A week never goes by that I do not see at least one patient in my office for abdominal pain. This is a challenging concern because the etiology can range from the minimally significant and self-limited to the life-threatening. Over the years, I have had to evaluate and treat patients with abdominal pain over the telephone, in person, and on video visits; I have cared for individuals with abdominal pain in the office, their home, the nursing home, the urgent care clinic, the emergency department, and the hospital. As I edited this monograph, I thought about some of the hundreds of patients I have treated for abdominal pain—the ones who were particularly sick, those who presented diagnostic challenges, and those with unexpected or unusual etiologies.
A surgeon who reviewed this monograph questioned whether some of the topics discussed were the territory of surgeons rather than family physicians. The case of abdominal pain that sticks with me most was an unassigned admission from the emergency department to our family medicine service. I was the senior resident on service, and we were at the end of a very long day of covering the unassigned admissions. I sent the medical student to talk with the patient while we checked out the rest of the service to night coverage. The medical student returned to present the patient, who was to be admitted to our service for right lower quadrant abdominal pain. The patient had been examined by the emergency medicine attending and the surgical resident, had an unremarkable computed tomography scan, and had laboratory results that were normal other than a borderline elevated white blood cell count. The medical student’s meticulous history and physical findings included notation of a rash. We went to talk with the patient as a team and found a band of vesicular rash on the right lower quadrant and right flank that stopped in the midline. Instead of completing admission paperwork for the patient, we returned them to the emergency medicine attending to discharge home on antiviral therapy and pain medication. This patient with a less common etiology for abdominal pain is always my reminder that even with all the advanced imaging and laboratory testing available to us, a careful history and physical examination are often the most valuable things we can do for our patients.
This monograph reviews the most common causes of abdominal pain, including acute appendicitis, gallstone disease, diverticular disease, and small bowel obstruction and ileus. Each section reviews the epidemiology, pathophysiology, and clinical presentation of the condition. Next, there is a discussion on the laboratory testing and imaging that are used for the condition, with a focus on how family physicians should evaluate patients in an outpatient setting. Finally, the monograph reviews the best evidence on treatment, scenarios in which surgical consultation should be considered, and actions that can be taken to prevent future episodes of abdominal pain and complications.
As family physicians, we see patients with abdominal pain on almost a daily basis. This monograph will give you the information to provide effective, evidence-based care for your patients, whether you are a resident still learning to manage these challenging conditions or, like me, you have been treating these conditions for decades but recognize that the science has moved beyond “the way we have always done it.”
Ryan D. Kauffman, MD, FAAFP, CCFP, Associate Medical Editor
Family Medicine Physician
Erie Shores Family Health Team, Leamington, Ontario, Canada
