Nonabdominal causes of abdominal pain: finding your heart in your stomach!

Abstract

BACKGROUND: The diagnosis of abdominal pain is difficult and often inaccurate. Nonabdominal disease, in particular cardiac and pulmonary disease, may present with abdominal symptoms.

OBJECTIVE: This article provides a brief review of the neuro-anatomical basis of abdominal pain in the adult patient population. Differential diagnoses are outlined with a specific focus on time critical conditions, and clinical 'red flags' for the physician in the 'frontline' are highlighted.

DISCUSSION: Physicians need a high clinical index of suspicion when the diagnosis is elusive. They must acknowledge atypical presentations are common, avoid over reliance on 'classic' presentations or the outcome of preliminary investigations, and specifically seek time critical diagnoses. A detailed history and examination remains the key to avoiding diagnostic error. The priority is not 'correct diagnosis' but 'correct patient disposition'. Options include prolonged observation, further sophisticated investigations, and early specialist referral. Physician's gestalt in elusive cases remains important.