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An ER Doctor's Diagnosis: Severe Stomach Pain

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An ER Doctor's Diagnosis: Severe Stomach Pain

May 22, 2018

Have an extreme pain or discomfort in your stomach? Has it lasted longer than five minutes? Many sufferers avoid going to the emergency room for fear they’ll just be told it’s nothing and then sent home. As a follow-up to “ER or Not: Severe Stomach Pain,” emergency physician Dr. Troy Madsen takes us step-by-step through what physicians do when a patient with abdominal pain comes into the ER and what signs you can look for at home when deciding whether to go to the hospital.

Episode Transcript

Interviewer: What will an emergency room physician do if you have a severe stomachache? Can you go into the ER? That's next on The Scope.

Announcer: This is "From the Front Lines" with emergency room physician, Dr. Troy Madsen, on The Scope.

Interviewer: One of our most popular pieces on is "I have a severe stomachache, ER or not?" And in that particular episode, we were told that if you have a severe stomachache, you should go to the ER and have a look at because it could be a couple of things. One of the comments on that is what do emergency room doctors do if you go in with a bad stomachache? Dr. Troy Madsen is an emergency room physician at University of Utah Health. Bad stomachache somebody comes in, what do you start doing?

When Should You Go to the Hospital for Stomach Pain?

Dr. Madsen: This is a really great question because you may think to yourself, "Okay, my stomach hurts. I'm going to go to the ER and they're going to look at me and say, 'Why are you here?' They're going to send me home."

So the first thing I'm going to do of course is find out more about the stomachache, when did it start, where does it hurt. Have there been any other symptoms with it like fever or any pain elsewhere, nausea, vomiting, diarrhea, pain with urination, any blood in the urine or in the stool. So these are all kind of things I'm doing to try and figure out, "Okay, what could be causing this sort of pain?"

The next thing often that I'm doing is, not often always, is a physical examination. So I'm examining this person trying to push on their abdomen and I really focus on certain areas because these areas will make me think of different things. If I push on the right lower side of their abdomen and it hurts, I'm thinking of appendicitis.

On the right upper side I'm thinking of the gallbladder, maybe a gallstone or an infection there. Just in the upper part of the abdomen, just kind of down below the ribs there where you feel a little notch that little bone there. Thinking about the pancreas there. It could be causing some symptoms.

And then in the left lower side of the abdomen. In older people you can have an infection in the intestines there called diverticulitis, that often causes pain there. So those are some of the things that are going through my mind as I'm pushing around saying, "Hey, does it hurt here? If I let go, does it hurt worst when I let go?" That can be a sign of a more severe infection. Is the pain just everywhere or does it really localize to one spot?

IV Fluids, Pain Treatment, Blood Tests, & Imaging Tests

Typically in the ER, you'll get an IV. We'll put an IV in, which is giving you medications. So if you're having severe pain we'll give you a pain medication. If you're having nausea we'll treat that. Often times we're giving fluid for dehydration, especially if a person has been vomiting a lot, "I've had a lot of diarrhea." And then I'm thinking about testing. What do I need to do to figure this out?

In some cases someone may come in, I may push on their abdomen and in doing that I pretty much have an idea of what's going on, but those cases are rare. A lot of times with abdominal pain we are sending tests and so typically there I'm doing blood work, looking at their white blood cell count, that's going to show me signs of infection.

Also, looking at their liver function test to see if there's anything there that suggests a liver problem. Look at something called the lipase, which is something that they have an issue in the pancreas. I'm going to see things that are abnormal there. Looking at the kidneys, electrolytes. So all sorts of different blood tests.

And then beyond that I may do an ultrasound, an ultrasound to look at the gallbladder. Maybe we end up getting a CT scan to look at the appendix or the other organs in the abdomen. So it's going to be more testing guided by where this person hurts.

There may be cases where we do an examination, push on the abdomen and we don't have to do tests. Maybe we'd say, probably gastroenteritis, probably a virus or something like that. But often times we are doing some sort of testing in the ER.

Interviewer: So a lot of the times it sounds like it's a very complicated thing. That's even difficult for a physician to figure out what the real problem is?

Dr. Madsen: It really is and this is one of the most common things we see in the ER is abdominal pain. So you've always got to be thinking of all these different things. There's really not just a certain way we go about it. We're going to be guiding that by how their symptoms started, where they hurt, but typically it does involve some blood work, may involve an ultrasound, maybe a CAT scan. Trying to sort through this and rule out the bad stuff to see what's going on.

Interviewer: To most people that come in, have a pretty good sense of the difference between kind of regular stomach pain that might be caused from something they ate or a gas bubble and one of these issues you've talk about?

Dr. Madsen: It's tough. At the end of the day the large majority of the time we send people home saying, "We're not finding anything really serious. It's probably something you ate, probably a virus or a gas bubble or something." So it is really tough for an individual to tease that out and so I can't say that most people really are sure exactly what's going on.

Interviewer: If the pain subsides after five minutes or so, would you recommend somebody still going to the ER? Is it that more pain that lasts longer that should worry somebody or not really?

Dr. Madsen: Yeah, I think probably pain that lasts longer and it depends on the individual and what other medical issues they might have. But typically if it's something that comes on and goes away, you can watch it, see what happens, see if things come back if they get worse. Most things that are serious, in pretty much all cases if it's going to be something that's really significant, it's going to get worse. It's not just going to come on and then go away and then you feel fine.

Interviewer: But it sounds like that it can be a difficult thing to figure out and if in doubt, really you should go see somebody.

Dr. Madsen: Sure, absolutely. Have someone at least take a look at you, examine you, see where you hurt. Get a better sense of what's going on.

Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there’s a pretty good chance you’ll find what you want to know. Check it out at

updated: May 22, 2018
originally published: April 22, 2016