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Abdominal Pain

Acute vs Subacute vs Chronic Trauma

Classification Methods Region of Pain: RUQ, LUQ, LLQ, RLQ, etc

History: OLDCARTS

O: Onset L: Location D: Duration C: Characteristics A: Aggravating factors R: Relieving factors T: Timing S: Severity

Complex presentation with an exceptionally broad DDx, multiple ways to classify based on etiology, mechanism, or presentation. DDx generation: VINDICATE mnemonic

VINDICATE: Vascular, Infection / Inflammatory, Neoplastic, Drugs/Deficiency/Degenerative, Idiopathic/Intoxication/Iatrogenic, Congenital, Autoimmune/Allergic/Anatomic, Trauma, Endocrine / Metabolic

Structure based on location: RUQ, LUQ, LLQ, RLQ, etc; moving front to back or back to front thinking of anatomic structures that might be involved in the pain.

Objectives

Section titled “Objectives”
  1. Given a patient with abdominal pain, paying particular attention to its location and chronicity:
    • Distinguish between acute and chronic pain.
    • Generate a complete differential diagnosis (ddx).
    • Investigate in an appropriate and timely fashion.
  2. In a patient with diagnosed abdominal pain (e.g., gastroesophageal reflux disease, peptic ulcer disease, ulcerative colitis, Crohn’s disease), manage specific pathology appropriately (e.g., with medication, lifestyle modifications).
  3. In a woman with abdominal pain:
    • Always rule out pregnancy if she is of reproductive age.
    • Suspect gynecologic etiology for abdominal pain.
    • Do a pelvic examination, if appropriate.
  4. In a patient with acute abdominal pain, differentiate between a surgical and a non-surgical abdomen.
  5. In specific patient groups (e.g., children, pregnant women, the elderly), include group-specific surgical causes of acute abdominal pain in the ddx.
  6. Given a patient with a life-threatening cause of acute abdominal pain (e.g., a ruptured abdominal aortic aneurysm or a ruptured ectopic pregnancy):
    • Recognize the life-threatening situation.
    • Make the diagnosis.
    • Stabilize the patient.
    • Promptly refer the patient for definitive treatment.
  7. In a patient with chronic or recurrent abdominal pain:
    • Ensure adequate follow-up to monitor new or changing symptoms or signs.
    • Manage symptomatically with medication and lifestyle modification (e.g., for irritable bowel syndrome).
    • Always consider cancer in a patient at risk.
  8. Given a patient with a diagnosis of inflammatory bowel disease (IBD) recognize an extra-intestinal manifestation.