Problem refinement

Pain originating from the abdomen is a symptom of many conditions that is not only restricted to the GI tract but can also be associated with the cardiovascular and musculoskeletal systems. However, it seems reasonable to start the process of differential diagnosis by considering those conditions emanating from the GI tract.

GI pain is often associated with a particular structure, so knowing what structures lie in the upper abdomen will help to narrow down the number of conditions that need to be considered. For example, pain caused by IBS or diverticulitis present with lower abdominal pain, so these can be eliminated from your thinking.

If we consider upper abdominal structures (and consequently conditions) we are primarily dealing with the liver, gall bladder, spleen, stomach and pancreas. Based on prevalence, conditions affecting the stomach – dyspepsia, GORD and peptic ulcers – will be most frequently seen by community pharmacists, and as such should be the starting point in the diagnostic process.