Abdominal pain

Abdominal pain is one of the most common reasons for casualty + OPD visits at Asian Hospital. The differential is wide — anything from a viral gastroenteritis (norovirus, rotavirus) to appendicitis to a kidney stone to gallbladder colic to a peptic ulcer. The clinical pattern tells most of the story.

Location matters

• Upper-right — gallbladder (gallstones, cholecystitis), liver (hepatitis).
• Upper-middle (epigastric) — stomach (gastritis, peptic ulcer), pancreas (pancreatitis), early appendicitis, sometimes a heart attack in disguise.
• Upper-left — spleen, occasionally cardiac.
• Right-lower — appendix (appendicitis), right ovary in women.
• Left-lower — diverticulitis, left ovary, large bowel.
• Generalised / cramping — gastroenteritis (food poisoning), inflammatory bowel disease.
• Loin / flank radiating to groin — kidney stone.

What we look for

History: where does it hurt, when did it start, what makes it better or worse, is there fever / vomiting / loose motion / blood, was there a similar episode before. Examination: where is it tender, is the abdomen soft or rigid, are bowel sounds present. Tests we typically order: CBC, CRP, urine routine, abdominal ultrasound, sometimes a CT scan when the picture is unclear.

The single most important question for any acute abdominal pain is "is this surgical?" — meaning, does the patient need an operation in the next few hours (appendicitis, perforation, obstruction). We have a low threshold for getting general surgery to see anyone whose pain is severe or rapidly worsening.