Why can diagnosis of the cause of abdominal pain be difficult?

Modern advances in technology have greatly improved the accuracy, speed, and ease of establishing the cause of abdominal pain, but significant challenges remain. There are many reasons why diagnosing the cause of abdominal pain can be difficult. They are:

• Symptoms may be atypical. For example, the pain of appendicitis sometimes is located in the right upper abdomen, and the pain of diverticulitis is on the right side. Elderly patients and patients taking corticosteroids may have little or no pain and tenderness when there is inflammation, for example, with cholecystitis or diverticulitis. This occurs because corticosteroids reduce the inflammation.

• Tests are not always abnormal.
  
  
  • Ultrasound examinations can miss gallstones, particularly small ones.
    
  • CT scans may fail to show pancreatic cancer, particularly small ones.
    
  • The KUB can miss the signs of intestinal obstruction or stomach perforation.
    
  • Ultrasounds and CT scans may fail to demonstrate appendicitis or even abscesses, particularly if the abscesses are small.
    
  • The CBC and other blood tests may be normal despite severe infection or inflammation, particularly in patients receiving corticosteroids.

• Diseases can mimic one another.
  
  • IBS symptoms can mimic bowel obstruction, cancer, ulcer, gallbladder attacks, or even appendicitis.
    
  • Crohn's disease can mimic appendicitis.
    
  • Infection of the right kidney can mimic acute cholecystitis.
    
  • A ruptured right ovarian cyst can mimic appendicitis; while a ruptured left ovarian cyst can mimic diverticulitis.
    
  • Kidney stones can mimic appendicitis or diverticulitis.

• The characteristics of the pain may change. Examples discussed previously include the extension of the inflammation of pancreatitis to involve the entire abdomen and the progression of biliary colic to cholecystitis.