Approach to Acute Abdomen Pain

Runal Shah

MEM-PGY1

KDAH,

Mumbai

Pathophysiology

Three distinct Pain Pathways

1) Visceral Due to stretching of fibers

innervating the walls of hollow or solid

2) Somatic Caused by irritation of parietal

peritoneum fibers

3) Referred Peripheral afferent nerve fibers

from many internal organs enter the spinal

cord through nerve roots that also carry

nociceptive fibers from other locations, this

makes interpretation of the location of noxious

stimuli difficult for the brain.

Quick Assessment

“S” of SAMPLE

1) Pain score + External look

2) Character of Pain (?Radiating to)

3) Site of Pain (Localized/Diffuse)

4) Associated Symptoms

5) Aggravated/Relieving Factors

• “A” for Allergy

History of Asthma/Allergy

“M” for Medications

Current meds list

Meds Over the counter

“P” for Past History

“L” for Last meal /LMP – imp in

Females

“E” for Events – Outside food

consumption / Travel history

Examination

• INSPECT for distention, scar, mass, rash.

• AUSCULATE for hyperactive, sluggish, absent, or normal bowel sounds.

• PALPATION to look for guarding, rigidity, rebound tenderness, organomegaly, ascites.

• PERCUSSION for Organ dullness, ascites

Pelvic Examination for Females (Per Vaginum)

Per Rectal Examination

Ref. Rosen 8/e

Early Interventions

Pain Management

NSAIDs vs. Opioids

Anti-Spasmodic

Symptomatic

Drugs

Invasive Interventions (RT, Flatus Tube)

Antibiotics

Definitive – Surgery (Elective vs. Emergency)

Imaging in Abd. Pain ??

USG Abdomen+Pelvis Billiary Tract Ds specific

CT Whole Abdomen Definitive !!Radiation Risk

X-Ray Erect Abdomen Air fluid level ?

Extra Abdominal Causes of Abd. Pain

Ref. Rosen 8/e

Disposition from A&E

If diagnosis is made upon CT or USG, patient can

be admitted with same for Observation &/or

Surgical intervention can be planned.

Non-specific abdominal pain

◦ If this is the working diagnosis, patients must be

re-examined in 24 hours. This may be done in the

outpatient setting.

Thank You…