Abdominal Pain is pain perceived anywhere between the lower chest and pelvis and is one of the most common symptoms encountered in clinical medicine. The abdomen contains gastrointestinal, hepatobiliary, pancreatic, urinary, reproductive and vascular structures, while abdominal pain can also originate from the abdominal wall or be referred from organs outside the abdomen. Its location, onset, character, severity, progression and associated symptoms provide important diagnostic information. Pain may be visceral, arising from internal organs, somatic or parietal, arising from the abdominal lining, or referred from another anatomical site through shared neural pathways.
Visceral Abdominal Pain is often poorly localised because internal organs have relatively diffuse sensory innervation. Distension, stretching, inflammation and ischaemia can stimulate visceral afferent pathways and produce vague cramping or aching sensations. Parietal pain tends to be sharper and more precisely localised because the parietal peritoneum has somatic sensory innervation. Referred pain occurs when sensory signals from different structures converge on shared spinal pathways, causing the brain to perceive pain in an area separate from the actual pathology. These physiological distinctions help explain why early disease can produce diffuse discomfort that later becomes more localised.
The anatomical location of Abdominal Pain can narrow the differential diagnosis but does not establish a diagnosis by itself. Upper abdominal pain can arise from the stomach, duodenum, gallbladder, liver or pancreas, while lower abdominal pain can involve the bowel, urinary tract or reproductive organs. Right-sided lower abdominal pain is classically associated with appendicitis but can also occur in numerous other conditions. Colicky pain can reflect contraction against an obstruction, whereas constant severe pain can accompany inflammation or ischaemia. Sudden maximal pain at onset raises different concerns from pain that gradually develops over hours or days.
Abdominal Pain can accompany constipation, diarrhoea, gastroenteritis, gallstones, cholecystitis and appendicitis, but the associated pattern differs. Gastroenteritis commonly produces cramping with diarrhoea and vomiting, whereas gallbladder pain can follow fatty meals and localise to the right upper abdomen or epigastrium. Appendicitis often begins with poorly localised discomfort before becoming more prominent in the right lower abdomen. Bowel obstruction can produce cramping, vomiting and distension, while perforation can cause severe pain and peritoneal irritation. These patterns are useful clinical clues but are not sufficiently specific to replace examination and appropriate investigation.
Diagnosis of Abdominal Pain requires careful history and examination. Clinicians consider onset, location, radiation, severity, duration, aggravating and relieving factors, bowel and urinary symptoms, menstrual or reproductive history where relevant, previous operations, medications and medical conditions. Physical examination may assess tenderness, guarding, rigidity, abdominal distension, bowel sounds and signs of systemic illness. Depending on the suspected cause, investigations can include blood tests, urine testing, pregnancy testing, ultrasound, computed tomography, magnetic resonance imaging or endoscopy. The appropriate investigation depends on age, pregnancy status, anatomical location and suspected disease.
Some forms of Abdominal Pain require urgent assessment. Severe or rapidly worsening pain, abdominal rigidity, persistent vomiting, gastrointestinal bleeding, fainting, shock, high fever, marked distension, jaundice or pain associated with pregnancy can indicate serious disease. Sudden severe pain can result from perforation, vascular catastrophe, torsion or other emergencies. Mild pain can occasionally precede serious deterioration, so the trajectory of symptoms matters. Conversely, severe pain does not always correlate perfectly with the severity of tissue damage, meaning that clinical assessment must integrate vital signs, examination and investigations rather than relying solely on subjective pain intensity.
Management of Abdominal Pain is cause-specific. Simple gastrointestinal upset may require hydration, dietary adjustment and observation, whereas appendicitis may require surgery, gallstone disease may require biliary intervention or surgery, and bowel obstruction may require hospital treatment. Analgesia should not routinely be withheld solely because clinicians fear that it will obscure diagnosis; appropriate pain control can coexist with careful examination and investigation. In chronic pain, treatment may involve dietary management, medication, psychological approaches, rehabilitation or management of an underlying gastrointestinal disorder. Treating pain without identifying a potentially reversible cause can be inadequate.
Abdominal Pain has an extensive differential diagnosis because many organ systems occupy a relatively small anatomical region. It can also be referred from the chest, spine or pelvis, so the absence of obvious abdominal findings does not always exclude significant disease. Functional gastrointestinal disorders can cause recurrent pain without structural abnormalities detectable by routine tests, whereas inflammatory, infectious, obstructive and vascular diseases can produce objective pathology. The term should therefore be understood as a symptom requiring anatomical and physiological interpretation rather than as a diagnosis. Timing, location, radiation, associated symptoms and examination findings collectively provide the framework for determining its significance.
