Acute abdominal pain in adults seen in the community: which tests before referral?

Gastroenterology and hepatology · Symptom or situation · updated 2026-10-31

BioMG follows French guidelines. Adapt it to the guidelines and the tests available where you practise.

Frequency: In France, non-traumatic abdominal pain accounts for 5 to 10% of reasons for attending emergency departments (old data, 2001) ^[1].

Adult seen in the community, without severity signs

Haemodynamic instability, guarding or rigidity, worrying pain or bleeding in a woman of childbearing potential: emergency department without waiting for tests.

Laboratory tests (depending on the clinical hypothesis)

Serum β-hCG (woman of childbearing potential; failing that, urine test in the practice)if needednon-French guidelineAny woman of childbearing potential, even if symptoms are non-specific and with no risk factor for ectopic pregnancy ^[2].
Serum lipase (pain suggestive of pancreatitis)if neededPain compatible with acute pancreatitis: diagnosis if lipase > 3 times normal ^[3]. Lipase alone, without amylase ^[3,4].
FBCif needednon-French guidelineAid to the diagnosis of appendicitis, without a firm recommendation in adults; routine in pregnant women and in children ^[5].
CRP (suspected appendicitis or intra-abdominal infection)if needednon-French guidelineAid to the diagnosis of appendicitis, without a firm recommendation in adults; routine in pregnant women and in children ^[5].
ASTif needednon-French guidelineLooking for a biliary origin (obstruction) in acute pancreatitis ^[3]; right upper quadrant pain: see the page "Biliary colic".
ALTif needednon-French guidelineLooking for a biliary origin (obstruction) in acute pancreatitis ^[3]; right upper quadrant pain: see the page "Biliary colic".
GGTif needednon-French guidelineLooking for a biliary origin (obstruction) in acute pancreatitis ^[3]; right upper quadrant pain: see the page "Biliary colic".
Alkaline phosphataseif needednon-French guidelineLooking for a biliary origin (obstruction) in acute pancreatitis ^[3]; right upper quadrant pain: see the page "Biliary colic".
Bilirubin (right upper quadrant pain or pancreatitis)if needednon-French guidelineLooking for a biliary origin (obstruction) in acute pancreatitis ^[3]; right upper quadrant pain: see the page "Biliary colic".
Urine dipstick (urinary signs)if needednon-French guidelineUrinary signs: pointer to urinary tract infection or renal colic (see these pages); in a woman of childbearing potential, urinary symptoms can also accompany an ectopic pregnancy ^[2].

Detailed explanation and international comparison (in French): read it in English (machine translation)

Do not order

Amylase: not indicated when acute pancreatitis is suspected, the laboratory substitutes lipase ^[4]; lipase is a more reliable marker ^[3]
Laboratory tests that delay referral of an unstable patient or one whose pain or bleeding is worrying: refer directly to the emergency department ^[2]

Sources (8)