What Is the Accuracy of the Physical Exam in Intra-abdominal Emergencies? Does Administration of Pain Medication Alter the Accuracy of the Physical Examination?

  • John C. Beauchamp
  • Jonathan GiordanoEmail author


Abdominal pain is one of the most frequent chief complaints encountered in the emergency department, and the physical examination is a key component in generating a differential diagnosis and treatment plan. Knowledge of the embryologic origins of the intra-abdominal organs and their innervation helps to narrow the differential diagnosis and focus laboratory and imaging studies. Non-specific or generalized abdominal pain presents a difficult diagnostic challenge and should be treated with a high index of suspicion. Pain medications should not be withheld as studies show they are safe and do not adversely affect physical exam findings.


Abdominal examination Abdominal pain and analgesia Embryologic abdominal organs Epigastric pain Left lower quadrant pain Right lower quadrant pain Visceral and somatic pain 


  1. 1.
    Mattson B, Dulaimy K. The 4 quadrants: acute pathology in the abdomen and current imaging guidelines. Semin Ultrasound CT MR. 2017;38(4):414–23.CrossRefGoogle Scholar
  2. 2.
    McNamara R, Dean AJ. Approach to acute abdominal pain. Emerg Med Clin North Am. 2011;29(2):159–73.CrossRefGoogle Scholar
  3. 3.
    Natesan S, Lee J, Volkamer H, et al. Evidence-based medicine approach to abdominal pain. Emerg Med Clin North Am. 2016;34(2):165–90.CrossRefGoogle Scholar
  4. 4.
    Cartwright SL, Knudson MP. Evaluation of acute abdominal pain in adults. Am Fam Physician. 2008;77(7):971–8.PubMedGoogle Scholar
  5. 5.
    Sherman R. Abdominal Pain. In: Walker HK, Hall WD, Hurst JW, editors. Clinical methods: the history, physical, and laboratory examinations. 3rd ed. Boston: Butterworths; 1990. Chapter 86.Google Scholar
  6. 6.
    Macaluso CR, McNamara RM. Evaluation and management of acute abdominal pain in the emergency department. Int J Gen Med. 2012;5:789–97.CrossRefGoogle Scholar
  7. 7.
    Breum Birger M, Bo R, Thomas K, Nordentoft T. Accuracy of abdominal auscultation for bowel obstruction. World J Gastroenterol. 2015;21(34):10018–24.CrossRefGoogle Scholar
  8. 8.
    Joshi R, Singh A, Jajoo N, Pai M, Kalantri SP. Accuracy and reliability of palpation and percussion for detecting hepatomegaly: a rural hospital-based study. Indian J Gastroenterol. 2004;23(5):171–4.PubMedGoogle Scholar
  9. 9.
    Moll van Charante E, de Jongh TO. Physical examination of patients with acute abdominal pain. Ned tijdschr Geneeskd. 2011;155:A2658.PubMedGoogle Scholar
  10. 10.
    Mills LD, Mills T, Foster B. Association of clinical and laboratory variables with ultrasound findings in right upper quadrant abdominal pain. South Med J. 2005;98(2):155–61.CrossRefGoogle Scholar
  11. 11.
    Avegno J, Carlisle M. Evaluating the patient with right upper quadrant abdominal pain. Emerg Med Clin North Am. 2016;34(2):211–28.CrossRefGoogle Scholar
  12. 12.
    Wagner James M, McKinney W, Paul C, John L. Does this patient have appendicitis? JAMA. 1996;276:1589–94.CrossRefGoogle Scholar
  13. 13.
    Bala M, Kashuk J, Moore EE, et al. Acute mesenteric ischemia: guidelines of the world Society of Emergency Surgery. World J Emerg Surg. 2017;12:38.CrossRefGoogle Scholar
  14. 14.
    Feingold D, Steele S, Lee S, Kaiser A, Boushey R, Buie D, Rafferty J. Practice parameters for the treatment of sigmoid diverticulitis. Dis Colon Rectum. 2014;57:284–94.CrossRefGoogle Scholar
  15. 15.
    Toorenvliet BR, Bakker RF, Breslau PJ, et al. Colonic diverticulitis: a prospective analysis of diagnostic accuracy and clinical decision making. Color Dis. 2009;12:179–187.CrossRefGoogle Scholar
  16. 16.
    Andersson RE. Meta-analysis of the clinical and laboratory diagnosis of appendicitis. Br J Surg. 2004;91:28–37.CrossRefGoogle Scholar
  17. 17.
    Paulson Erik K, Thompson WM. Review of small-bowel obstruction: the diagnosis and when to worry. Radiology. 2015;275(2):332–42.CrossRefGoogle Scholar
  18. 18.
    Graff L, Radford MJ, Werne C. Probability of appendicitis before and after observation. Ann Emerg Med. 1991;20(5):503–7.CrossRefGoogle Scholar
  19. 19.
    LoVecchio F, Oster N, Sturmann K, Nelson LS, et al. The use of analgesics in patients with acute abdominal pain. J Emerg Med. 1997;15(6):775–9.CrossRefGoogle Scholar
  20. 20.
    Manterola C, Vial M, Moraga J, Astudillo P. Analgesia in patients with acute abdominal pain. Cochrane Database Syst Rev. 2011;1:CD005660.Google Scholar
  21. 21.
    Gallagher EJ, et al. Randomized clinical trial of morphine in acute abdominal pain. Ann Emerg Med. 2006;48(2):150–60.CrossRefGoogle Scholar
  22. 22.
    Onur OE, et al. Outpatient follow-up or “Active clinical observation” in patients with nonspecific abdominal pain in the Emergency Department. A randomized clinical trial. Minerva Chir. 2008;63(1):9–15.PubMedGoogle Scholar

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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Emergency MedicineMcGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth)HoustonUSA

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