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Acute Abdominal Pain
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Acute Abdominal Pain
, Acute Abdomen, Abdominal Pain
See Also
Acute Pelvic Pain
Pediatric Abdominal Pain
Abdominal Pain in Older Adults
Acute
Abdominal Pain Evaluation
Definition
Acute Abdominal Pain
Abdiominal pain onset under 6 hours
Epidemiology
Abdominal Pain represents 5% of ER visits
Only 10% of these evaluations require surgery
Accounts for 10% of
Malpractice
claims
Pearls
Cohorts with atypical presentations of serious Abdominal Pain causes
Elderly and immunocompromised
Use low threshold for admiting elderly (and immunocompromised) for observation
See
Abdominal Pain in Older Adults
Pregancy
Appendix migrates upward into peri-renal and even RUQ in third trimester
Most commonly missed surgical diagnoses
Appendicitis
Small Bowel Obstruction
Specific Warning signs
Low Back Pain
in elderly
Abdominal Aortic Aneurysm
Atrial Fibrillation
and Abdominal Pain
Mesenteric Ischemia
Common serious causes mimicking more benign causes
Retrocecal appendix
May present with back pain or upper quadrant Abdominal Pain
Abdominal aoortic aneurysm
May present with
Renal Colic
symptoms (
Flank Pain
,
LLQ Pain
and even
Hematuria
)
Signs and symptoms
Findings suggestive of surgical
Abdomen
See Acute
Abdominal Pain Evaluation
Duration of pain at presentation
Severe, sudden onset pain under 1 hour
High risk for intra-abdominal catastrophe
Causes (especially in elderly)
Ruptured
Abdominal Aortic Aneurysm
Mesenteric Ischemia
Myocardial Infarction
Perforated viscus
Nephrolithiasis
Pain duration under 48 hours: 18% need surgery
Pain duration over 48 hours: 11% need surgery
Delayed presentation in young and old
Pain precedes
Vomiting
Appendicitis
Cholecystitis
Small Bowel Obstruction
Fever
>38 C (only when accompanied by another sign)
Fever
lags symptoms in elderly
Tachycardia
(
Heart Rate
exceeds 110 bpm)
Leukocytosis
with
Neutrophil
s >75%
Peritoneal signs
Age over 65 years
Signs and symptoms
Findings suggestive of non-surgical
Abdomen
Anorexia
not present
Differential Diagnosis
See
Acute Abdominal Pain Causes
See
Generalized Abdominal Pain
See
Left Upper Quadrant Abdominal Pain
See
Right Upper Quadrant Abdominal Pain
See
Left Lower Quadrant Abdominal Pain
See
Right Lower Quadrant Abdominal Pain
See
Extraperitoneal Abdominal Pain Causes
See
Abdominal Wall Pain Causes
See
Epigastric Pain
See
Suprapubic Pain
Evaluation
See Acute
Abdominal Pain Evaluation
Labs and Diagnostic Studies
See Acute
Abdominal Pain Evaluation
Imaging
See Acute
Abdominal Pain Evaluation
Management
Surgery
Consultation
Indications
Severe Abdominal Pain or progressive Abdominal Pain (regardless of non-diagnostic imaging)
Vomit feculent or bile-stained
Abdominal guarding or rigidity
Abdominal
Rebound Tenderness
Abdominal Distention
and hypertympanic to percussion
Significant
Traumatic Injury
to
Abdomen
Abdominal Pain of unclear etiology
Intra-abdominal fluid accumulation
Management
Gene
ral
Antiemetic
s
Ondansetron
(
Zofran
)
Prochlorperazine
(
Compazine
)
More effective
Antiemetic
in Abdominal Pain than
Phenergan
, Reglan
Ernst (2000) Ann Emerg Med 36(2): 89-94 +PMID:10918098 [PubMed]
Parenteral
Analgesic
s
Opioid
Dosing
Dilaudid
0.3 to 0.5 mg every 15 minutes prn
Morphine Sulfate
2-4 mg every 15 minutes prn
Parenteral
NSAID
s
Toradol
15-30 mg IV (or 30-60 mg IM) every 6 hours as needed
Do not delay adequate analgesia
Does not interfere with exam
Pace (1996) Acad Emerg Med 3:1086-92 [PubMed]
Thomas (2003) J Am Coll Surg 196:18-31 [PubMed]
Management
Disposition
Re-evaluate in 6-12 hours persistent Abdominal Pain with non-diagnostic evaluation and unclear cause
Appendicitis
rupture is unlikely in first 36 hours (<2%)
Bickell (2006) J Am Coll Surg 202(3):401-6 [PubMed]
References
Natesan (2015) Crit Dec Emerg Med 29(12): 2-11
Graff (2001) Emerg Med Clin North Am 19:123-36 [PubMed]
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