Digestive Disease Myths Slideshow Pictures Appendicitis & Appendectomy Slideshow Pictures What's Causing Your Pelvic Pain Slideshow Pictures

Medical Author:

Jerry R. Balentine, DO, FACEP

Jerry R. Balentine, DO, FACEP

Dr. Balentine received his undergraduate degree from McDaniel College in Westminster, Maryland. He attended medical school at the Philadelphia College of Osteopathic Medicine graduating in1983. He completed his internship at St. Joseph's Hospital in Philadelphia and his Emergency Medicine residency at Lincoln Medical and Mental Health Center in the Bronx, where he served as chief resident.

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Medical Editor:

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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Abdominal Pain in Adults Diagnosis

Diagnosing the cause of abdominal pain is one of the hardest tasks for a health care practitioner. Sometimes all that the practitioner can do is be sure that the pain does not require surgery or admission to the hospital.

The health care practitioner may ask these or similar questions to try to determine what is causing the patient's pain. Some may seem unrelated to the patient's current condition, but try to answer them as completely as possible. The answers to these questions can help the health care practitioner find the cause of the patient's pain more quickly and easily.

• How long have you had the pain?
  
  
• What were you doing when it started?
  
  
• How did you feel before the pain started?
  
  
• Have you felt OK over the last few days?
  
  
• What have you tried to make the pain better? Did it work?
  
  
• What makes the pain worse?
  
  
• Does the pain make you want to stay in one place or move around?
  
  
• How was the ride to the hospital? Did riding in the car hurt you?
  
  
• Is the pain worse when you cough?
  
  
• Have you thrown up?
  
  
• Did throwing up make the pain better or worse?
  
  
• Have your bowel movements been normal?
  
  
• Are you passing gas?
  
  
• Do you feel you might have a fever?
  
  
• Have you had a pain like this before? When? What did you do for it?
  
  
• Have you ever had surgery? What surgery? When?
  
  
• Are you pregnant? Are you sexually active? Are you using birth control?
  
  
• Have you been around anyone with symptoms like this?
  
  
• Have you traveled out of the country recently?
  
  
• When did you eat last? What did you eat?
  
  
• Did you eat anything out of the ordinary?
  
  
• Did your pain start all over your stomach and move to one place?
  
  
• Does the pain go into your chest? Into your back? Where does it go?
  
  
• Can you cover the pain with the palm of your hand, or is the hurting area bigger than that?
  
  
• Does it hurt for you to breathe?
  
  
• Do you have any medical problems such as heart disease, diabetes, or AIDS?
  
  
• Do you take steroids? Pain medicine such as aspirin or Motrin?
  
  
• Do you take antibiotics? Over-the-counter pills, herbs, or supplements?
  
  
• Do you drink alcohol? Coffee? Tea?
  
  
• Do you smoke cigarettes?
  
  
• Do you use cocaine or other drugs?

Physical examination will include a careful examination of the patient's abdomen, heart, and lungs in order to pinpoint the source of the pain.

• The examiner will touch different parts of the abdomen to check for tenderness or other signs that indicate the source of the pain.
  
  
• The examiner may do a rectal exam to check for small amounts of blood in the stool or other problems such as a mass or internal hemorrhoids.
  
  
• If the patient is a man, the doctor may check the penis and testicles.
  
  
• If the patient is a woman, the doctor may do a pelvic exam to check for problems in the uterus, Fallopian tubes, and ovaries.
  
  
• The doctor also may look at the patient's eyes for yellow discoloration (jaundice) and in the mouth to be sure the patient is not dehydrated.

Laboratory tests may not help to find the cause of the abdominal pain. However, if combined with the information gained from the questions the patient was asked and the physical examination performed by the health care practitioner, certain blood or urine tests may be ordered and could assist in determining the diagnosis.

• One of the most important tests is to see if a woman is pregnant.
  
  
• A raised white blood cell count may mean infection or may just be a reaction to the stress of pain and vomiting.
  
  
• A low blood count (hemoglobin) may show that the patient is bleeding internally, but most conditions that involve bleeding are not painful.
  
  
• Blood in the urine, which may not be visible to the eye, may suggest the patient may have a kidney stone.
  
  
• Other blood tests, such as liver enzymes and pancreas enzymes, can help determine which organ is involved, but they do not point to a diagnosis.

Radiology studies of the patient's abdomen can be useful, but are not always necessary or helpful.

• Occasionally, an X-ray will show air outside of the bowel, meaning that something has ruptured or perforated.
  
  
• An X-ray also can help diagnose bowel obstruction.
  
  
• Sometimes X-rays can show a kidney stone.

Ultrasound is a painless procedure useful in finding some causes of abdominal pain.

• This may be done if the health care practitioner suspects problems with the gallbladder, pancreas, liver, or the reproductive organs of women.
  
  
• Ultrasound also assists in the diagnosis of problems with the kidneys and the spleen, or the large blood vessels that come from the heart and supplies blood to the lower half of the body.

CT scan is a special type of x-ray that provides useful information about the liver, pancreas, kidneys and ureters, spleen, and small and large intestine, including diseases such as appendicitis and diverticulitis.

You and your health care practitioner should discuss the diagnostic needs for an X-ray, and the potential radiation exposure before proceeding with any X-ray examination.

The health care practitioner may perform no tests at all. The cause of the patient's pain may be clear without any tests and may be known not to be serious. If the patient does undergo tests, the practitioner should explain the results to them.