Abdominal pain

On any particular Saturday night in a big city hospital emergency department, there will be at least 40 patients seen with abdominal pain.  Of those, perhaps 2 will be operated on that night or the next day.  Some may be kept in hospital a day or two for observation and then discharged.  The rest will have been sent home from the emergency room with instructions to see their family doctor.  Perhaps one or two of these will eventually have a diagnosis and maybe one will eventually undergo surgery as a result.  But the rest will never get a diagnosis.  Their pain will go away, or come back intermittently, but the patients will remain essentially healthy.  This example illustrates a few things about abdominal pain – it is very common, it may be impossible to determine the cause in many or most cases, and it is most often not life-threatening.

The causes of abdominal pain may be divided into three major sources: the abdominal wall itself (muscle, ribs, nerves, fat and skin problems), pains arising in the intraabdominal organs (appendix, colon, gallbladder, pancreas, liver, etc.) and finally, the structures behind the abdominal cavity such as the kidneys and blood vessels like the aorta.

Abdominal wall problems are rarely serious and can usually be identified by careful physical examination.  Pain arising within the intraabdominal organs can be from a variety of causes and can vary from harmless but a real nuisance (Irritable Bowel Syndrome) to life-threatening (e.g. Appendicitis).  While surgeons can be very accurate in determining the seriousness of intraabdominal pain, knowing exactly which organ it is originating in is somewhat harder. Pain arising from structures behind the abdominal cavity can be very difficult to diagnose and usually requires special testing.

Medicine has made extraordinary advances in imaging the intraabdominal organs (ultrasound, CT scan, MRI scan) and we can now often identify the cause of abdominal pain in cases which, in the past, would have required exploratory surgery.  Similarly, these tests now eliminate much of the risk of treating a patient non-surgically, by ruling out serious disease.

Notwithstanding the new tests available to physicians, determining the true cause of abdominal pain can be something of an art form, and the experience and capability of physicians in this area vary widely.

© Pezim Clinic, Vancouver, British Columbia, Canada