The "Stomachache" of Medicine: Concepts and Mechanisms of Abdominal Pain

Abdominal pain (AP) is by far among the most common complaints in healthcare institutions. Approximately every tenth patient in the acute setting is estimated to present with AP. Although cultural, geographical and sociodemographic variations exist, it is an outstanding complaint in all patient groups, independent of age and gender. Although it can be a manifestation of an intraabdominal pathology itself, a serious systemic or extraabdominal condition can be revealed following a thorough investigation of AP. Therefore, it is vital to evaluate the patient systemically, a focused but elaborate history, and extensive physical examination not confined to the abdomen in order to establish important diagnoses. Inspection, auscultation, percussion, superficial and deep palpation are important elements of the examination methods for the abdomen. Each positive or negative finding on examination should be interpreted cautiously for the individual patient. After history and evaluation narrow the list of differential diagnoses (DD), ancillary investigations including laboratory tests and radiological modalities can be ordered.