Acute Abdominal Pain in Adults: Evaluation and Diagnosis

Acute Abdominal Pain in Adults: Evaluation and Diagnosis

Acute abdominal pain, defined as nontraumatic abdominal pain lasting fewer than seven days, is a common presenting concern with a broad differential diagnosis. The most common causes are gastroenteritis and nonspecific abdominal pain, followed by cholelithiasis, urolithiasis, diverticulitis, and app...

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Bibliographic Details
Published in:American family physician Vol. 107; no. 6; pp. 585 - 596
Main Authors: Yew, Ken S, George, Mary K, Allred, Heidi B
Format: Journal Article
Language:English
Published: United States American Academy of Family Physicians 01-06-2023
Subjects:
Abdomen
Abdominal surgery
Angina pectoris
Appendicitis
Constipation
Cysts
Emergency medical care
Evidence-based medicine
Gallbladder diseases
Gallstones
Heart attacks
Hernias
Inflammatory bowel disease
Irritable bowel syndrome
Ischemia
Kidney stones
Medical diagnosis
Pain
Patients
Pneumonia
Probability
Systematic review
Tomography
Ulcers
Ultrasonic imaging
Vomiting
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Summary:Acute abdominal pain, defined as nontraumatic abdominal pain lasting fewer than seven days, is a common presenting concern with a broad differential diagnosis. The most common causes are gastroenteritis and nonspecific abdominal pain, followed by cholelithiasis, urolithiasis, diverticulitis, and appendicitis. Extra-abdominal causes such as respiratory infections and abdominal wall pain should be considered. Pain location, history, and examination findings help guide the workup after ensuring hemodynamic stability. Recommended tests may include a complete blood count, C-reactive protein, hepatobiliary markers, electrolytes, creatinine, glucose, urinalysis, lipase, and pregnancy testing. Several diagnoses, such as cholecystitis, appendicitis, and mesenteric ischemia, cannot be confirmed clinically and typically require imaging. Conditions such as urolithiasis and diverticulitis may be diagnosed clinically in certain cases. Imaging studies are chosen based on the location of pain and index of suspicion for specific etiologies. 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. Point-of-care ultrasonography can aid in the prompt diagnosis of several etiologies of acute abdominal pain, including cholelithiasis, urolithiasis, and appendicitis. In patients who have female reproductive organs, diagnoses such as ectopic pregnancy, pelvic inflammatory disease, and adnexal torsion should be considered. If ultrasonography results are inconclusive in pregnant patients, magnetic resonance imaging is preferred over computed tomography when available.
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ISSN:0002-838X
1532-0650