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CDHB

Acute Abdominal Pain

• See also Common Emergency Presentations - Abdominal Pain.
• If the abdominal pain is likely to have a surgical cause, discuss the patient with the on-call Surgical Registrar (pager 8600).

Initial Assessment of Abdominal Pain

This will reflect the general clinical situation and the severity and stability of the patient's condition.

Subsequent management depends on the results of further assessments.

If unstable - resuscitate

• Get as much history and examination as is practicable.
• IV access (no smaller than 18 gauge), IV fluids.
• Analgesia.
• ABG.
• Urine output, indwelling urinary catheter.
• Consider CXR, abdominal X-ray, ECG, cardiac injury markers, CBC + diff, group and hold or cross-match. Na, K, creatinine, LFTs, amylase.

  Note: Generalized peritonitis may proceed directly to theatre.

  Note: Inform the on-call Consultant of all acute cases going to theatre.

• When stable, or if presents in a stable condition, transfer to SARA if Surgical Registrar agrees.

Further Assessment of Abdominal Pain

• Obtain a full history and examination.
• Consider the following investigations:
  • CBC, urea, Na, K, creatinine, CRP.
  • Coagulation screen (bleeding disorder, anticoagulants, jaundice).
  • MSU (dipstick, microscopy, culture and sensitivities).
  • Cardiac injury markers (chest/upper abdominal pain).
  • ECG (chest/upper abdominal pain).
  • Group and hold, cross-match (bleed, signs of anaemia, recent major surgery).
  • Imaging:
    • CXR (perforation, pneumonia).
    • Supine abdominal X-ray (bowel obstruction, renal colic).

    Discuss further imaging investigations (CT, USS) with Registrar/Consultant.

  • LFTs (upper abdominal pain, biliary history).
  • Amylase, lipase (pancreatitis).
  • Beta-HCG (pre-menopausal women).
  • ABG (ischaemic bowel, pancreatitis, unwell).
  • Lactate (ischaemic bowel).

Management of Acute Abdominal Pain

• If a definite diagnosis is established after the initial assessment, follow the appropriate pathway - Acute Appendicitis, Acute Cholecystitis, Acute Pancreatitis, Small Bowel Obstruction, Suspected Diverticulitis.
• If none of these diagnoses is likely, then further investigation and treatment as directed by the General Surgical team.
• Appropriate referrals for other diagnoses, i.e., Cardiology, Respiratory Services etc. as indicated.

Topic Code: 66053