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‫ادارة الطوارئ والحوادث‬

Abdominal pain work up in emergency department

 Causes of abdominal pain in emergency department :

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‫ادارة الطوارئ والحوادث‬

According to Site and region

Types of abdominal pain

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‫ادارة الطوارئ والحوادث‬

Abdominal pain works up in emergency department:

1. Focused physical examination and history and co – morbidities.

2. Assessing hemodynamic stability of the patient.
3. Assessing your urgent consultations (urology – surgery –gynecology - cardiology – gastroenterology –
ICU) According to your provisional diagnosis.
4. Investigations withdrawal according to your provisional diagnosis.
5. Your pain assessment, site, region and co – morbidities will help you to select your investigations.

History taking

Pain assessment

o Severity: ____ 0-10

1. 0 – 3: No pain if the patient have past history of present illness without co – morbidity old age
,hypertension, DM , AF and Ischemic heart disease , also the patient is hemodynamic stable e.g. ( acid
Reflux , heart burn and irritable bowel syndrome ) , (maybe there is no need for investigation )
 Surgical consultation must be done to exclude surgical causes.
2. 4 -7: moderate (according to site region, provisional diagnosis , investigations will be requested )
3. 8 - 10: severe (according to site region, provisional diagnosis , investigations will done)
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‫ادارة الطوارئ والحوادث‬

Radiation: Acute coronary syndrome – acute cholecystitis – hepatitis

o Quality:
Pressure tightness colicky ( renal colic – cholecysitits )
Burning ( acid reflux ) dull aching ( early appendicitis ) sharp stabbing ( acute coronary syndrome – acute
abdomen – rupture abdominal aortic aneurism- dissecting aortic aneurism-ectopic pregnancy )
o Association:
Nausea/ vomiting (DKA - Acute kidney injury – acute pancreatitis – perforated gastric ulcer) sweating (Acute
coronary syndrome – inferior MI)

Dyspnea (Pulmonary Embolism) dizziness palpitation ( acute abdomen - Pulmonary Embolism)

o Allevating and aggravating factors

Eating – sitting up – melena – dysuria - juandice

o Past history
Diabetes mellitus – atrial fibrillation – ischemic heart disease – chronic kidney disease – hypertension –F.M.F

o Past Surgeries
E.g. Exploration (Q adhesions – intestinal. obstruction)

o Medication and allergies history

o Social history
o Evaluation of needed score
o The Alvarado score ( to exclude acute appendicitis
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‫ادارة الطوارئ والحوادث‬

Investigation

According to provisional diagnosis

Cardiac cause (epigastrium)

1. Pelvi- abdomen ultrasound .

2. ECG ( Epigastirc pain )
3. C.B.C + Cardiac enzymes

Pancreatitis , hepatitis and acute cholecysitis

1. Full lab (C.B.C – s .Urea - s. Creatinine – AST – ALT– S. bilirubin total – S. bilirubin direct - amylase –
lipase- Gamma GT – Alkaline phosphatase- Na + k + - )
2. Pelvi- abdomen ultrasound .

Renal colic

1. (C.B.C – s .urea-s. Creatinine – complete urine analysis ) .

2. Pelvi abdominal U/S + Scrotal duplex ( if suspected torsion testis ).
3. C.T UT .

Acute abdomen

1. Full lab ( C.B.C – S .Urea- S. Creatinine – AST – ALT - Na + - k + - C.R.P- D.Dimer ) .

2. Pelvi abdominal U/S + x ray abdomen erect – supine.
3. C.T Abdomen & pelvis with oral and iv contrast if suspected perforated viscus
Mesenteric vascular occlusion

1. Full lab ( C.B.C – S .Urea- S. Creatinine – AST – ALT - Na + - k + - C.R.P- D.Dimer ) .

2. Pelvi - abdominal U/S + x ray abdomen erect – supine .
3. C.T abdomen – with contrast – angiography ) .

+ Coagulation profile ( PT , PTT , INR )

 Atrial fibrillation Patient on warfarin

1. Sub therapeutic level ( mesenteric ischemia )
2. Supra therapeutic level ( active bleeding )
 Melena & HEMATAMISIS

Ectopic pregnancy

1. Full lab ( cbc – s .urea-s. creatinine – ast – alt – bilirubin total – bilirubin direct - Na + k + - amylase –
lipase).
2. Pelvi abdominal U/S .
 ‫مستشفى شفا التخصصي‬
‫ادارة الطوارئ والحوادث‬

3. Quantitative HCG blood after urine pregnancy test.

DKA

1. ABG
2. FULL LAB
3. PELVI ABDOMEN U/S
4. ACCORDING TO UNDERLYING CAUSE