Non-surgical Causes of Abdominal Pain

It is important to remember that both medical and gynaecological problems may present with abdominal pain. The following are non-surgical causes of abdominal pain:

Acute myocardial infarction (MI)

Consider based on history. If in any doubt obtain an ECG. MI (especially inferior MI) can present with minimal or even no chest pain.

Diabetic ketoacidosis (DKA)

A history of diabetes with possibly some prodromal infective symptoms and vomiting may be clues, but a bedside glucose should always be taken and followed up with serum/urinary ketones and arterial blood gas.
To complicate matters further it is important to remember that some abdominal pathology may be the initiating factor in DKA.


This can present with abdominal pain, either non-specific generalised pain or related to renal colic.
Other features may be present, including vomiting, weight loss, change in bowel habit and anorexia.
Check serum calcium and albumin levels (remember to correct calcium for hypoalbuminaemia).


This may present as non-specific upper abdominal pain. Vomiting may be a feature and respiratory symptoms may be minimal. Be alert to unexpected hypoxia and obtain a chest x-ray (CXR).

Inflammatory bowel disease

This straddles the distinction between a surgical and a medical condition.
It may present with abdominal pain during acute flare but can also present due to perforation or obstruction.
A previous or prodromal history may be present but may be short in a new diagnosis.

Urinary tract infection (UTI)

Usually presents with lower abdominal pain but may radiate into the flanks or be primarily located in one renal angle in pyelonephritis.
Departmental dipstick analysis may give a clue, but if suspicious send for urgent gram stain.

Learning bite

Maintain a high index of suspicion for medical conditions that can cause abdominal pain.