{"id":538,"date":"2016-08-14T13:00:46","date_gmt":"2016-08-14T13:00:46","guid":{"rendered":"http:\/\/emedsa.org.au\/CoreMed\/?p=538"},"modified":"2016-08-16T15:15:58","modified_gmt":"2016-08-16T15:15:58","slug":"abdominal-pain-assessment","status":"publish","type":"post","link":"http:\/\/emedsa.org.au\/CoreMed\/2016\/08\/14\/abdominal-pain-assessment\/","title":{"rendered":"Abdominal Pain &#8211; Assessment"},"content":{"rendered":"<p><a href=\"http:\/\/twitter.com\/share?url=http%3A%2F%2Femedsa.org.au%2FCoreMed%2F2016%2F08%2F14%2Fabdominal-pain-assessment%2F&amp;count=none&amp;text=Abdominal Pain - Assessment - CoreMed\" class=\"twitter-share-button\">Tweet<\/a><\/p><h1 align=\"left\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full wp-image-593 aligncenter\" src=\"http:\/\/emedsa.org.au\/CoreMed\/wp-content\/uploads\/2016\/08\/Abdomen-e1471180650697.jpg\" alt=\"Abdomen\" width=\"414\" height=\"335\" srcset=\"http:\/\/emedsa.org.au\/CoreMed\/wp-content\/uploads\/2016\/08\/Abdomen-e1471180650697.jpg 414w, http:\/\/emedsa.org.au\/CoreMed\/wp-content\/uploads\/2016\/08\/Abdomen-e1471180650697-300x243.jpg 300w\" sizes=\"auto, (max-width: 414px) 100vw, 414px\" \/><\/h1>\n<h1 align=\"left\">ACUTE ABDOMINAL PAIN<\/h1>\n<ul>\n<li><a href=\"http:\/\/emedsa.org.au\/EDHandbook\/anaesthetics\/IVOpiates.htm\">Analgesia<\/a>\u00a0early \u00a0in assessment usually improves the accuracy of abdominal findings<\/li>\n<li>Early IV access, surgical opinion, fluid resuscitation prior to completing assessment if patient is <a href=\"http:\/\/emedsa.org.au\/CoreMed\/2016\/07\/26\/shock-a-practical-approach\/\">shocked<\/a><\/li>\n<li>don&#8217;t just focus on the abdomen <em>e.g.\u00a0\u00a0cardiothoracic conditions in <\/em><strong>upper abdominal pain <\/strong><em>such as acute MI, oesophageal rupture, pneumonia; or testicular pathology<\/em> in <strong>lower abdominal pain<\/strong><\/li>\n<li>beware of ischaemic bowel where pain is out of proportion to abdominal findings<\/li>\n<li>recurrent bouts of abdominal pain can be diagnostically challenging after standard investigation<em> e.g. lead poisoning, porphyria<\/em><\/li>\n<li>in puzzling cases consider acute medical causes of abdominal pain <em>e.g. DKA<\/em><\/li>\n<\/ul>\n<h2>ASSESSMENT<\/h2>\n<ul>\n<ul>\n<li>There are many causes for acute abdominal pain so it important to follow the <a href=\"http:\/\/emedsa.org.au\/CoreMed\/2016\/08\/01\/the-patient-consultation\/\">Principles of a Systematic Assessment<\/a><\/li>\n<li>Classic presentations do occur but there often are atypical features and specific pattern recognition is not useful<\/li>\n<li>Focus on the <a href=\"http:\/\/emedsa.org.au\/CoreMed\/2016\/08\/14\/abdominal-pain-chronology\/\">chronology<\/a> which gives an indication of\u00a0<a href=\"http:\/\/emedsa.org.au\/CoreMed\/2016\/07\/23\/emergency-presentations-common-causes\/\">urgency<\/a>\u00a0alongside\u00a0<a href=\"http:\/\/emedsa.org.au\/CoreMed\/2016\/08\/12\/abdominal-pain-anatomy\/\">location <\/a>and <a href=\"http:\/\/emedsa.org.au\/CoreMed\/2016\/08\/12\/abdominal-pain-character\/\">character<\/a> of pain. \u00a0This and the <a href=\"http:\/\/emedsa.org.au\/CoreMed\/2016\/08\/12\/abdominal-pain-assessment-review-of-systems\/\">associated symptoms<\/a> greatly assists at narrowing down the possibities to the likely culprit organ, the pathological process and best investigative strategy<\/li>\n<li>Beware of <a href=\"http:\/\/emedsa.org.au\/CoreMed\/2016\/08\/14\/abdominal-pain-chronology\/\">abrupt or rapid onset<\/a> of severe abdominal pain<\/li>\n<li>Consider <a href=\"http:\/\/emedsa.org.au\/CoreMed\/2016\/08\/12\/abdominal-pain-anatomy\/\">non intra-abdominal causes<\/a> of abdominal pain<\/li>\n<li>Review <em>risk factors for disease<\/em> &#8211; previous surgical intervention, family history, alcohol use, smoking, NSAID use<\/li>\n<li>Briefly review <a href=\"http:\/\/emedsa.org.au\/CoreMed\/2016\/08\/12\/peri-operative-assessment\/\">anaesthetic \/ Peri-operative risk <\/a>\u00a0<em>e.g.\u00a0current physiological status cardio-respiratory co-morbidities, previous anaesthetics, anticogulant use, fasting status<\/em><\/li>\n<\/ul>\n<\/ul>\n<p>See\u00a0<a href=\"http:\/\/emedsa.org.au\/DocumentationForms\/AbdoPainChecklist.htm\">Acute abdomen Assessment Form<\/a>\u00a0(printable form)<\/p>\n<p><strong>Examination<\/strong><\/p>\n<ul>\n<li>Abnormal vital signs give clues to serious pathology <em>e.g. sepsis, third-spacing, internal haemorrhage<\/em><\/li>\n<li>Evaluate hydration<\/li>\n<li>Identify <a href=\"http:\/\/emedsa.org.au\/CoreMed\/2016\/08\/13\/abdominal-examination-peritonism\/\">signs of peritonism<\/a><\/li>\n<\/ul>\n<h3>COMMON TRAPS<\/h3>\n<ul>\n<li>Constipation should not be considered a diagnosis before it is a considered a symptom (of something serious)<\/li>\n<li>Diagnosing renal colic in a AAA<\/li>\n<li>Ignoring the vital signs<\/li>\n<li>Severe abdominal pain without abdominal findings = ischaemic bowel<\/li>\n<\/ul>\n<h2>INVESTIGATIONS<\/h2>\n<p>Depending on clinical assessment, severity of symptoms and likelihood of acute pathology<\/p>\n<p>For more than mild symptoms in non-specific abdominal pain.<\/p>\n<ul>\n<li>Full blood Count<\/li>\n<li>Electrolyte and renal function<\/li>\n<li>Urinalysis (most patients)<\/li>\n<li>BHCG (if fertile woman regardless of contraceptive or sexual history)<\/li>\n<li>ECG (in upper abdominal pain without abdominal findings)<\/li>\n<\/ul>\n<p>Otherwise <a href=\"http:\/\/emedsa.org.au\/CoreMed\/2016\/08\/14\/abdominal-pain-investigation\/\">investigations should be selective<\/a> according to the suspected pathology<\/p>\n<h3>High patient risk groups<\/h3>\n<p>Examination unreliable<\/p>\n<ul>\n<li>Elderly and children<\/li>\n<li>Intellectually disabled<\/li>\n<li>Spinal patients<\/li>\n<li><a href=\"http:\/\/emedsa.org.au\/CoreMed\/2016\/07\/23\/immunocompromise\/\">Immuno-compromise<\/a><\/li>\n<\/ul>\n<p>Persistent or recurrent symptoms<\/p>\n<ul>\n<li>&#8216;Second presentation&#8217;<\/li>\n<li>&#8216;Came in the middle of the night&#8217;<\/li>\n<\/ul>\n<h3>DISPOSITION<\/h3>\n<p style=\"text-align: left;\">Immediate surgical consultation (may need urgent laparotomy \u00a0without further imaging)<\/p>\n<ul style=\"text-align: left;\">\n<li>Severe bleeding<\/li>\n<li>Hypotension<\/li>\n<li>Severe metabolic acidosis<\/li>\n<\/ul>\n<p style=\"text-align: left;\">Indications for admission<\/p>\n<ul style=\"text-align: left;\">\n<li>Active GI bleeding<\/li>\n<li>Bilious vomiting<\/li>\n<li>Abnormal vital signs<\/li>\n<li>Elevated inflammatory markers<\/li>\n<li>Abnormal acid-base or elevated lactate<\/li>\n<li>Peritonism<\/li>\n<li>Free fluid, free gas or signs of obstruction on abdominal imaging<\/li>\n<li>Ongoing pain in high-risk patients<\/li>\n<\/ul>\n<p style=\"text-align: left;\">Discharge Criteria<\/p>\n<ul>\n<li style=\"text-align: left;\">Uncomplicated infection e.g. UTI, gastroenteritis<\/li>\n<li style=\"text-align: left;\">Mild pain<\/li>\n<li style=\"text-align: left;\">Tolerating fluids\/Not vomiting<\/li>\n<li style=\"text-align: left;\">Afebrile<\/li>\n<li style=\"text-align: left;\">Not tachycardic<\/li>\n<li style=\"text-align: left;\">No peritonism<\/li>\n<li style=\"text-align: left;\">Investigations normal<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Tweet ACUTE ABDOMINAL PAIN Analgesia\u00a0early \u00a0in assessment usually improves the accuracy of abdominal findings Early IV access, surgical opinion, fluid resuscitation prior to completing assessment if patient is shocked don&#8217;t&#8230; <a href=\"http:\/\/emedsa.org.au\/CoreMed\/2016\/08\/14\/abdominal-pain-assessment\/\">Read more &raquo;<\/a><\/p>\n","protected":false},"author":1,"featured_media":593,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"episode_type":"","audio_file":"","cover_image":"","cover_image_id":"","duration":"","filesize":"","date_recorded":"","explicit":"","block":"","filesize_raw":"","footnotes":""},"categories":[1],"tags":[],"class_list":["post-538","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-uncategorized"],"_links":{"self":[{"href":"http:\/\/emedsa.org.au\/CoreMed\/wp-json\/wp\/v2\/posts\/538","targetHints":{"allow":["GET"]}}],"collection":[{"href":"http:\/\/emedsa.org.au\/CoreMed\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/emedsa.org.au\/CoreMed\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/emedsa.org.au\/CoreMed\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/emedsa.org.au\/CoreMed\/wp-json\/wp\/v2\/comments?post=538"}],"version-history":[{"count":15,"href":"http:\/\/emedsa.org.au\/CoreMed\/wp-json\/wp\/v2\/posts\/538\/revisions"}],"predecessor-version":[{"id":599,"href":"http:\/\/emedsa.org.au\/CoreMed\/wp-json\/wp\/v2\/posts\/538\/revisions\/599"}],"wp:featuredmedia":[{"embeddable":true,"href":"http:\/\/emedsa.org.au\/CoreMed\/wp-json\/wp\/v2\/media\/593"}],"wp:attachment":[{"href":"http:\/\/emedsa.org.au\/CoreMed\/wp-json\/wp\/v2\/media?parent=538"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/emedsa.org.au\/CoreMed\/wp-json\/wp\/v2\/categories?post=538"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/emedsa.org.au\/CoreMed\/wp-json\/wp\/v2\/tags?post=538"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}