Acute assessment of abdominal pain

A medical consult is recommended where there is no specific protocol for a condition

Always consider Sepsis — signs and symptoms can include

High or low temperature
Fast breathing
Fast pulse
Low BP or dizziness
Confusion and/or agitation

Red Flags — Urgent Medical Consult
Severe pain with tenderness or guarding Pain goes through to back Strong point of pain when coughing — peritonitis Blood in faeces, melaena (black faeces) Large amount of blood in vomit Mass (lump) especially pulsating (throbbing) mass Over 55 years old — consider ruptured abdominal aortic aneurism

Check

Calculate age-appropriate REWS

Adult — AVPU, RR, O₂ sats, pulse, BP, Temp
Child (less than 13 years) — AVPU, respiratory distress, RR, O₂ sats, pulse, central capillary refill time, Temp

Weight, BGL

If REWS score 3 or more — medical consult straight away
If available POC Test — WBC, electrolytes
U/A, pregnancy test
History and head-to-toe exam — abdominal pain assessment

Do

If severe pain and systolic BP greater than 100 — give pain relief prior to abdominal palpation

Table 1.14 Possible causes of abdominal pain

Location of pain	Signs and Symptoms	Possible Cause
Upper abdominal or epigastric pain	Nausea, short of breath, cool and sweaty	Heart attack
	Severe pain, tenderness below breastbone	Pancreatitis — medical consult
	Pain radiates to back or shoulder tip, vomiting blood or passing black faeces	Bleeding ulcer — medical consult
	Abdomen soft, mild tenderness	Gastritis, reflux or indigestion
Right upper quadrant pain	Nausea, short of breath, cool and sweaty	Heart attack
	Pain in waves, right-sided or central, may go through to back	Gall bladder disease
	Fever, usually cough, pain with breathing	Pneumonia
	Unwell, no appetite, dark urine	Hepatitis
Lower abdominal pain	Central to right lower pain, nausea and vomiting	Appendicitis
	Usually one side of groin, tender painful swelling	Strangulated or stuck hernia — medical consult
	Childbearing age, vaginal bleeding Early ectopic pregnancy or miscarriage may still occur with a negative pregnancy test	Ectopic pregnancy Miscarriage
	Fever, nausea, painful sex, common in non-pregnant women aged 15–35 years	Pelvic Inflammatory Disease
	Swollen painful testicle	Twisted testicle Testicular Pain
	Burning when passing urine, no fever	Bladder infection
	Crampy pain, not unwell	Constipation
	Pain in waves, right-sided or central, may go through to back	Gall bladder disease
	Older person, pain more on left side	Diverticulitis — medical consult
Generalised abdominal pain	Very unwell, severe pain, guarding, rigidity	Generalised peritonitis — medical consult
	Usually older person with high BP, very pale, fast pulse, falling BP, fast breathing	Ruptured abdominal aortic aneurysm
	Usually older person with AF, severe pain, soft abdomen	Intestinal ischaemia — medical consult
	Nausea and vomiting, crampy pain, diarrhoea	Gastroenteritis
	Nausea and vomiting, diarrhoea then nothing	Bowel obstruction
	Crampy pain, not unwell	Constipation
One-sided (flank/loin) pain	Mild to severe flank pain (may be both sides), unwell, fever, fast pulse	Kidney infection (pyelonephritis)
One-sided (flank/loin) pain	Severe one-sided pain, vomiting, no fever, blood in urine	Renal colic (kidney stone)