Evaluation of Abdominal Pain

Last updated: April 6, 2026, 6:50 PM Pacific Time (PDT)

Interactive chalk-talk framework for abdominal pain. Start with pain location and immediate red flags, then narrow toward surgical, inflammatory, hepatobiliary, obstructive, gynecologic, urinary, and vascular causes.

All Upper abdomen Lower abdomen Diffuse Vascular / emergent Back to Main Page

Interactive diagnostic assistant

Activate the assistant to re-rank likely abdominal pain buckets and diagnoses automatically as you enter partial data.
Pain location
Symptoms and basic labs
Associated symptoms
Danger signs and exam clues

Likely diagnoses from entered data

Recommended next labs, imaging, and diagnostics

Flowchart

Pattern First
Organize abdominal pain by location and acuity
Upper abdominal pain suggests hepatobiliary, gastric, pancreatic, cardiac, or pulmonary causes. Lower abdominal pain raises appendiceal, colonic, urinary, and gynecologic causes. Diffuse pain broadens toward gastroenteritis, obstruction, peritonitis, ischemia, metabolic disease, and systemic illness.
↓
Urgent Triage
Identify red flags first
Peritonitis, shock, GI bleeding, pain out of proportion, chest symptoms, or pregnancy-related emergencies should jump ahead of routine differential refinement.
Upper abdomen
RUQ
Hepatobiliary causes
Biliary colic, cholecystitis, cholangitis, hepatitis, and hepatic congestion are key anchors.
Epigastric
Gastric, pancreatic, cardiac, or aortic causes
PUD, pancreatitis, ACS, and aortic pathology can overlap here.
Lower abdomen
RLQ
Appendiceal and ileocecal causes
Appendicitis is the classic anchor, but think terminal ileitis, cecal disease, or gynecologic mimics.
Pelvic
Gynecologic and urinary causes
Ectopic pregnancy, ovarian torsion, PID, cystitis, and stone disease all live here.
Diffuse or generalized pain
Inflammatory / obstructive
Gastroenteritis, obstruction, ileus, colitis, peritonitis
Bowel-pattern symptoms and exam severity matter here.
Metabolic / systemic
DKA, porphyria, sickle pain, medication, systemic infection
Not all abdominal pain is primarily intra-abdominal.
Vascular or emergent causes
Pain out of proportion
Mesenteric ischemia or catastrophic vascular disease
Lactate, risk factors, and clinical mismatch matter more than a tidy abdominal exam.
Shock / back pain
AAA, rupture, or extra-abdominal emergency
Always remember chest, vascular, and retroperitoneal catastrophes in abdominal pain.