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Abdominal Pain

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Abdominal Pain - Family Medicine Approach

Overview

Abdominal pain in family medicine requires a systematic approach to diagnosis and management, focusing on common conditions while recognizing serious pathology requiring urgent referral.

Common Presentations in Primary Care

Functional Gastrointestinal Disorders

Key Management Guidelines

Initial Treatment for Dyspepsia

See the dyspepsia treatment algorithm for stepwise approach:

  1. Lifestyle modifications
  2. Antacids and alginate preparations
  3. H2 receptor antagonists
  4. Proton pump inhibitors
  5. Helicobacter pylori testing and treatment

Diagnostic Probabilities

Clinical diagnosis of GERD:

  • Typical symptoms (heartburn, regurgitation): 70-80% probability
  • Atypical symptoms: 30-40% probability
  • Response to PPI therapy: Confirmatory diagnosis in 80% of cases

ROME III Criteria for IBS

Recurrent abdominal pain/discomfort at least 3 days/month in the last 3 months, with two or more of:

  1. Improvement with defecation
  2. Onset associated with change in stool frequency
  3. Onset associated with change in stool form

Red Flags - When to Refer Urgently

Dyspepsia Red Flags

Immediate endoscopy required for:

  • Age > 55 years with new-onset dyspepsia
  • Weight loss
  • Dysphagia
  • Odynophagia
  • Gastrointestinal bleeding
  • Anemia
  • Persistent vomiting
  • Palpable mass
  • Family history of upper GI cancer

Abdominal Pain Red Flags

Urgent specialist referral for:

  • Acute severe pain
  • Signs of peritonitis
  • Unstable vital signs
  • Pregnancy with abdominal pain
  • Immunocompromised patients
  • Elderly patients with acute pain

Common Causes of Dyspepsia

Functional Dyspepsia (50-60%)

  • Postprandial distress syndrome
  • Epigastric pain syndrome

Organic Causes (40-50%)

  • GERD (most common organic cause)
  • Peptic ulcer disease
  • H. pylori infection
  • Medication-induced (NSAIDs, aspirin)
  • Gastric cancer (rare but important)

Clinical Approach

History Taking

Follow the systematic Abdominal pain assessment approach with focus on:

  • Alarm symptoms
  • Medication history
  • Family history
  • Psychosocial factors

Physical Examination

  • General appearance
  • Vital signs
  • Abdominal examination
  • Check for masses

Investigation Strategy

Based on clinical presentation:

Low risk patients:

  • Trial of therapy (empirical treatment)
  • H. pylori testing if indicated

High risk patients:

  • Urgent endoscopy
  • Complete blood count
  • Liver function tests
  • Imaging if indicated

Management Algorithms

Refer to specific condition protocols for:

  • GERD management
  • IBS management
  • PUD treatment
  • H. pylori eradication

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