Abdominal Pain, Nonspecific

• • Nonspecific abdominal pain is a diagnosis of exclusion characterized by abdominal pain without identifiable organic pathology

  • Mild, fleeting abdominal pain

  • Abdominal pain short-lived (< 6hrs)

  • Improvement or no change in abdominal pain since onset of symptoms

  • Patients frequently complain of nausea and/or diarrhea

  • Lack of associated serious signs or symptoms

Epidemiology

• • Most common diagnosis among children complaining of abdominal pain

  • -Accounts for up to 33% of all cases

  • Adults with the symptoms of nonspecific abdominal pain are often diagnosed with irritable bowel syndrome

  • Nonspecific abdominal pain is a diagnosis of exclusion

  • -Extreme care should be taken before diagnosing this disorder in the very young or old and immunocompromised

Symptoms and Signs

• • Patient appears comfortable

  • No documented fever

  • Vital signs normal

  • No evidence of peritoneal irritation

Laboratory Findings

• • Normal WBC count

  • Normal serum chemistries, amylase, lipase, and UA

Imaging Findings

• • Abdominal x-ray: Reveal no free air and a normal bowel gas distribution

  • CT scan: Although expensive, it is quite specific in ruling out surgical etiologies of abdominal pain

• • Irritable bowel syndrome

  • Viral gastroenteritis

  • Dysmenorrhea

  • Psychosomatic pain

  • Abdominal wall pain

  • Causalgia

  • Acute hip bursitis

  • Hip joint dislocation

  • Thoracolumbar spinal nerve root compression

  • Constipation

  • Mesenteric adenitis

Rule Out

• • Surgical etiology of abdominal pain

  • -Acute appendicitis

    -Acute cholecystitis

    -Bowel obstruction

    -Perforated peptic ulcer

    -Incarcerated hernia

    -Diverticulitis

  • Inflammatory bowel disease

  • Acute salpingitis/pelvic inflammatory disease

• • CBC

  • Basic chemistries

  • UA

  • Amylase and lipase

  • Abdominal x-ray

  • Abdominal/pelvic CT may be indicated when diagnosis is in doubt

When to Admit

• • Admission for 24-hour observation may be indicated if a surgical etiology is contemplated (most commonly "rule out appendicitis")

  • Most patients can be sent home and asked to come to the emergency department if their symptoms recur or worsen

When to Refer

• • Patients with recurrent abdominal symptoms may benefit from a gastroenterology consult

  • Young female patients with cyclical pain that correlates with their menstrual cycle benefit from a thorough gynecologic evaluation

• • Educate patients regarding significant signs and symptoms that should prompt them to return to the emergency department

  • Arrange outpatient follow-up as indicated

Surgery

Indications

• • None

Medications

• • Avoid narcotics

  • NSAIDs may be beneficial and nonaddictive

Complications

• • Misdiagnosis

Prognosis

• • Excellent

References