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May 8, 2012

1 Minute Read: Abdominal Pain Differential Diagnosis

The Isabel Healthcare 1 Minute Read program highlights various diseases and conditions, providing the Isabel tool differential list. Subscribe to the Isabel blog to receive clinical content and articles.

With abdominal pain, it is important to determine what the cause is by taking a good history and the cause of the pain -- like how the pain begins, the location, pattern of the pain, the duration of the pain, and if anything causes or relieves the pain.  The examination of the patient will allow for tenderness to be felt and to identify if any mass exists.  A stomach ache normally refers to abdominal cramps or a dull ache in the abdomen and can be self-limiting and resolve quickly if caused by Gastroenteritis.  Severe abdominal pain indicates pain arising from the abdomen and could originate in the abdominal wall but can also arise from organs contained within the abdominal cavity like the stomach, pancreas or appendix.  Severe abdominal pain is a significant symptom as could require surgical or medical intervention and should be fully investigated. 

Abdominal Pain Causes

Potential causes of abdominal pain including red flagged or "don’t miss" diagnoses which should be ruled in or ruled out quickly, as they could require urgent medical/surgical intervention:

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Pancreatitis can present with severe upper abdominal pain radiating to the back, nausea and vomiting.

Peritonitis can occur suddenly with severe abdominal pain, chills and high fever.

Recurrent abdominal pain presents in children with wax and waning abdominal pain, three episodes within a three month period and is severe enough to interfere with a child’s activities.  It is fairly common and difficult to diagnose as not accompanied by easily definable organic pathology but can cause a lot of disruption to the child.

Acute appendicitis should be considered in any child presenting with abdominal pain which starts in the middle of the abdomen and then transfers to the lower right quadrant of the abdomen where the appendix normally lies.  The pain worsens as the appendix becomes more inflamed and other symptoms may be fever and vomiting.  Occasionally constipation or diarrhea may develop.

Urinary tract infection normally present with the urge to urinate frequently, a painful burning sensation when urinating, abdominal pressure or discomfort and sometimes pain in the lower back.

Tests can help determine the actual diagnosis or cause of the abdominal pain by carrying out full blood counts, checking liver and pancreatic enzymes and performing a urinalysis.  Other investigations which may be deemed necessary include an abdominal xray, abdominal ultrasound, MRI, barium xray or CT.

As Isabel is not a rules-based system, it is possible to use Isabel’s natural language processing abilities to obtain a differential diagnosis checklist using other terms like “cramping abdominal pain” which describes the nature of the pain more accurately and potentially narrow the disease list as the symptom is more specific and due to the differential checklist of  abdominal pain spanning many specialities of medicine.

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Its also possible to concentrate on a specific part of the abdomen affected like “lower right quadrant abdominal pain” and obtain a differential checklist.

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There are many benign causes of abdominal pain but if pain develops suddenly, is severe or is prolonged, then it is important to determine the cause as soon possible and treat accordingly.

~by Mandy Tomlinson, RN, Isabel Quality Assurance Director

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Mandy Tomlinson

Mandy Tomlinson

Mandy has worked for Isabel Healthcare since 2000. Prior to this, she was a Senior Staff Nurse on the Pediatric Infectious disease ward and high dependency unit at one of London's top hospitals, St Mary’s in Paddington which is part of Imperial College Healthcare NHS Trust. Her experience in the healthcare industry for the past 28 years in both the UK and USA means she's a vital resource for our organization. Mandy currently lives and works in Scottsdale, Arizona.


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