Section N How would you manage abdominal pain?

Nov 18, 2025
3 min read

Index

Introduction
Understanding the Importance of Structured History-Taking
Conducting a Thorough Physical Examination
Key Investigations in the Assessment of Abdominal Pain
Formulating a Differential Diagnosis
Principles of Initial Management
Accurate Recording and Communication of Findings
Clinical Reflections and Skills Gained
Conclusion

1. Introduction

Abdominal pain is one of the most frequent—and often most challenging—presentations encountered in clinical environments. From benign, self-limiting conditions to acute surgical emergencies, its causes are broad and diverse. High-quality assessment requires clinical structure, vigilance, and the ability to synthesise information rapidly and safely.

At Kraken Medical, we emphasise a systematic, evidence-based approach that empowers clinicians to make confident decisions even in complex scenarios. This reflective article explores the practical steps involved in assessing abdominal pain, drawing on foundational clinical skills, reasoned judgement, and professional insight.

2. Understanding the Importance of Structured History-Taking

History serves as the gateway to diagnosis. A calm, methodical, and patient-centred history not only builds rapport but also shapes the entire clinical pathway.

Key areas of focus include:

Pain characteristics — onset, location, radiation, duration, pattern, severity, and triggers.
Associated symptoms — nausea, vomiting, fever, diarrhoea or constipation, urinary symptoms, weight loss, appetite changes, or gastrointestinal bleeding.
Lifestyle and dietary habits — recent meals, alcohol intake, new medications, or food intolerances.
Medical and surgical history — previous abdominal operations, chronic illnesses, allergies, and family history.
Travel or exposure risks — relevant when considering gastroenteritis or parasitic disease.

A high-quality history often provides the strongest early indication of the likely diagnosis and helps determine which cases require urgent escalation.

3. Conducting a Thorough Physical Examination

The physical examination is essential for validating or challenging the impressions formed during history-taking.

A comprehensive abdominal assessment includes:

Inspection for distension, scars, bruising, or visible peristalsis.
Auscultation to evaluate bowel sounds—hyperactive in obstruction, absent in ileus.
Percussion to detect tympany, fluid accumulation, or organ enlargement.
Palpation to identify tenderness, guarding, masses, or peritonism.

Vital signs remain critical. Hypotension, tachycardia, fever, or signs of shock may indicate serious underlying pathology requiring immediate intervention.

4. Key Investigations in the Assessment of Abdominal Pain

Investigations are selected according to clinical suspicion and examination findings.

Common investigations include:

Blood tests: full blood count, CRP, renal function, liver enzymes, amylase/lipase, and electrolytes. These help differentiate infection, inflammation, dehydration, or metabolic disturbance.
Urinalysis to screen for urinary tract infection or renal colic.
Pregnancy testing where applicable—critical for identifying ectopic pregnancy.
Imaging:
- Ultrasound for biliary disease, gynaecological pathology, or fluid collections.
- CT abdomen for suspected appendicitis, obstruction, perforation, diverticulitis, or complex abdominal presentations.

Appropriate investigations allow the clinician to confirm suspicions, rule out life-threatening conditions, and guide targeted management.

5. Formulating a Differential Diagnosis

Abdominal pain requires broad thinking and careful prioritisation. Differential diagnoses may include:

Common benign causes: gastritis, constipation, viral gastroenteritis, urinary tract infection.
Acute inflammatory conditions: appendicitis, diverticulitis, cholecystitis, pancreatitis.
Obstructive or surgical emergencies: bowel obstruction, perforated viscus, ruptured aneurysm.
Renal or urinary causes: kidney stones, pyelonephritis.
Gynaecological causes: ovarian torsion, pelvic inflammatory disease, ectopic pregnancy.

A structured list ensures that dangerous diagnoses are not overlooked and helps justify the need for further tests or escalation.

6. Principles of Initial Management

Initial management must be shaped by the most likely aetiology while maintaining patient comfort and safety.

Core elements include:

Analgesia: timely and appropriate pain relief improves patient comfort without compromising diagnostic accuracy.
Fluid resuscitation: essential in dehydration, sepsis, vomiting, or haemodynamic instability.
Targeted therapy:
- Antiemetics for nausea and vomiting.
- Anti-inflammatory agents when appropriate.
- Antibiotics for confirmed or highly suspected infection.
Urgent surgical review when red flags indicate possible obstruction, perforation, appendicitis, or haemorrhage.

Early, well-judged intervention can prevent complications and accelerate recovery.

7. Accurate Recording and Communication of Findings

High-quality documentation is a cornerstone of safe clinical practice.

Clear records should include:

Detailed history
Examination findings
Rationale for investigations
Differential diagnosis
Initial management decisions
Escalation or referral plans

Thorough documentation supports continuity of care, provides medicolegal protection, and ensures cohesive team communication.

8. Clinical Reflections and Skills Gained

Reflecting on the management of abdominal pain reinforces several key clinical competencies:

The importance of structure in assessment to avoid missing subtle but significant clues.
Confidence in performing abdominal examinations, interpreting findings, and linking them to likely pathology.
Developing diagnostic reasoning, balancing common causes with potentially life-threatening conditions.
Improved decision-making regarding investigation selection and escalation.
Enhanced communication and documentation, which strengthens interdisciplinary collaboration.

These reflections highlight the ongoing value of clinical learning and reinforce best practice in patient-centred care.

9. Conclusion

Managing abdominal pain requires a blend of technical knowledge, methodical clinical skill, and professional judgement. By approaching each case systematically—taking a detailed history, carrying out a thorough examination, selecting appropriate investigations, and formulating a reasoned differential diagnosis—clinicians can deliver safe, effective and timely care.