Approach to abdominal pain

To operate or not

Cause of abdominal pain Infection/inflammation of an intra-

abdominal organ Obstruction of a hollow viscus Ischemia- impaired blood supply Referred pain- chest/spine/genitalia Metabolic- uremia/DKA/porphyria/lead

poisoning/Black widow spider bite Neurogenic Psychogenic

Commonest cause

Irritable bowel syndrome

Characteristics of abdominal pain Inflammatory- constant, localised, worsens

with movement, guarding/rigidity

Obstruction- intermittent, colicky, writhing, radiates (scapula/umbilicus/groin)

Vascular- sudden/severe or dull/constant

Acute abdomen

Sudden, severe, persistent abdominal pain,

likely to require surgical intervention

Don’t forget

Pregnancy & its complications causing acute abdomen in women

of childbearing age

Work-up History of pain & associated symptoms Vital sign Relevant general examination Abdominal examination-

looking for mass/collection/ascites, guarding/rigidity, bowel sounds

Rectal and/or pelvic examination, when required

Investigation Relevant blood/serum investigation Urinalysis Pregnancy test ECG AxR- erect/lateral & supine, CxR Ultrasound CT scan Endoscopy- UGI, LGI, capsule

If all fail

Diagnostic laparoscopy/laparotomy

Treatment NSAIDs- oral/IM Opioids- IM/IV

Antispasmodics- for colicky pain

Treat underlying cause