Division of Gastroenterology and the Medically Associated Science and Technology (MAST) Program, Cedars-Sinai, Los Angeles, CA.
Am J Gastroenterol. 2019 May;114(5):726-732. doi: 10.14309/ajg.0000000000000130.
Abdominal pain is a common reason for referral to a gastroenterologist. The workup of patients with chronic abdominal pain can be extremely challenging as clinicians are responsible for determining whether the patient can be observed or treated symptomatically or this abdominal pain heralds a more systemic disease. The differential is typically wide and given the innervation of the abdomen, localization of abdominal pain does not always provide clear insight into the etiology. This review attempts to help the gastroenterologist narrow down that broad differential and focus on key elements of the patient visit. We emphasize the importance of a detailed history from the patient, along with review-specific details of their history and physical examination that can clue one in about the etiology of the abdominal pain. We review the causes of diffuse abdominal pain that may not first be considered along with uncommon causes of localized abdominal pain. We also review the functional causes of abdominal pain and the importance of identifying these disorders, to avoid unnecessary testing that commonly occurs with these patients.
腹痛是转介至胃肠病学家的常见原因。由于临床医生负责确定患者是可以观察或对症治疗，还是这种腹痛预示着更系统性的疾病，因此慢性腹痛患者的评估极具挑战性。鉴别诊断通常非常广泛，而且由于腹部的神经支配，腹痛的定位并不总能清楚地提示病因。本综述试图帮助胃肠病学家缩小该广泛鉴别诊断范围，并关注患者就诊的关键要素。我们强调详细询问患者病史的重要性，以及病史和体格检查中与腹痛病因相关的特定细节。我们回顾了可能最初未考虑的弥漫性腹痛的原因以及少见的局限性腹痛的原因。我们还回顾了腹痛的功能性原因，以及识别这些疾病的重要性，以避免对这些患者进行常见的不必要检查。
