Abdominal Pain

Abdominal pain is one of the most common reasons for both primary-care visits and emergency department presentations. The location of the pain (right upper quadrant, epigastric, peri-umbilical, lower quadrants) and its character (sharp, dull, colicky) narrow the differential dramatically. Lab work usually plays a supporting role to clinical examination and imaging — the central job is identifying inflammation, organ injury or biliary obstruction quickly.

• Gastritis, peptic ulcer — epigastric, often related to meals or NSAIDs.
• Gallbladder disease — right upper quadrant, often after fatty meals.
• Hepatitis or fatty liver — right upper quadrant discomfort.
• Pancreatitis — epigastric pain radiating to the back, with elevated lipase.
• Appendicitis — peri-umbilical pain migrating to right lower quadrant.
• Inflammatory bowel disease, irritable bowel — chronic lower abdominal pain.
• Ovarian, gynaecological causes — pelvic pain in women.

Initial panel: CBC, comprehensive metabolic (ALT, AST, GGT, bilirubin, alkaline phosphatase, albumin, glucose, creatinine), lipase, urinalysis, pregnancy test in women of reproductive age, CRP. Imaging (ultrasound, CT) usually follows immediately when an acute abdomen is suspected.