ACUTE ABDOMINAL PAIN

ASSESSMENT

See Acute abdomen Assessment Form (printable form)

See Diagnosing abdominal pain - Simple rules

CLINICAL FEATURES OF SERIOUS PATHOLOGY

Voluntary Guarding Involuntary guarding
Pathophysiology Voluntary contraction of abdominal muscles in response to pain or anxiety Increased muscle tone due to irritation of parietal peritoneum
Relieved with pillow under feet/back Yes No
Relieved with distraction Yes No
Relieved with analgesia Yes No
Relieved with distraction Yes No
Relieved with deep inspiration Yes No

COMMON TRAPS

INVESTIGATIONS

Should be selective according to the suspected pathology
(e.g. do not do a FBC, EUC/LFT, AXR on every person with abdominal pain!)

INVESTIGATION INDICATION
HB GI blood loss
Ectopic pregnancy
Ruptured AAA
WCC Fever, Localizing tenderness
EUC Protracted diarrhoea/Vomiting
(not for simple gastroenteritis)
Bowel obstruction
Renal colic
LFT Hepato-biliary disease
Amylase Biliary colic
Pancreatitis
CK/Phosphate Ischaemic bowel
Calcium/Urate Renal colic
Pancreatitis (Ca++ for Ranson's criteria)
ABG Shock
Sepsis
Ischaemic bowel

IMAGING

IMAGING MODALITY

INDICATION

CXR Perforated viscus
Pancreatitis (Ranson's criteria)
AXR Bowel obstruction
Upper abdominal Ultrasound
Biliary Colic
Cholecystitis
Pelvic Ultrasound Ectopic pregnancy (if stable)
Ovarian torsion
Ovarian cyst rupture
CT abdomen AAA (if stable)
Renal calculi
Intrabdominal collection/abscess

 

INDICATIONS FOR URGENT LAPAROTOMY

DISPOSAL

Indications for admission

Other considerations:

Discharge Criteria