Primary care diagnosis of acute abdominal pain

The abdomen, as the largest cavity in the body, holds both fixed as well as relatively mobile organs, which when either diseased, traumatized, malfunctioning, or infected may present a wide and diverse range of signs and symptoms. Clues to the origin of abdominal pain can be well-localized or referred and quite obtuse. This article reviews the surface anatomy of the abdomen, the types of abdominal pain, approach to the patient with abdominal pain, and history-taking and physical examination. Adjunctive studies, which might help to reduce the differential diagnosis, are mentioned. The goal of this article is to help the reader formulate an accurate diagnosis in a timely manner via a complete but also well-focused physical examination; attention is paid to a comprehensive differential diagnosis to include common and not so common causes of acute abdominal pain. Intra-abdominal sources of abdominal pain include: peritonitis, bowel obstruction, and vascular disorders. Extra-abdominal sources of abdominal pain include the thorax, pelvis, and the abdominal wall. Some metabolic and neurogenic sources of abdominal pain are examined. Life-threatening causes of abdominal pain include ectopic pregnancy, acute myocardial infarction, abdominal aortic aneurysm, splenic rupture, and obstructed bowel. Discussion of these entities concentrates on the initial presentation of the patient, typical progression of symptoms, and appropriate initial treatment as well as referral. The process of ruling out emergent abdominal pain is also examined.