General evaluation of abdominal pain

Abdominal pain is a common presenting symptom for the clinician. Primary evaluation includes an interview to assess the acute versus chronic nature of the complaints, exacerbating and ameliorating factors, and definition of coexisting disease. Chronic use of medications which alter bowel motility is meaningful. A detailed clinical history alone will result in a functionally accurate diagnosis in most patients.3 Palpation of the abdomen can identify abdominal wall rigidity suggesting a peritoneal process, distended bowel, or underlying masses suggestive of neoplastic, infectious or obstructive processes and localizable tenderness which may suggest a particular organ system. Auscultation of bowel sounds may suggest the presence or absence of gastrointestinal motility and give evidence for obstruction. Rectal and pelvic exams may give additional information related to local pathology. Neurological examination may demonstrate evidence of neuropathy or localized radicu-lopathy. Basic laboratory examinations include testing for fecal blood, urinalysis, blood cell count with white cell differential, serum amylase/lipase levels, electrolytes, and liver function tests. Radiographic evaluations, other tests, endoscopic evaluations, ultrasonography, paracentesis, or advanced imaging studies would be dependent upon the persistence or progression of complaints.

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