Abdominal Pain: Clinical Overview & Red Flags
A practical reference for patients and families on common presentations, differential diagnoses, and critical red flags requiring urgent evaluation.
Overview
Abdominal pain is one of the most frequent reasons for consultations in general practice and emergency departments. It spans a wide spectrum from mild, self-limiting functional discomfort to acute surgical emergencies that necessitate immediate intervention.
An accurate assessment requires evaluating the pain's onset, exact quadrant localisation, progression, relationship to meals, and associated systemic symptoms.
Common Causes by System
The differential diagnosis of abdominal pain involves multiple organ systems:
- Gastrointestinal: Gastroenteritis, constipation, functional abdominal pain of childhood, irritable bowel syndrome (IBS), appendicitis, inflammatory bowel disease (Crohn's disease / ulcerative colitis), diverticulitis, and gastro-oesophageal reflux (GORD).
- Hepatobiliary & Pancreatic: Gallstones (biliary colic), cholecystitis, and pancreatitis.
- Urological: Urinary tract infections (UTIs), pyelonephritis, and renal colic (kidney stones).
- Gynaecological: Dysmenorrhoea (menstrual cramps), endometriosis, pelvic inflammatory disease (PID), ruptured ovarian cyst, or ectopic pregnancy.
- Musculoskeletal & Hernias: Abdominal wall muscle strain, inguinal or umbilical hernias.
Clinical Assessment in General Practice
During a general practice consultation, a structured examination is performed. This includes vital signs, abdominal palpation for focal tenderness, percussion, and assessment of organomegaly.
Depending on clinical suspicion, initial investigations may include:
- Urine dipstick, microscopy, and culture (to assess for infection, hematuria, or pregnancy).
- Targeted blood tests (full blood count, inflammatory markers, renal and liver function, coeliac serology, or lipase).
- Diagnostic imaging, such as targeted ultrasound (for biliary, renal, or pelvic pathology) or urgent hospital referral if appendicitis is suspected.