 * Inflammatory bowel disease
 * Meckel diverticulitis
 * Colitis (bacterial, amebic)
 * Diverticulitis

Solid visceral

 * Pancreatitis
 * Hepatitis
 * Abscess (pancreatic, hepatic, splenic, etc.)

Mesenteric

 * Lymphadenitis (bacterial, viral)
 * Epiploic appendagitis

Pelvic

 * Pelvic inflammatory disease (salpingitis)
 * Tubo-ovarian abscess
 * Endometritis

Hollow visceral

 * Intestinal obstruction
 * Adhesions, hernias, neoplasms, volvulus
 * Intussusception, gallstone ileus, foreign bodies
 * Bezoars, parasites
 * Biliary obstruction
 * Calculi, neoplasms, choledochal cyst, hemobilia

Solid visceral

 * Acute splenomegaly
 * Acute hepatomegaly, (congestive heart failure, Budd-Chiari syndrome)

Mesenteric

 * Omental torsion

Pelvic

 * Ovarian cyst
 * Torsion or degeneration of fibroid
 * Ectopic pregnancy

Hemoperitoneum

 * Ruptured hepatic neoplasm
 * Spontaneous splenic rupture
 * Ruptured mesentery
 * Ruptured uterus
 * Ruptured graafian follicle
 * Ruptured ectopic pregnancy
 * Ruptured aortic or visceral aneurysm

Ischemic

 * Mesenteric thrombosis
 * Hepatic infarction (toxemia, purpura)
 * Splenic infarction
 * Omental ischemia
 * Strangulated hernia

Genitourinary

 * Pyelonephritis
 * Perinephric abscess
 * Renal infarct
 * Nephrolithiasis
 * Ureteral obstruction (urolithiasis, tumor)
 * Acute cystitis
 * Prostatitis
 * Seminal vesiculitis
 * Orchitis/Epididymitis
 * Testicular torsion
 * Dysmenorrhea
 * Threatened abortion

Pulmonary

 * Pneumonia
 * Empyema
 * Pulmonary embolism (infarction)
 * Pneumothorax

Cardiac

 * Myocardial ischemia/infarction
 * Acute rheumatic fever
 * Acute pericarditis

Metabolic

 * Acute intermittent porphyria
 * Familial Mediterranean fever
 * Hypolipoproteinemia
 * Hemochromatosis
 * Hereditary angioneurotic edema
 * Uremia

Endocrine

 * Diabetic ketoacidosis
 * Hyperparathyroidism (hypercalcemia)
 * Acute adrenal insufficiency (Addisonian crisis)
 * Hyperthyroidism or hypothyroidism

Musculoskeletal

 * Rectus sheath hematoma
 * Arthritis/diskitis of thoracolumbar spine

Neurogenic

 * Herpes zoster
 * Tabes dorsalis
 * Nerve root compression
 * Spinal cord tumors
 * Osteomyelitis of the spine
 * Abdominal epilepsy
 * Abdominal migraine
 * Multiple sclerosis

Inflammatory

 * Henoch-Schönlein purpura
 * Systemic lupus erythematosus
 * Polyarteritis nodosa
 * Dermatomyositis
 * Scleroderma

Infectious

 * Bacterial
 * Parasitic (malaria)
 * Viral (measles, mumps, infectious mononucleosis)
 * Rickettsial (Rocky Mountain spotted fever)

Hematologic

 * Acute leukemia
 * Acute hemolytic states
 * Coagulopathies
 * Pernicious anemia
 * Other dyscrasias

Vascular

 * Vasculitis
 * Periarteritis

Toxins

 * Bacterial toxins (tetanus, staphylococcus)
 * Insect venom (black widow spider)
 * Animal venom
 * Heavy metals (lead, arsenic, mercury)
 * Poisonous mushrooms
 * Drugs
 * Narcotics withdrawal

Retroperitoneal

 * Retroperitoneal hemorrhage (spontaneous adrenal hemorrhage)
 * Psoas abscess

Psychogenic

 * Hypochondriasis
 * Somatization disorders

Factitious

 * Munchausen syndrome
 * Malingering

Complete Differential Diagnosis of the causes of abdominal pain
(In alphabetical order)


 * 4-Nitrophenol
 * Abdominal Aortic Aneurysm
 * Abdominal cramps
 * Abdominal cutaneous nerve entrapment syndrome
 * Abdominal mass
 * Accessory pancreas
 * Acetylsalicylic acid
 * Aciclovir
 * Acute pancreatitis
 * Adjustable gastric band
 * African horse sickness
 * Alcoholic Hepatitis
 * Amanita phalloides
 * Aminocaproic acid
 * Anisakis
 * Appendicitis
 * Arsenic Poisoning
 * Ascaris infection
 * Astroviridae
 * Auranofin
 * Autoimmune Hepatitis
 * Autoimmune pancreatitis
 * Autonomic neuropathy
 * Azithromycin
 * Bacillus cereus
 * Bacterial gastroenteritis
 * Barium nitrate
 * Bezafibrate
 * Blastocystosis
 * Bowel obstruction
 * Brachylaima
 * Budd-Chiari syndrome
 * Caecitis
 * Campylobacteriosis
 * Capillary leak syndrome
 * Carcinoid syndrome
 * Caspofungin
 * Cat scratch fever
 * Cefdinir
 * Cefuroxime
 * Celiac disease
 * Cervical cancer
 * Cestoda
 * Charcot's triad
 * Cholangiocarcinoma
 * Cholangitis
 * Cholecystitis
 * Choledochal cysts
 * Cholesterol Emboli Syndrome
 * Chronic Fatigue Syndrome
 * Chronic functional abdominal pain
 * Chronic pancreatitis
 * Cicutoxin
 * Cinchonism
 * Cirrhosis
 * Cladribine (patient information)
 * Clidinium
 * Clindamycin
 * Clitocybe dealbata
 * Clofibrate
 * Clostridial necrotizing enteritis
 * Clostridium difficile
 * Colchicine
 * Colitis
 * Colonic polyps
 * Colorado tick fever
 * Colorectal cancer
 * Constipation
 * Contraceptive patch
 * Cresol
 * Crohn's disease
 * Cryptosporidium parvum
 * Dactinomycin (patient information)
 * Danazol (patient information)
 * Daptomycin
 * Dengue fever
 * Depo-Provera
 * Desmoplastic small round cell tumor
 * Diabetic ketoacidosis
 * Diflunisal
 * Diverticulitis
 * Donepezil
 * Drotrecogin alfa
 * Duodenitis
 * Dydrogesterone
 * Dyspepsia
 * Ebola
 * Ectopic pregnancy
 * Endometrial cancer
 * Endometriosis
 * Enoxaparin
 * Entamoeba histolytica
 * Enteritis
 * Epiploic appendagitis
 * Erythromycin
 * Ethcathinone
 * Etoposide Phosphate (patient information)
 * Familial Mediterranean fever
 * Fasciolopsiasis
 * Fasciolosis
 * Flucytosine
 * Fluoride poisoning
 * Fluvastatin
 * Food allergy
 * Food intolerance
 * Foreign body
 * Functional bowel disorder
 * Fungemia
 * Fusarium
 * Gallbladder cancer
 * Gastric outlet obstruction
 * Gastritis
 * Gastroenteritis
 * Gastrointestinal perforation
 * Gastrointestinal stromal tumor
 * Giardia lamblia
 * Gilbert's syndrome
 * Grape seed extract
 * Halofantrine
 * Hantavirus pulmonary syndrome
 * Hebeloma crustuliniforme
 * Helicobacter pylori infection
 * Hemosuccus pancreaticus
 * Henipavirus
 * Histrelin Injection (patient information)
 * Hookworm
 * Hydronephrosis
 * Hydroxychloroquine
 * Hymenolepiasis
 * Hypercalcemia
 * Hyperkalemia
 * Hypocalcemia
 * Idarubicin (patient information)
 * Ileitis
 * Ileus
 * Implanon
 * Intestinal malrotation
 * Intestinal pseudoobstruction
 * Intussusception (medical disorder)
 * Irritable bowel syndrome
 * Irukandji syndrome
 * Ischemic colitis
 * Isoniazid
 * Isosporiasis
 * Itraconazole
 * König's syndrome
 * Krukenberg tumor
 * Lactic acidosis
 * Lead poisoning


 * Leptospirosis
 * Liposarcoma
 * Liver tumor
 * Loperamide
 * Lopinavir
 * Loprazolam
 * Magnesium citrate
 * Malabsorption
 * Marfan syndrome
 * Marine toxins
 * Mastocytosis
 * Meckel's diverticulum
 * Menstruation
 * Mercaptopurine
 * Mesenteric ischemia
 * Mesothelioma
 * Metabolic acidosis
 * Metagonimiasis
 * Methimazole (patient information)
 * Methylphenidate
 * Mifepristone
 * Misoprostol
 * Moxifloxacin
 * Muscarine
 * Mushroom poisoning
 * Mycobacterium avium complex
 * Nafcillin
 * Natural childbirth
 * Neuromuscular-blocking drugs
 * Niclosamide
 * Nitazoxanide
 * Norovirus
 * Nutcracker syndrome
 * Octreotide injection (patient information)
 * Ogilvie syndrome
 * Oleander
 * Omeprazole
 * Opisthorchis infection
 * Orlistat (patient information)
 * Ovarian cancer
 * Ovarian cyst
 * Ovarian hyperstimulation syndrome
 * Ovarian torsion
 * Pancreatic cancer
 * Pancreatitis
 * Pantothenic acid
 * Paragonimus Infection
 * Parathion
 * Pegaspargase (patient information)
 * Pelvic inflammatory disease
 * Pentavalent antimonial
 * Pentostatin (patient information)
 * Peptic ulcer
 * Perindopril
 * Periodic fever syndrome
 * Peritonitis
 * Pesticide
 * Phenazocine
 * Pink lady (medicine)
 * Placental abruption
 * Polyarteritis nodosa
 * Polycystic kidney disease
 * Porcelain gallbladder
 * Porphyria
 * Postcholecystectomy syndrome
 * Praziquantel
 * Prazosin and polythiazide (patient information)
 * Pregnancy
 * Premature birth
 * Procainamide (patient information)
 * Procarbazine (patient information)
 * Proctitis
 * Propylthiouracil (patient information)
 * Prostate cancer
 * Prostatitis
 * Pseudomembranous colitis
 * Pseudomyxoma peritonei
 * Pyelonephritis
 * Pyridine
 * Pyruvate carboxylase deficiency
 * Q Fever
 * Rheumatic fever
 * Rocky Mountain spotted fever
 * Roxithromycin
 * Ruptured spleen
 * Sacrococcygeal teratoma
 * Salmonellosis
 * Salpingitis
 * Scarlet fever
 * Schistosomiasis
 * Scombrotoxic fish poisoning
 * Shigellosis
 * Short bowel syndrome
 * Side stitch
 * Simvastatin
 * Situs inversus
 * Slone's Disease
 * Small intestine cancer
 * Snakebites
 * Soft tissue sarcoma
 * Sorafenib (patient information)
 * Sorbitol
 * Spider bite
 * Splenic infarction
 * Splenomegaly
 * Spontaneous bacterial peritonitis
 * Statins (patient information)
 * Stomach cancer
 * Strongyloidiasis
 * Sucralfate (patient information)
 * Sulfasalazine (patient information)
 * Systemic lupus erythematosus
 * Tegaserod (patient information)
 * Tetrodotoxin
 * Thiotepa (patient information)
 * Tianeptine
 * Topiramate
 * Topotecan Hydrochloride (patient information)
 * Toxic megacolon
 * Toxocariasis
 * Transfusion-associated graft versus host disease
 * Trastuzumab (patient information)
 * Tributyl phosphate
 * Trichomoniasis
 * Triclofos
 * Typhoid fever
 * Ulcerative colitis
 * Ureterocele
 * Urinary tract infection
 * Uterine fibroids
 * Uterine rupture
 * Uterine sarcoma
 * Vardenafil
 * Vibrio vulnificus
 * Vigabatrin
 * Vinblastine (patient information)
 * Viral Hepatitis
 * Vitamin A
 * Volvulus
 * Voriconazole
 * Whipple's disease
 * Whipworm Infection
 * Yellow fever
 * Yersiniosis
 * Zieve's syndrome
 * Zollinger-Ellison syndrome

Complete Differential Diagnosis of the Causes of abdominal pain
(By organ system)

Selected causes

 * Parietal peritoneal inflammation
 * Due to infection: inflamed or suppurative appendix in appendicitis, pelvic inflammatory disease
 * Due to chemical irritation: perforated gastric or peptic ulcer; pancreatitis, Mittelschmerz, ruptured ectopic pregnancy
 * Miscellaneous (familial Mediterranean fever)
 * Inflammation of bowel wall Crohn's disease, ulcerative colitis, microscopic colitis, diverticulitis, gastroenteritis
 * Autoimmune: sarcoidosis, vasculitis
 * Mechanical obstruction of hollow viscera such as the small intestine, the appendix associated with appendicitis, the large intestine (e.g. by intussusception), the biliary tree (e.g. by gallstones), or the ureter (e.g. by urinary calculi)
 * vascular disturbances (leading to ischemia): embolism, thrombosis, vascular rupture, torsional occlusion (volvulus), sickle cell anemia, left renal vein entrapment, superior mesenteric artery syndrome (nutcracker syndrome)
 * Abdominal wall injury/disruption: mesenteric traction, muscle trauma, muscular infection, abdominal cutaneous nerve entrapment syndrome (ACNES), also known as intercostal neuralgia; diverticulosis (rare)
 * Digestive: lactose intolerance, Celiac sprue
 * distention of visceral surfaces such as the hepatic or renal capsule
 * Referred pain from the thorax (pneumonia, coronary occlusion), the spine (radiculitis secondary to arthritis), genitals (testicular torsion)
 * Metabolic disturbance: lead poisoning, Black widow spider bite, uremia, diabetic ketoacidosis, porphyria, C1-esterase inhibitor deficiency, adrenal insufficiency
 * Neurogenic pain: tabes dorsalis, herpes zoster, Lyme disease (Lyme radiculitis or Bannwarth syndrome)
 * Functional pain, Irritable Bowel Syndrome (affecting up to 20% of the population, IBS is the most common cause of recurrent, intermittent abdominal pain)
 * Reproductive organs (in women): mittelschmerz, torsion of the ovary, ectopic pregnancy,
 * Pelvic inflammatory disease
 * Endometriosis
 * Post-surgical adhesions
 * Diarrhea
 * Meningitis

Acute Abdomen
Acute abdomen can be defined as severe, persistent abdominal pain of sudden onset that is likely to require surgical intervention to treat its cause. The pain may frequently be associated with nausea and vomiting, abdominal distention, fever and signs of shock.

Selected causes of acute abdomen

 * Traumatic : blunt or perforating trauma to the stomach, bowel, spleen, liver, or kidney
 * Inflammatory :
 * Infections such as appendicitis, cholecystitis, pancreatitis, pyelonephritis, pelvic inflammatory disease, hepatitis, mesenteric adenitis, or a subdiaphragmatic abscess
 * Perforation of a peptic ulcer, a diverticulum, or the caecum
 * Complications of inflammatory bowel disease such as Crohn's disease or ulcerative colitis
 * Mechanical :
 * Small bowel obstruction secondary to adhesions caused by previous surgeries, intussusception, hernias, benign or malignant neoplasms
 * Large bowel obstruction caused by colorectal cancer, inflammatory bowel disease, volvulus, fecal impaction or hernia
 * Vascular : occlusive intestinal ischemia, usually caused by thromboembolism of the superior mesenteric artery

Recurrent Abdominal Pain in Female Adolescents
Recurrent abdominal pain (RAP) occurs in 5–15% of female children 6–19 years old. In a community-based study of middle and high school students, 13–17% had weekly abdominal pain. Using criteria for irritable bowel syndrome (IBS), 14% of high school students and 6% of middle school students fit the criteria for adult IBS. As with other difficult to diagnose chronic medical problems, patients with RAP [Recurrent Abdominal Pain] account for a very large number of office visits and medical resources in proportion to their actual numbers.

Chronic Functional Abdominal Pain
Chronic functional abdominal pain (CFAP) is the ongoing presence of abdominal pain for which there is no known medical explanation. It is quite similar to, but less common than, Irritable Bowel Syndrome (IBS), and many of the same treatments for IBS can also be of benefit to those with CFAP. The fundamental difference between IBS and CFAP is that in CFAP, unlike in IBS, there is no change in bowel habits such as constipation or diarrhea. Bowel dysfunction is a necessary diagnostic criteria of IBS.

CFAP is characterized by chronic pain, with no physical explanation or findings (no structural, infectious, or mechanical causes can be found). It is theorized that CFAP is a disorder of the nervous system where normal nerve impulses are amplified "like a stereo system turned up too loud" resulting in pain. This visceral hypersensitivity may be a stand-alone cause of CFAP, or CFAP may result from the same type of brain-gut nervous system disorder that underlies IBS. As with IBS, low doses of antidepressants have been found useful in controlling the pain of CFAP.

Non-pharmaceutical approaches to CFAP also overlap with treatments for Irritable Bowel Syndrome. This includes enteric coated peppermint oil capsules, which act as anti-spasmodics to relax the gut and also have pain-killing properties due to the methyl salicylate that naturally occurs in peppermint. Gut-directed hypnotherapy or self-hypnosis can also mitigate the hyperreactive nervous system of CFAP, and help alleviate abdominal pain.

Etiology

 * Gynecologic Etiologies
 * Dysmenorrhea
 * Endometriosis
 * Müllerian abnormalities
 * Pelvic Inflammatory Disease
 * Ovarian Abnormalities
 * Abdominal Etiologies

Medical Assessment
When a physician assesses a patient to determine the etiology and subsequent treatment for abdominal pain the patients history of the presenting complaint and physical examination should derive a diagnosis in over 90% of cases.

It is important also for a physician to remember that abdominal pain can be caused by problems outside the abdomen, especially heart attacks and pneumonias which can occasionally present as abdominal pain.

Anamnesis

 * Note the following during a complete history and physical examination:
 * Symptom progression
 * Associated complaints
 * Urinary complaints
 * Exposure to medications and illness
 * Past medical history (including previous episodes of discomfort)

Physical Examination and Diagnostic Tests

 * Inspection
 * Look for dehydration, fever
 * Vitals
 * Patient's body position tends to relieve the pain
 * Cardiac examination
 * Pulmonary examination
 * Abdominal examination
 * Distention
 * Bowel sounds
 * Tympany
 * Palpitation for masses and organomegaly
 * Guarding
 * Tenderness
 * Rebound tenderness
 * Investigations that would aid diagnosis include
 * Blood tests including Full blood count, Electrolytes, Urea, Creatinine, Liver function tests, pregnancy test and lipase.
 * Urinalysis
 * Imaging including erect Chest X-ray and plain films of the abdomen
 * An electrocardiograph to rule out a heart attack which can occasionally present as abdominal pain

Other Tests
If diagnosis remains unclear after history, examination and basic investigations as above then more advanced investigations may reveal a diagnosis. These as such would include
 * Computed Tomography of the Abdomen / Pelvis
 * Abdominal or Pelvic ultrasound
 * Endoscopy and Colonoscopy (not used for diagnosing acute pain)
 * Mantoux test
 * Barium enema
 * Small bowel enema
 * Bone scan

Additional Reading

 * Apley J, Naish N: Recurrent abdominal pains: A field survey of 1,000 school children. Arch Dis Child 1958;33:165 - 170.
 * Chronic Pelvic Pain and Recurrent Abdominal Pain in Female Adolescents
 * Boyle JT, Hamel-Lambert J: Biopsychosocial issues in functional abdominal pain. Pediatr Ann 2001;30:1.
 * Stomach ache or abdominal pain can be misdiagnosed.Consult a Gastroenterologist rather than ER doctor if Pain persists more than a day.

Schmerz Tripako min Douleur abdominale 복통 腹痛 Dor abdominal