Claudia Machado Cooke, MD, FACP, MPH  |  Health Through Understanding

Abdominal Pain

A thorough history and a careful and detailed physical examination are of primary importance in the evaluation of abdominal pain, with well selected diagnostic tests to complement these.  As with chest pain, or headache or shortness of breath, the patient’s story is primary, physical examination secondary, with clinical testing providing the factual data. Each aspect of the examination is equally vital.

Dr. Cooke still has her well-worn copy of one of the cornerstone medical texts on the evaluation of abdominal pain, “Cope’s Diagnosis of the Acute Abdomen”. Years spent in the emergency room helped to hone her diagnostic acumen. Abdominal pain presents a particularly broad differential diagnosis due to causes ranging from the benign to the sublime to the catastrophic.

From time to time, Dr. Cooke receives patients who come with an expectation that only alternative therapy will be offered. One woman came several years ago, not having seen a physician in many years, with a complaint of several days of abdominal pain. Within 20 minutes of questioning, Dr. Cooke was quite certain that her symptoms suggested appendicitis, although her physical exam was in no way typical for appendicitis. Delicately, she expressed her suspicion to the patient and the patient’s husband. She contacted the emergency room, transmitted her assessment, and gave recommendations for further evaluation. The lack of physical findings postponed diagnosis in the ER. Fortunately, by the time the patient’s exam evolved, the surgeons were able to remove the diseased appendix. That patient, now the proud owner of a Bikram yoga center in Minnesota with her husband, still maintains contact with Dr. Cooke.

Sometimes the doctor’s most challenging task is to convince a patient or their family of the value of conventional diagnostic or therapeutic procedures. Dr. Cooke strives for a balanced approach, bridging the interface between the conventional and the complementary.