Chronic abdominal pain

Rationale

Chronic or recurrent abdominal pain is a common symptom with an extensive differential diagnosis and heterogeneous pathophysiology. The history and physical examination frequently differentiate amongst the causative disorders.

Causal Conditions

(list not exhaustive)

1. Upper abdominal region
   1. Malignancy
   2. Ulcer and nonulcer dyspepsia
   3. Biliary disease
   4. Pancreatic disease
   5. Hepatic disease
   6. Referred cardiothoracic pain
2. Lower abdominal region
   1. Bowel disease
      1. Inflammatory bowel disease
      2. Diverticular disease
      3. Irritable bowel syndrome
      4. Malignancy
   2. Genitourinary disease
      1. Dysmenorrhea
      2. Benign or malignant tumors
3. Other causes
   1. Food allergies and intolerances (including celiac disease)
   2. Constipation
   3. Musculoskeletal
   4. Functional

Key Objectives

Given a patient with chronic abdominal pain, the candidate will diagnose the cause, severity, and complications, and will initiate an appropriate management plan.

Enabling Objectives

Given a patient with chronic abdominal pain, the candidate will

1. list and interpret critical clinical findings, including those derived from a detailed history and an appropriate physical examination;
2. list and interpret critical investigations, including laboratory investigations, basic and advanced imaging, and endoscopic evaluation; and
3. construct an effective initial management plan, including
   1. appropriate medical, surgical, and nonpharmacologic management;
   2. determining whether this is a case for which long-term follow-up is required due to the risk of later complications; and
   3. recognition of possible underlying psychosocial issues leading to abdominal pain (e.g., spousal abuse, anxiety).