Diagnosis and Frequency of Abdominal Pain in Emergency Room Patients

Abdominal pain is one of the most common reasons for emergency department (ED) visits worldwide. When a patient presents with acute abdominal pain, the diagnosis can be challenging due to the wide range of potential underlying causes. Abdominal pain can be caused by conditions that are benign and self-limiting, as well as life-threatening diseases that require immediate intervention. Emergency physicians must take a thorough history, perform a physical examination, and use diagnostic tools to identify the cause of the pain accurately.

Common Causes of Abdominal Pain in the Emergency Department

1.Acute Appendicitis

1.Diagnosis: Acute appendicitis is one of the most common causes of abdominal pain in young adults and often presents with periumbilical pain that eventually localizes to the lower right quadrant (McBurney’s point). Symptoms include fever, nausea, and vomiting. The diagnosis is typically made through clinical examination and imaging studies such as ultrasound or CT scans.

2.Frequency: Appendicitis accounts for about 5% of all emergency abdominal surgeries and is most common in people aged 10 to 30 years.

2.Gastrointestinal (GI) Perforation

1.Diagnosis: Conditions such as peptic ulcer disease or diverticulitis can lead to gastrointestinal perforation, which is characterized by sudden, severe abdominal pain, often described as a sharp or stabbing sensation. The pain is usually diffuse at first but can become localized. Perforation can lead to peritonitis, a life-threatening condition that requires urgent surgical intervention.

2.Frequency: Gastrointestinal perforation is less common but still represents a significant cause of emergency abdominal pain, particularly in patients with a history of ulcers, Crohn’s disease, or diverticulitis. It occurs in approximately 2-4% of patients presenting with abdominal pain.

3.Cholecystitis (Gallbladder Inflammation)

1.Diagnosis: Cholecystitis often presents as right upper quadrant pain, nausea, and vomiting, commonly after a fatty meal. Physical examination may reveal Murphy’s sign (pain upon palpation of the right upper abdomen during inspiration). Ultrasound is the diagnostic imaging of choice to confirm the presence of gallstones and inflammation.

2.Frequency: Cholecystitis is a common cause of abdominal pain in adults, particularly in those over 40 years old, and is responsible for around 10-15% of ED visits for acute abdominal pain.

4.Ectopic Pregnancy

1.Diagnosis: Ectopic pregnancy occurs when a fertilized egg implants outside the uterus, usually in the fallopian tubes. It typically presents with lower abdominal pain, vaginal bleeding, and a history of missed periods. The diagnosis is confirmed by a combination of clinical examination, pregnancy test (hCG levels), and ultrasound.

2.Frequency: Ectopic pregnancy is a critical condition and occurs in approximately 1-2% of all pregnancies. It represents a significant cause of abdominal pain in women of reproductive age and is a major cause of maternal morbidity and mortality if not diagnosed early.

5.Ovarian Torsion

1.Diagnosis: Ovarian torsion occurs when the ovary twists around its ligaments, cutting off its blood supply. It often presents with sudden, severe, unilateral lower abdominal pain, nausea, and vomiting. Pelvic ultrasound with Doppler flow is used to diagnose this condition.

2.Frequency: Ovarian torsion is relatively uncommon, occurring in 3-7% of women with acute abdominal pain, but it requires immediate surgical intervention to prevent ovarian necrosis.

6.Pancreatitis

1.Diagnosis: Acute pancreatitis presents with severe epigastric pain that radiates to the back. The pain is often exacerbated by eating or drinking. Diagnosis is confirmed through elevated serum amylase and lipase levels, along with characteristic imaging findings such as CT scans or ultrasound.

2.Frequency: Pancreatitis is a common cause of severe abdominal pain, particularly in patients with a history of alcohol consumption or gallstones. It is responsible for about 2-5% of all abdominal pain cases in the ED.

7.Intestinal Obstruction

1.Diagnosis: Abdominal pain due to intestinal obstruction typically presents with crampy pain, bloating, vomiting, and failure to pass gas or stool. The underlying causes include adhesions, hernias, and tumors. Diagnosis is made through imaging, particularly abdominal X-rays or CT scans, which show dilated bowel loops and air-fluid levels.

2.Frequency: Intestinal obstruction is a frequent cause of abdominal pain in the ED, especially in older adults, and accounts for approximately 5-10% of cases.

8.Diverticulitis

1.Diagnosis: Diverticulitis, inflammation of small pouches in the colon, typically causes left lower quadrant pain. Associated symptoms include fever, nausea, and changes in bowel habits. Diagnosis is usually confirmed with a CT scan, which reveals thickening of the colonic wall and inflamed diverticula.

2.Frequency: Diverticulitis is common in older adults and accounts for approximately 5-10% of cases of abdominal pain in the ED.

9.Urinary Tract Infection (UTI) and Kidney Stones

1.Diagnosis: Urinary tract infections and kidney stones can also cause lower abdominal or flank pain. UTI symptoms include dysuria, urgency, and cloudy urine. Kidney stones typically cause colicky, severe pain in the lower back or abdomen, often radiating to the groin. Urinalysis and imaging such as ultrasound or CT scan help in diagnosis.

2.Frequency: UTIs and kidney stones are common causes of abdominal pain, particularly in females and middle-aged adults. UTIs are responsible for around 10-15% of ED visits for abdominal pain, while kidney stones occur in 3-5% of cases.

Other Less Common Causes

Other less common but critical causes of abdominal pain include mesenteric ischemia, renal infarction, and abdominal aortic aneurysm. These conditions are rarer but potentially life-threatening, requiring rapid diagnosis and intervention.

Conclusion

In the emergency setting, abdominal pain can be caused by a variety of conditions ranging from benign to life-threatening. The most common causes include appendicitis, cholecystitis, and gastrointestinal perforation, but emergency physicians must maintain a broad differential diagnosis. Early and accurate diagnosis, often aided by imaging, is essential for determining the appropriate management plan and preventing serious complications. The frequency of these conditions varies, but appendicitis, cholecystitis, and diverticulitis are among the most common causes, while conditions like ectopic pregnancy and ovarian torsion, though less frequent, require prompt attention to prevent significant morbidity and mortality.