Further diagnostic procedures for abdominal pain will often include an instrumental examination of the rectum and lower bowel to directly visualize the bowel lining (proctoscopy and sigmoidoscopy), x-rays. and various laboratory tests. A white blood cell count (WBC) may help reveal an inflammatory disease, while a urinalysis may help spot (or rule out) renal disease or diabetes, as well as provide a clue to the body’s general state of water balance. Tests to determine blood sugar, blood urea nitrogen (BUN), serum bilirubin, and serum amylase levels may also be employed.
In some cases in which a patient complains of acute pain and there is an obvious and excessive accumulation of fluid in the abdomen (as determined by physical examination or x-ray), the abdominal paracentesis may be performed. This procedure involves inserting a needle into the abdomen for the purpose of extracting some of the fluid for analysis. The results of many of the above tests usually cannot be given to the patient immediately but must await laboratory processing and interpretation by the physician.
Despite the increasing sophistication of diagnostic tools, it is nevertheless true that physical examination, x-rays, and laboratory tests may sometimes fail to provide a conclusive diagnosis. This is because the condition of some internal organs cannot be readily determined by external examination or even by x-ray, and laboratory tests may often point to more than one possible cause of illness. If a patient has a “medical” abdomen—one that can probably be treated by medical, rather than surgical means—the physician may begin a course of therapy designed either to correct an assumed disorder or eliminate it as a probable cause of illness.
What should a doctor focus on?
If the patient does not respond to the treatment, the physician can then focus upon another possible cause. In the case of an acute, surgical abdomen, however—where there are the severe or incapacitating pain and an obviously critical malfunction in the body—the decision may be made to operate even before the cause of illness has actually been determined. This course may be taken when the surgeon feels that he may be able to uncover the problem once he can actually see the affected organ or organs, or when the patient’s condition is so severe that there is simply no choice but to operate if the patient’s life is to be safeguarded.
In either case, the presumption is that the exploratory operation will enable the surgeon to diagnose the condition and, hopefully. to correct it, either in the same operation or in a succeeding one. Of course, there is no guarantee that this procedure will either positively identify the illness or cure it, but the chances of success are usually good. Exceptions are cases in which there may be some long-term and often fatal disease involved, such as cancer.