Patients who present to the clinic or urgent care with abdominal pain can be some of the most challenging, because of the many different causes. The job of your primary care or urgent care provider is to determine whether the pain is requiring immediate surgical evaluation.
Medical providers must try to determine which patients can safely be observed and their symptoms treated and which patients require further investigation by a specialist such as a surgeon. This is difficult because abdominal pain is often non-specific and presents with other symptoms very commonly.
Triage: We must urgently investigate abdominal pain in many patients. Some patients require assessment of their airway, breathing and circulation followed by appropriate resuscitation. Patients who may need surgery must be transferred to a facility where they can receive that care where appropriate nursing care, laboratory, surgical consultation, and radiology facilities are available. Patients who are having less severe pain or signs on exam may require consultation or referral for further management.
Helpful information from patients:
1) Time course of pain
2) Location of pain
3) Radiation of pain
4) Factors that make the pain worse or better (such as foods or antacids)
5) Associated symptoms including fever, chills, weight loss, nausea, vomiting, diarrhea, constipation, blood in the stools, jaundice, change in stool or urine color or diameter of the stools.
6) Past medical history, including history of abdominal surgeries
7) Family history of bowl disorders
8) Alcohol intake
9) Medications – including Tylenol, aspirin, and ibuprofen/aleve
10) Menstral and contraceptive history in women
Surgical abdomen: Usually defined as a condition with rapidly worsening course without surgical intervention. Obstructions of the intestines and peritonitis (inflammation/irritation of the inner wall of the abdomen that covers most abdominal organs) are reasons for referral to a surgeon.
Sometimes tests will be ordered such as an abdominal radiograph, CBC, comprehensive metabolic panel with liver enzymes, lipase, a urine analysis and pregnancy test (in women of childbearing potential).
Other things we consider in determining the cause of the abdominal pain are the location of the pain and changes in where the pain radiates as well as how rapidly the pain gets worse.
Some possible causes of abdominal pain are many – gallstones or gallbladder dysfunction, peptic ulcer, hiatal hernia, pneumonia, heart attack, pancreatitis, heartburn, lactose intolerance, celiac sprue, pregnancy (including ectopic), endometriosis, sickle cell disease, appendicitis, ovarian cyst or torsion, UTI, kidney stones, constipation, colitis, diverticulitis, pelvic inflammatory disease, gastroenteritis, intestinal ischemia (decreased blood flow to the intestines), diabetic ketoacidosis, kidney infection, abdominal aortic aneurism, or even trauma.
Treatment: Is tailored to address the cause of the pain. If no cause can be found at your doctor’s office, the goal is to determine whether it is safe for you to go home with medications to help with the pain, and testing done as an outpatient or whether you need to be transferred to the hospital where further workup can be done immediately.
This document is for informational purposes only, and should not be considered medical advice for any individual patient. If you have questions please contact your medical provider.
I hope that you have found this information useful. Wishing you the best of health,
Scott Rennie, DO