Miscellaneous
Clinical Reasoning
Abdominal Pain — A Clinical Framework
Systematic approach, alarm features, visceral vs. somatic pain, functional disorders, mesenteric ischemia, and abdominal wall pain.
6 Key Topics5 Clinical CasesCarnett Sign · CAPS · CMI · ACNES
1
Approach to Abdominal Pain
Systematic, structured evaluation
A Structured Approach to Abdominal Pain
Abdominal pain is the most common GI complaint in clinical practice. A systematic approach — characterizing the pain and anchoring it anatomically — prevents missed diagnoses.
OPQRST Framework
O
Onset: Sudden (perforation, ischemia) vs. gradual (IBD, cancer)
P
Provocation/Palliation: Food (mesenteric ischemia, peptic ulcer), position
Q
Quality: Crampy (obstruction), burning (GERD), dull (visceral), sharp (somatic)
R
Radiation: To back (pancreatitis), right shoulder (biliary), groin (renal colic)
S
Severity + Site: Quadrant, periumbilical, diffuse
T
Timing: Intermittent (functional), constant (structural), nocturnal (organic red flag)
Anatomic Localization
RUQ
Liver, GB, Hepatic flexure, Duodenum
Epigastric
Stomach, Pancreas, AAA, Cardiac
LUQ
Splenic flexure, Spleen, LLL PNA
RLQ
Appendix, Terminal ileum, Right ovary
Periumbilical
SI, Mesentery, AAA, Volvulus
LLQ
Sigmoid, Left ovary, Diverticulitis
RIF
Suprapubic
Bladder, Uterus, Prostate
LIF
Note: Pain can refer widely — always correlate with mechanism.
Essential History Items Beyond OPQRST
Recent surgery or procedures
Menstrual/reproductive history (women)
Prior abdominal pain episodes and workup
Weight loss, anorexia, early satiety
Medications (NSAIDs, steroids, immunosuppressants)
Alcohol and substance use
Travel history (infectious causes)
Family history of GI malignancy or IBD
Feldman M et al. Sleisenger and Fordtran's Gastrointestinal and Liver Disease, 11th ed.