What Tests Are Needed for Abdominal Pain?

Abdominal pain is a common symptom that can be caused by various factors such as indigestion, gastrointestinal diseases, gastritis, and other conditions. There are numerous potential causes of abdominal pain, leading to a range of diagnostic methods. Typically, patients with abdominal pain undergo a series of examinations at the hospital.

Firstly, abdominal examination is performed, including the use of gastrointestinal endoscopy to monitor intestinal issues. If no issues are detected in the intestines, a full-body examination is conducted to ultimately identify the cause of the abdominal pain. The focus of the examination is on the abdomen, but a full-body examination cannot be overlooked.

During the full-body examination, apart from checking vital signs such as temperature, pulse, respiration, and blood pressure, the patient's mental state and physical appearance often reflect the severity of the condition. Signs such as pallor, excessive thirst, cold and sweaty hands and feet, hyperventilation, high fever, and chills can indicate acute illness. Posture, such as a flexed position with reluctance to move, may suggest ischemia in the abdominal cavity or peritoneal inflammation. Other symptoms like pressing hands to the abdomen, restless movement, crying, and screaming may indicate spasmodic colicky pain in hollow viscera within the abdominal cavity.

Additionally, examination of the skin and sclera for jaundice, petechiae, purpura, and enlargement of superficial lymph nodes, as well as cardiopulmonary, limb, spinal, and nervous system assessments, and rectal examination, are all valuable in the diagnostic process.

Abdominal examination involves assessing the shape and contours of the abdomen. The presence of gastric peristalsis waves may indicate gastric outlet obstruction, while intestinal peristalsis waves can suggest intestinal obstruction. Abdominal distension is commonly seen in acute pancreatitis or hemorrhagic necrotizing pancreatitis and intestinal paralysis. A scaphoid abdomen may be observed in cases of perforation or hemorrhage leading to acute peritonitis. Prominent abdominal wall veins can be a sign of portal hypertension caused by liver cirrhosis.

Palpation is used to check for enlargement of the liver and spleen, and the presence of masses or tumors within the abdomen. Tenderness, rebound tenderness, and muscular tension of the abdominal muscles may indicate acute peritonitis. Auscultation may reveal hyperactive bowel sounds or the passage of air and fluids, indicating acute intestinal obstruction or strangulated intestinal obstruction.

Rectal examination may reveal tenderness or a soft mass in the right recess, suggesting low-lying appendicitis or pelvic cavity swelling.

Laboratory tests are also conducted to aid in diagnosis. Blood tests may show elevations in total white blood cell count and neutrophils in cases of acute abdominal pain, such as acute appendicitis, ulcer perforation, and intestinal obstruction. These elevations may exceed 20X109/L in cases of septic shock, acidosis, intestinal obstruction, pneumonia, or myocardial infarction. Elevated neutrophils suggest bacterial infection or suppurative lesions, while increased eosinophils may indicate allergies or parasitic diseases. Lymphocyte elevations are commonly seen in tuberculosis, while monocyte elevations may suggest tuberculosis, typhoid, or protozoal infections.

Urinalysis is primarily used to diagnose urinary system diseases but can also provide information in cases of shock, dehydration, acid-base imbalance, burns, diabetes, ketoacidosis, various types of poisoning, heart failure, encephalitis, hepatobiliary, pancreatic, splenic, and gynecological diseases. Renal failure is a common and potentially life-threatening complication in many of these conditions.

Fecal examination focuses on gastrointestinal bleeding, ulcers, and tumors.

Instrumental examinations may also be performed. Abdominal puncture and lavage can be used to visually confirm the diagnosis of visceral rupture, hemorrhage, peritonitis, hemorrhagic necrotizing pancreatitis, and perforation of the gastrointestinal tract, gallbladder, and bile ducts. Biopsies may be obtained through laparoscopic or intraoperative resection or puncture of organs such as the liver, spleen, kidneys, and tumors for histopathological examination.

Indirect methods such as ultrasonography, percutaneous transhepatic cholangiography (PTC), and endoscopic retrograde cholangiopancreatography (ERCP) can also be used to diagnose pancreatic and biliary stones, infections, and strictures.

Overall, the diagnosis of abdominal pain involves a comprehensive approach that combines clinical examination, laboratory tests, and instrumental examinations to accurately identify the underlying cause and initiate appropriate treatment.