Common Tests Used to Diagnosed Abdominal Pain

When Your Belly Hurts, Diagnosis Can Be Challenging

Pain or cramps in stomach
Abdominal Pain. MarsBars/Getty Images

Abdominal pain is a fairly common medical problem, and the severity of the issue ranges from a minor annoyance to life-threatening. This is because abdominal complaints may be as simple as an upset tummy in a child who has had too much candy after trick or treating on Halloween or as complex as a patient who needs emergency surgery to remove part of the intestine that has been starved of oxygen.

While abdominal pain is common, each case is unique—just as each patient is unique.

Your health history, type of pain, age, gender, how long the pain has been present, what it feels like and where you feel it will all help determine what tests are ordered to diagnose the problem.

Is It Acute or Chronic Abdominal Pain?

An acute illness is one that has a sudden and often severe onset. An example of acute abdominal pain would be when a patient experiences a severe case of appendicitis, where infection causes the appendix to swell and become increasingly painful. While an acute illness typically has a quick onset, the illness or the pain may last for weeks or even months. For example, a broken leg is an acute problem, but the leg may continue to hurt for an extended period of time.

A chronic illness is one that lasts for six months or longer. Chronic abdominal pain is belly pain that has lasted for at least six months and may be expected to last even longer, possibly even for a lifetime if the cause cannot be treated or cured.

Chronic pain may be caused by ongoing problems that cannot be cured, such as cirrhosis of the liver.

Chronic abdominal pain may have a known cause and a planned course of treatment, where acute abdominal pain may need to be diagnosed first in order to then be treated appropriately.

History Taking for Abdominal Pain

If you are experiencing significant abdominal pain, don’t be surprised if it seems like the provider is asking many questions.

 Finding out the history of the illness, as well as the patient’s medical history, is often the quickest and easiest way to narrow down the potential causes of abdominal pain.

For example, a patient who indicates that they have been drinking heavily for decades will be more likely to have a liver problem, while a young woman of child bearing age who is sexually active and not using birth control would be more likely to be experiencing a complication of pregnancy.

Some of the questions may seem extremely personal, but it is absolutely essential that you answer the questions to the best of your ability, as your answers will determine what tests are appropriate for your condition. 

The Physical Examination

One of the best ways to diagnose abdominal pain is a physical examination of the abdomen performed by a knowledgeable clinician. The standard physical examination is done in the following order.

  • Inspection: The abdomen is exposed and examined for any external clues to the nature of the problem. Bruises, scars, and other marks on the skin can help suggest potential problems.
  • Auscultation: Listening to the different areas of abdomen with a stethoscope can be very useful. The sounds the intestines make—or don’t make—can help rule different problems in or out.
  • Percussion: This is when the clinician methodically tapping on different areas of the abdomen. This process can help determine organ size without an x-ray or imaging studies.
  • Palpation: This is the process where different areas of the abdomen are gently pushed on to determine if they are tender or painful. This allows the area of likely concern to be narrowed down, and can make it easier to diagnose an issue.

    For example, if the pain is mostly in the patient’s right lower abdomen, also known as the right lower quadrant, is tender the appendix might be the cause of the pain. If the left upper quadrant hurts after a serious car accident, the cause of pain could potentially be the spleen.

    Lab Tests for Abdominal Pain

    One way to diagnose a serious problem in the body is to examine bodily fluids. This may mean drawing blood, taking a stool sample, or collecting a sample of saliva, among other options. Blood tests and urine tests are among the most common tests done for abdominal pain, and are often followed by additional tests after the results are available.

    CBC: A complete blood count, or CBC, is a blood test that can help determine if infection is present in the body. Certain types of blood cells increase when an infection is present, and the presence of infection can help determine the nature of the problem. If an infection is present in the blood, a culture and sensitivity is often done to determine the type of infection and best treatment.

    Liver Enzymes/Hepatic Function Test: Liver enzymes are tests that, when elevated, indicate a problem with the function of the liver. Other liver tests can indicate whether the liver is successfully doing its job removing harmful toxins from the body. The liver can be damaged in many ways, including taking too much medication that is harmful to the liver, drinking too much alcohol, or by a natural disease process--and these conditions are often painful.

    Urinalysis: This looks at the urine to determine if blood or infection is present in the urinary tract. A urinary tract infection can cause pain in the kidneys, ureters, bladder or urethra, or a combination of all four. This can lead to pain that is felt in the back, the abdomen or pelvis.

    Amylase and Lipase: These blood tests look at enzyme levels produced by the pancreas. Elevated levels can indicate an infection in the pancreas called pancreatitis, which can be extremely painful and can lead to hospitalization.

    Occult Stool/Hemoccult Test: This is a test that looks for blood in the stool, which is not a normal finding. Blood in the stool that cannot be seen with the naked eye can indicate a problem in the upper digestive tract.

    Pregnancy Test: For women of childbearing age who are experiencing abdominal pain, a pregnancy test is one of the first tests that are typically done. A positive pregnancy test can explain many symptoms, and the presence of pain may indicate an ectopic pregnancy.

    Imaging Studies For Abdominal Pain

    CT: The CT scan, or Computed Tomography imaging study, is often pronounced “cat scan”. This test is non-invasive, looking at the inside of the human body without even touching the body. This test uses many x-ray type images to create an image of the inside of the human body, which can then be read by a skilled radiologist. The test images may be enhanced by the use of contrast, which can provide more detailed images but cannot be safely used in most patients with known kidney problems.

    MRI: Magnetic Resonance Imaging uses magnetic fields to produce images of the inside of the human body. Like the CT scan, it is non-invasive and allows images of the body to be made without touching the body directly. An MRI cannot be performed on a person with certain types of metal in their body, as the test uses very strong magnets that can be harmful to patients with some implants. Contrast may be used to enhance the images, but again cannot be used safely in some patients with kidney problems.

    Pelvic Exam: This examination looks at the reproductive organs of a woman by inspecting the genitalia and the inside of the vagina. This test, along with obtaining swabs from the cervix or testing any drainage that may be present, can determine if an infection or disease process is causing pain.

    Rectal Exam: The digital rectal exam, or DRE, is an examination of the rectum with a finger. During this test the examiner will place a gloved and lubricated finger in the rectum. They are looking for rectal tone, which is the strength with which the anal sphincter muscle is held closed. They will also be examining for obvious blood, masses in the rectum, and can potentially examine the prostate in male patients. A small stool sample is often obtained during the rectal exam so that an occult stool test may be performed. Constipation may also be able to be diagnosed using this type of examination, as stool often feels like small, hard pellets during the rectal examination.

    EGD: Known as an Upper GI, Esophagogastroduodenoscopy, panendoscopy or upper endoscopy, this test is used to inspect the upper digestive tract from the inside. Using a lighted endoscope with a camera, the endoscope is inserted into the mouth so that the inside of the esophagus, stomach and duodenum (the first part of the small intestine) can be inspected. This test will help determine if stomach pain is being caused by acid reflux or stomach ulcers. This test requires anesthesia, as the patient is sedated for the duration of the procedure, which is performed by a trained physician.

    Colonoscopy: This is a test that allows a physician to inspect the inside of the colon (large intestine) with an instrument that has both a light and a camera, with the images shown on a monitor. During this test the examiner can inspect the entire large intestine for sources of pain or even bleeding, and can also take biopsy samples and perform other minor procedures during the examination. This test requires anesthesia so that the patient may sleep through the examination and is performed by a trained physician.

    KUB: This is an x-ray of the abdomen that looks at the kidneys, ureters and bladder as well as the intestines and the bones of the pelvis and spine. This test is very useful for determining if gas in the GI tract or constipation is playing a role in the pain the patient is experiencing, or if kidney stones are present that could be causing pain.

    Ultrasound: This test uses sound waves that are higher than the human ear can detect to create images of the inside of the human body. While this test is most commonly known as a test used during pregnancy to see the fetus and determine gender, the ultrasound can be used to examine the abdomen and determine if there are issues present with the tissues and organs there. An ultrasound can often detect problems with the gallbladder, and is frequently used to evaluate the kidneys.

    Sources:

    A Practical Guide to Clinical Medicine. Exam of the Abdomen. University of California San Diego.

    Imaging For Chronic Abdominal Pain in Adults.

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