1. Abdominal Pain Scope of the problem Anatomic Essentials Visceral Pain
Parietal Pain
Referred Pain

2. History Where is your pain? Has it always been there?
Does the pain radiate anywhere?
How did the pain begin (sudden vs. gradual onset)? How long have you had the pain?
What were you doing when the pain began?
What does the pain feel like?
On a scale of 0–10, how severe is the pain?
Does anything make the pain better or worse?
Have you had the pain before?

4. History (continued) Associated symptoms Gastrointestinal Genitourinary
Gynecologic
Cardiopulmonary
Past medical

5. Physical Examination - Directed
General appearance
Vital Signs
Abdomen
Inspection
Auscultation
Percussion
Palpation

8. Physical Examination - Directed
Pelvic
Genital
Back
Rectal
Head-to-toe

9. Differential Diagnosis
Appendicitis
Biliary colic, cholecystitis, cholangitis
Bowel obstruction
Diverticulitis
Ectopic pregnancy
Gastroenteritis
Intussuception
Mesenteric Ischemia
Ovarian torsion
Pancreatitis
Pelvic Inflammatory Disease (PID)
Perforated peptic ulcer
Ruptured or leaking abdominal aortic aneurysm (AAA)
Testicular torsion
Ureteral colic
Volvulus

10. Diagnostic Testing Laboratory Studies Electrocardiogram CBC Urinalysis
Pregnancy
Amylase/Lipase
Other
Electrocardiogram

11. Diagnostic Testing - continued
Radiologic Studies
Plain Films
Ultrasound
Computed Tomography

14. General Treatment Principles
Volume repletion
Pain relief
Antibiotics
Other

15. Special Patients
Elderly
Pediatric
Immune compromised

17. Disposition
Surgical consultation
Serial evaluation
Discharge

18. Pearls, Pitfalls and Myths
Do not restrict the diagnosis solely by the location of the pain.
Consider appendicitis in all patients with abdominal pain and an appendix, especially in patients with the presumed diagnosis of gastroenteritis, PID or UTI.
Do not use the presence or absence of fever to distinguish between surgical and medical causes of abdominal pain.
The WBC count is of little clinical value in the patient with possible appendicitis.
Any woman with childbearing potential and abdominal pain has an ectopic pregnancy until her pregnancy test comes back negative.
Pain medications reduce pain and suffering without compromising diagnostic accuracy.
An elderly patient with abdominal pain has a high likelihood of surgical disease.
Obtain an ECG in elderly patients and those with cardiac risk factors presenting with abdominal pain.
A patient with appendicitis by history and physical examination does not need a CT scan to confirm the diagnosis; they need an operation.
The use of abdominal ultrasound or CT may help evaluate patients over the age of 50 with unexplained abdominal or flank pain for the presence of AAA.