Approach to abdominal pain management

Definition

Abdominal pain is one of the most common complaints among patients presenting to the Emergency Department. Although the majority of cases have a benign and self-limiting cause, the primary objective is to identify patients with serious or life-threatening conditions that require early intervention.

Differential diagnosis

Surgical causes

• Abdominal aortic aneurysm

• Mesenteric ischemia

• Gastrointestinal perforation (peptic ulcer disease, bowel, esophagus, or appendix)

• Intestinal obstruction

• Upper gastrointestinal bleeding

• Lower gastrointestinal bleeding

• Splenic rupture

• Acute appendicitis

• Pancreatitis

• Gallbladder diseases

Genitourinary and gynecological causes

• Ectopic pregnancy

• Testicular torsion

• Ovarian torsion

• Dysmenorrhoea

• Endometriosis

• Ureteric stones

• Kidney stones

• Urinary tract infection

• Pelvic inflammatory disease

Medical causes

• Myocardial infarction

• Peptic ulcer disease

• Gastroesophageal reflux disease

• Inflammatory bowel syndrome

• Gastritis

• Hepatitis

Investigations

Investigations should be guided by the clinical presentation.

Recommended investigations include:

• ECG

• Bedside ultrasound (gallbladder, liver, lungs, inferior vena cava, abdominal aorta, kidneys, and other relevant structures)

• Serum electrolytes

• Troponin

• Blood gas analysis

• Serum lactate

• Serum creatinine and urea

• Urine pregnancy test, where indicated

• Radiological investigations:

  • Chest X-ray

  • Abdominal X-ray

  • CT scan of the abdomen, where indicated

Pharmacological treatment

Treat the underlying cause as indicated in the relevant disease-specific chapters.

Oral analgesia

Use one of the following:

Paracetamol (PO)

• 1 g every 6 hours for 24 hours.

OR

Diclofenac (IM)

• 50–100 mg stat.

OR

Hyoscine butyl bromide (PO)

• 10 mg every 8 hours for 24 hours.

Analgesia for patients unable to take oral medication

Use one of the following:

Tramadol (IV)

• 50–100 mg stat.

OR

Morphine (IV)

• 0.1 mg/kg stat.

OR

Hyoscine butyl bromide (IM)

• 10 mg stat.

OR

Paracetamol (IV)

• 1 g stat.