Abdominal pain is cited as the most common reason for going to the emergency department in the 18- to 64-year age group and is the third most common reason in the population older than 65 years.1 Approximately 8% of chief complaints are specifically for abdominal pain or include abdominal pain as a component of a constellation of symptoms resulting in the perceived need to access emergent health care services.2 The admission rate for abdominal pain in the adult population is approximately 18%; however, in the population older than 65 years, the admission rate increases to 50%.3,4 Most individuals (65%-75%) with acute abdominal pain have a nonsurgical problem.3 A life-threatening cause for abdominal pain is identified in 10% of patients, with most requiring surgery.3 Even in today's era of advanced diagnostic testing, approximately 20% to 40% of patients will not have a definitive diagnosis for their abdominal pain at the conclusion of their evaluation and discharge.4
The abdomen, like a "mysterious black box," contains multiple distinct, yet interrelated organ systems. Specific pathology can develop in each organ, and each organ can be affected by systemic disease. The spectrum and acuity of disease is quite large, with benign abdominal processes and acute life-threatening events having considerable overlap in presentation. Common causes of intra-abdominal pathology frequently lack the signs and symptoms of the classic presentation, which can vary with age, sex, and comorbidities.3
Confounding the evaluation of abdominal pain is the potential for a nonabdominal source to manifest as an intra-abdominal process.3 Providing care for patients with acute abdominal pain requires familiarity with the epidemiology, prevalence, and presentation of abdominal pathology, as well as a working knowledge of the differential diagnoses. The evaluation and management of this population require a thorough history, complete physical examination, and selected diagnostic testing to pinpoint a specific diagnosis.5
The problem of abdominal pain is not unique to the emergency department. Acute abdominal pain is a complication that can occur across the continuum of care, from primary care to the acute care inpatient setting. Acute gastrointestinal (GI) pathology occurring in the acutely and critically ill inpatient population frequently has an atypical presentation. Classic signs and symptoms are absent or diminished, delaying diagnosis and surgical evaluation of the patient, which increases morbidity and mortality rates. Patients at greatest risk for a delay in diagnosis are those admitted with an initial presentation not involving the GI system.6
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