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The first step in evaluating a patient with severe abdominal pain involves obtaining a detailed history and performing a physical examination. This foundational step allows the healthcare provider to gather critical information about the patient's symptoms, medical history, and potential red flags that may indicate the cause of the abdominal pain.

A thorough history can reveal the onset, duration, location, and character of the pain, as well as associated symptoms such as nausea, vomiting, diarrhea, or changes in bowel habits. Understanding the patient’s medical history, including any previous abdominal surgeries, chronic conditions, and medications, can also guide the assessment.

Performing a physical examination is equally important as it helps identify signs of distress, tenderness, guarding, rebound tenderness, or any abdominal masses. The examination can provide immediate insights into potential causes of the pain, such as appendicitis, cholecystitis, or perforation, and guide further diagnostic and therapeutic interventions.

Without this critical information from history taking and physical assessment, decisions regarding pain management, imaging studies, or intravenous fluids might not adequately address the underlying issue or could risk delaying appropriate treatment for serious conditions. Therefore, this step is essential in forming a clear clinical picture before progressing to additional interventions or diagnostics.