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    Acute Abdominal Pain: Step-By-Step Assessment

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    zafar_18325
    This document provides guidance on assessing and managing patients presenting with acute abdominal pain. It details steps to exclude potentially life-threatening causes like abdominal aortic aneurysms. It recommends checking for signs of kidney infection like elevated white blood cells if a kidney stone is confirmed. It also describes considering alternative diagnoses if urinalysis is negative and the patient has abdominal tenderness. The document stresses how localized pain can help diagnosis and provides guidance on further steps based on upper or lower abdominal pain location. It concludes by noting some atypical presentations of common disorders and functional causes like IBS, as well as the importance of repeated examinations over time and observation for diagnosis.

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    Acute Abdominal Pain: Step-By-Step Assessment

    Uploaded by

    zafar_18325
    37 views1 page
    This document provides guidance on assessing and managing patients presenting with acute abdominal pain. It details steps to exclude potentially life-threatening causes like abdominal aortic aneurysms. It recommends checking for signs of kidney infection like elevated white blood cells if a kidney stone is confirmed. It also describes considering alternative diagnoses if urinalysis is negative and the patient has abdominal tenderness. The document stresses how localized pain can help diagnosis and provides guidance on further steps based on upper or lower abdominal pain location. It concludes by noting some atypical presentations of common disorders and functional causes like IBS, as well as the importance of repeated examinations over time and observation for diagnosis.

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    This document provides guidance on assessing and managing patients presenting with acute abdominal pain. It details steps to exclude potentially life-threatening causes like abdominal aortic aneurysms. It recommends checking for signs of kidney infection like elevated white blood cells if a kidney stone is confirmed. It also describes considering alternative diagnoses if urinalysis is negative and the patient has abdominal tenderness. The document stresses how localized pain can help diagnosis and provides guidance on further steps based on upper or lower abdominal pain location. It concludes by noting some atypical presentations of common disorders and functional causes like IBS, as well as the importance of repeated examinations over time and observation for diagnosis.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    37 views1 page

    Acute Abdominal Pain: Step-By-Step Assessment

    Uploaded by

    zafar_18325
    This document provides guidance on assessing and managing patients presenting with acute abdominal pain. It details steps to exclude potentially life-threatening causes like abdominal aortic aneurysms. It recommends checking for signs of kidney infection like elevated white blood cells if a kidney stone is confirmed. It also describes considering alternative diagnoses if urinalysis is negative and the patient has abdominal tenderness. The document stresses how localized pain can help diagnosis and provides guidance on further steps based on upper or lower abdominal pain location. It concludes by noting some atypical presentations of common disorders and functional causes like IBS, as well as the importance of repeated examinations over time and observation for diagnosis.

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    Abdominal pain

    Acute abdominal pain: step-by-step assessment


    typically restless and unable to lie still.
    Visible or dipstick haematuria is present in
    90% of cases and vomiting is common
    during bouts of pain.
    Exclude an AAA if the patient is at high
    risk e.g. elderly male with vascular disease,
    or the presentation is atypical e.g. absence
    of haematuria/restlessness/radiation to
    groin: request an urgent USS and, if this
    confirms the presence of an AAA, arrange
    immediate surgical review. Otherwise,
    organise abdominal CT (or IVU if CT is
    not available) to confirm the presence of a
    stone.
    In patients with a confirmed stone, check
    renal function and look for features of infection proximal to the obstruction including
    an temperature/WBC/CRP or leucocytes/
    nitrites on urinalysis. If you suspect proximal infection, take urine and blood cultures, give IV antibiotics and refer urgently
    to urology.
    Suspect pyelonephritis if flank pain is
    non-colicky and associated with inflammatory features (see Box 4.1), leucocytes and
    nitrites on urine dipstick, or loin/renal
    angle tenderness lower urinary tract
    symptoms. Consider alternative diagnoses
    e.g. acute cholecystitis, appendicitis, if
    there is prominent abdominal tenderness/
    guarding or if urinalysis is negative for both
    leucocytes and nitrites. Take blood and
    urine cultures, start IV antibiotics and
    arrange prompt renal USS to exclude a
    perinephric collection or renal obstruction.
    6

    Pain localised to upper or lower abdomen?

    The localisation of pain within the abdomen


    can be very helpful in narrowing the differential diagnosis (see Figs 4.1 and 4.2).
    If the patient has predominantly RUQ,
    LUQ, epigastric or generalised upper
    abdominal pain, proceed to acute upper
    abdominal pain (p. 34).
    If the patient has RIF, LIF, suprapubic
    or bilateral lower abdominal pain,

    proceed to Acute lower abdominal pain


    (p. 38).
    7

    Consider other causes surgical review


    or further imaging if any concern

    Organise CT angiography to look for features of mesenteric ischaemia in any


    patient with severe, diffuse pain, shock
    or unexplained lactic acidosis especially
    if patients are elderly or have vascular
    disease/atrial fibrillation. The abdominal
    examination may be unremarkable until
    advanced stages.
    Consider atypical presentations of
    common disorders such as acute appendicitis or inflammatory bowel disease. A
    retrocaecal appendix may present with
    flank pain while any area of the gut may
    develop a Crohns inflammatory mass.
    Both gastroenteritis and hypercalcaemia
    may cause abdominal discomfort with conspicuous vomiting and minimal abdominal
    signs measure serum calcium and enquire
    about infectious contacts and recent ingestion of suspicious foodstuffs.
    Functional disorders, e.g. irritable bowel
    syndrome (IBS), are a frequent cause of
    acute abdominal pain. The diagnosis of IBS
    is discussed on page 88, but enquire about
    a background of longstanding intermittent
    abdominal pain with altered bowel habit
    and review the notes for previous similar
    admissions.
    A period of observation with repeated
    clinical evaluation is very often the key to
    successful diagnosis; for example, abdominal pain that was originally central and
    non-specific may, on repeat examination,
    have migrated to the RIF, suggesting a
    diagnosis of acute appendicitis. Patients
    who remain systemically well and whose
    pain appears to be settling has settled can
    usually be discharged safely, with outpatient review. Those with marked systemic
    upset or other features causing concern but
    no clear underlying cause require further
    investigation surgical review.

    33

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