When Abdominal Pain Is Not What It Seems
Ask an Expert. Emergency Physician Dr. Melissa White explains how abdominal pain is evaluated in the ER and which symptoms and patterns raise concern
What is the first thing going through your mind when a patient comes in with abdominal pain?
In emergency medicine, we first think about the things that could kill you.
That includes conditions like an aortic dissection, which is a tear in the body’s main artery, a ruptured aneurysm, severe infection coming from a surgical source, or a ruptured ectopic pregnancy, which is a pregnancy growing outside the uterus.
The goal is to identify dangerous causes quickly.
What surprises patients most about abdominal pain?
Many dangerous causes of abdominal pain are actually rare. Most abdominal pain is not life-threatening, though serious conditions can sometimes present in unexpected ways.
Abdominal pain can also be complicated because many different conditions can present in similar ways.
When do you know it is something serious?
Pain and vomiting that medications cannot control are warning signs.
Signs of sepsis are also especially concerning. Sepsis is the body’s overwhelming response to infection and can become life-threatening if not treated quickly.
Referred pain can also make diagnosis difficult. This means the pain is felt in one part of the body even though the actual problem is somewhere else. Uncontrolled diabetes with neuropathy, which is nerve damage from diabetes, can further complicate presentations because patients may not experience pain in typical ways.
One surprising diagnosis I have seen was Nutcracker syndrome, a rare condition involving compression of a vein near the kidney. Most abdominal pain follows familiar patterns. Occasionally something does not, and that is why we keep looking.
THE BOTTOM LINE
Abdominal pain has many possible causes, ranging from routine problems to life-threatening emergencies.
The ER focuses on identifying dangerous patterns quickly while recognizing that symptoms do not always present in typical ways.
About the Expert
Dr. Melissa White is a Board-Certified Emergency Physician.
She is a Professor of Emergency Medicine, Director of Alumni Engagement and Relations, and Residency Program Director Emerita for the Emory Emergency Medicine Residency Program.
This article is for educational purposes only and is not a substitute for medical advice from your own healthcare provider.