CBL : Acute Abdominal

Pain

Lecturer
Dr Azlan Helmy
 Acute
Abdominal
Pain
Mohammad Nur Kamal Effendy Bin Husein
Nur Farihah Binti Azman
Wong Sii Riong
 
By the end of this session, student should be able to assess a patient presenting with abdominal pain and
loin pain to produce a valid differential diagnosis, investigate appropriately and formulate a management
plan
 
1. To outline the different classes of abdominal pain and how the history and clinical findings differ between
the causes
2. To identify the possible surgical causes of abdominal pain, depending on site, details of history,
acute or chronic including but not limited to peptic ulcer disease, pancreatitis, cholecystitis,
cholangitis, biliary colic, bowel obstruction, diverticular disease, viscus perforation, acute
appendicitis and ischaemic colitis, AAA, hernias, renal calculi, pyelonephritis, chronic
inflammatory bowel disease, and volvulus
3. Know the common and serious causes of loin pain including renal colic, infection and obstruction of the
urinary tract, abdominal aortic aneurysm
4. Know the medical causes of abdominal pain
5. To define the situations in which urgent surgical, urological or gynaecological opinion should be sought
6. Determine which first-line investigations are required, depending on the likely diagnoses following
evaluation using ECG, plain radiology, CT, ultrasound and blood tests.
7. Outline the management plan for patients presented with chest pain
• A 66-year-old man presented to ED complaining of
abdominal pain of 1 day duration. The pain originatesin
the upper abdomen which progressively worsen. It
radiates to the back. He feels nauseated and feverish.
Her past medical history is notable for duodenal ulcer
which was successful treated with Helicobacter
eradication therapy 5 year earlier. He smoke 10
cigarettes a day. He has a history of long standing
hypertension and diabetes mellitus on medication.
Question 1

• What are the possible causes of abdominal

pain? Categorize your answers into surgical
and non-surgical causes
Surgical
• Pancreatitis • Ischaemic Colitis
• Cholecystitis • Abdominal Aortic Aneurysm
• Cholangitis (AAA)
• Biliary Colic • Hernias
• Viscus Perforation • Renal Calculi
• Peptic Ulcer Disease • Pyelonephritis
• Small Bowel Obstruction • Chronic Inflammatory bowel
Disease
• Diverticular Disease
• Volvulus
• Acute Appendicitis
• Gastroesophageal Reflux Disease
(GERD)
 NON SURGICAL
• METABOLIC CAUSES :
o DKA
o Uremia
o Hypercalcemia
o Acute Intermittent Porphyria
 NON SURGICAL
• HAEMATOLOGICAL DISEASES
o Hemolytic Crisis of Chronic Haemolytic Anaemia
o Polycythemia
o Henoch-Schonelein Purpura
o Lymphoma
o Leukemia
 NON SURGICAL
• INTRA-ABDOMINAL CONDITION
o Gastro-enteritis
o Infective Colitis
o Typhoid Fever
o UTI
o Acute Viral Hepatitis
o Congestive Hepatomegaly
 NON SURGICAL
• Intra-Thoracic Condition :
o MI
o Basal Lobar Pneumonia & Lung Abcess
o Pericarditis
2. List four (4) common conditions that presents with
upper abdominal pain?

Syuhara Binti Yusuf

Navendren A/L Annbalagan
Norsaiful Akmal Bin Adnan
 Gastroesophage
4 Common Gastritis al reflux disease
( GERD)
conditions that
present with upper
abdominal pain
Peptic ulcer Cholecystitis
Location of pain
• Epigastric region

Symptoms
• Nausea & Vomiting
Gastrit
• Heartburn is

Type of pain
• Localized pain
Location of pain
• Epigastric region

Symptoms
• Heartburn Peptic
• Bloating Ulcer
• Vomiting & Nausea
• Gnawing or burning pain in the
middle or upper stomach
between meals or at night
Location of pain
• Epigastrium

Symptoms Gastroeso
• A burning sensation in your
chest (heartburn), usually after phageal
eating reflux
• Regurgitation of food or sour
liquid
disease
• Nausea or vomiting (GERD)
Location of pain
• Right side of upper abdomen

Cholecys
Symptoms titis
• Nausea & Vomiting
• Fever

Type of pain
• back pain between your
shoulder blades
• Colicky pain
 CBL ACUTE ABDOMEN

3. LIFE THREATENING CONDITIONS IN UPPER

ABDOMINAL PAIN
LECTURER:
DR. AZLAN HELMY

GROUP MEMBERS:
WAN NURUL SYUHADA BINTI SALLEHUDDIN
KAMAL ABIDI BIN KASIM
MOHD IBNI HISHAM BIN MOHD NOOR
 • Perforated Peptic Ulcer:

• Patients with perforated peptic ulcer

disease usually present with a sudden
LIFE onset of severe, sharp abdominal pain
THREATENING (epigastric).
CONDITIONS IN
UPPER • History of peptic ulcer disease, H
ABDOMINAL pylori infection, ingestion of nonsteroidal
anti-inflammatory drugs (NSAIDs) or
PAIN
smoking.

• These patients may also demonstrate

signs and symptoms of septic shock, such
as tachycardia, hypotension, and anuria.
 • Acute Pancreatitis

LIFE • Inflammation of the pancreas, severity ranges from

mild local inflammation to multisystem organ
THREATENING failure.
CONDITIONS IN
UPPER • Common symptoms mid-epigastric pain radiated to
ABDOMINAL the back that worse when patient is supine.
PAIN
• Associated with nausea, vomiting, low-grade fever.

• Complications is pancreatic pseudocyst, intra-

abdominal hemorrhage, intra-abdominal infection
and multi-organ system failure.
 • Acute Coronary Syndrome (ACS):

LIFE • Cardiac disorders with myocardial ischemia

THREATENING or injury includes STEMI, NSTEMI and
Unstable Angina.
CONDITIONS IN
UPPER
• Common symptoms is chest pain and
ABDOMINAL important history is include the symptom
PAIN onset, location, severity and duration.

• Atypical symptoms includes abdominal pain

(upper) may radiated to the back, shortness
of breath, dizziness and palpitations.
 • Diabetic Ketoacidosis (DKA):
LIFE
THREATENING • Results from a relative insulin deficiency and
CONDITIONS IN counter-regulatory hormone excess causing
UPPER hyperglycemia and ketonemia.
ABDOMINAL
PAIN • Patient presents with significant polyuria,
polydipsia, weight loss and dehydration.

• GI complaints is common such as diffuse

abdominal pain, nausea and vomiting. High
index of suspicion when seeing patient with GI
complaints especially with abnormal vital sign
and has rapid shallow kussmaul’s breathing.
 • Abdominal Aortic Aneurysm (Ruptured):
LIFE
THREATENING • AAA - Aneurysm of the aorta, the main blood
vessel that leads away from the heart, down
CONDITIONS IN through the abdomen to the rest of the body.
UPPER
ABDOMINAL • Ruptured AAA - can cause massive internal
PAIN bleeding.

• Usually asymptomatic until rupture, patient may

have sudden abdominal pain radiated to the
back.

• Ruptured AAA has 50% mortality and elective

 LIFE
THREATENING • Perforated Cholelithiasis:
CONDITIONS IN
UPPER • Cholelithiasis involves the presence of
ABDOMINAL gallstones usually in the gallbladder.
PAIN
• Infection that cause inflammation can lead
to gallbladder rupture.

• Gallbladder rupture can cause sudden onset,

sharp and severe abdominal pain (right
upper quadrant and radiated to the back).
REFERENCES
• Ooi, S.   2016.   Emergency Medicine.     Mc
Graw Hill.
• Cydulka, R. K.   2012.   Emergency Medicine
Manual.  8.   Mc Graw Hill.
• Koochak, H. E.   2014.   Abdominal Pain as
Extrapulmonary Presentation of Pneumonia
in an Adult: A Case Report.   
• Tang, J. C. F.   2019.   Acute Pancreatitis. 
Medscape  
Blood Investigations
Blood parameter Lab value Normal value

Haemoglobin 14.7g/dL 11.7-15.7g/dL

White cell count 12.0 x 109/L 3.5-11.0x 109/L

Platelet 239 x 109/L 150/440 x 109/L

Sodium 137 mmol/L 135-145 mmol/L

Potassium 4.8 mmol/L 3.5-5.0 mmol/L

Urea 10.6 mmol/L 2.5-6.7 mmol/L

Creatinine 116 umol/L 70-120 umol/L

Bilirubin 14 umol/L 3-17 umol/L

Alkaline phosphatase(ALP) 58 IU/L 30-300 IU/L

Alanine Aminotransferase(ALT) 35 IU/L 5-35 IU/L

CRP Pending  
Examination
The patient looks unwell and dehydrated. He weighs 115kg. He is
febrile, 38.5 degree Celsius, his pulse is 120/min and BP: 90/60mmHg.
Cardiovascular and respiratory system examination is normal. She is
tender in the right upper quadrant and epigastrium, with guarding and
rebound tenderness. Bowel sounds are sluggish.
 ASSESSMENT
OF HYDRATION
STATUS

NICKHANSON HENDRY
MUHAMAD SHAHRIL BIN BAHARUDIN
MOHD LATHIF BIN MOHD NOOR
What is HYDRATION status of a
patient?
• Assessment of whether a patient is :
• Hypovolaemic (dehydrated)
• Euvolaemic (normal)
• Hypervolaemic (fluid overloaded)

DEHYDRATED OVERLOAD
 Dehydrated VS Overloaded
• Euhydration – state or situation of being in water balance
!! It is not a steady state.

• Hypovolaemia – deficit of fluid body (fluid loss > fluid intake)

• Hypervolemia – excess of fluid body (overloaded) (excessive fluid
intake/ inappropriate fluid retention)
 HYPOVOLAEMIA HYPERVOLAEMIA
INPUT Poor fluid intake Excessive fluid admiration
• Dementia/delirium • IV fluid
• Intellectual disability • Blood transfusion
• Peri-operative patient • Polydipsia
Fluid loss Fluid retention
• Vomiting/Diarrhoea • Heart Failure
• Blood loss • Renal Failure
OUTPUT

• Post operative • Liver Failure

• Diuretics
• Fever/Sepsis
• High stoma output
• Polyuria
Dizziness – especially postural SOB
Nausea Oedema
SX

Lethargy Fatigue and weight gain

Factors to be consider
• Patient’s age
• Trauma
• Febrile illness and sepsis
• Burn
• Gastrointestinal losses
• Medication
• Medical condition
HOW TO ASSESS??
• History taking
• Clinical Examination
• Lab/ radiology test
Details in the patient’s history
• Bleeding from any source
• Vomit and diarrhoea – frequency, amount
• Fevers and diaphoresis
• Urine output – colour and amount
• Oral status
• Symptoms of fluid overload – shortness of breath, orthopnoea,
paroxysmal nocturnal dyspnoea, leg swelling
• Medical condition and fluid restriction
 CLINICAL EXAMINATION
General appearances
EXAMINATION Vital Sign
Capillary refill
CLINICAL

Mucous Membrane
Lung Sounds
Heart Sound
Extravascular spaces
• Abdomen
• Sacrum
• Lower limb
CLINICAL EXAMINATION DEHYDRATED OVERLOADED
General appearances Lethargic, Drowsy, Pallor Anxious, respiratory distress

Vital Sign (Postural) hypotension, Decreased SaO2, Tachypnoea,

tachycardia hypertension
Capillary refill Delayed refill -

Mucous Membrane Dry mucous membranes, tongue -

dryness
JVP Low JVP High JVP

Lung Sounds - Crepitation, pleural effusion

Heart Sound - Extra heart sounds

Extravascular spaces - • Oedema – sacral oedema,

ascites, lower limb oedema
• Abdomen
• Sacrum
• Lower limb
DON’T FORGET
YOUR CCRTV
• Colour
• CRT
• Rate
• Temperature
• Volume
LAB & RADIO TEST
BLOOD TEST
• FCB
• Sudden drop in Hb- haemorrhage
• Haematocrit raise – sign of dehydration
• Infection
• Urea/Creatinine
• Raise – sign of dehydration (AKI)
• Urea raised in upper gastrointestinal haemorrhage
• Sodium level
• Elevated in dehydration
• Low in fluid overload
• Urine
• Severely decreased urine
output or no urine output
• Darker urine suggesting
dehydration
• Urine specific gravity
(concentration of solute in
the urine) – raise-
dehydration
Imaging
• Chest X-ray – pulmonary oedema
• Echo – assessment of heart failure
• IVC Ultrasound – volume depleted
- volume overloaded
• Bladder Scan- retention of urine
POAC Clinical Guideline 2015
• Acute Adult Dehydration
Mild (<5%) Moderate (6-9%) Severe (>10%)
• May have no • Significant thirst • Significant thirst
symptoms • Oliguria • Tachycardia
• Mild thirst • Sunken eyes • Low pulse volume
• Concentrated • Dry mucous membranes • Cool extremities
Urine • Weakness • Reduced skin turgor
• Light headiness • Marked hypotension
• Postural hypotension • Confusion
(>20mmHg)
• The patient looks unwell. He weighs 115kg. He is febrile, 38.5 degree
Celsius, his pulse is 120/min and BP: 90/60mmHg. Cardiovascular and
respiratory system examination is normal. She is tender in the right
upper quadrant and epigastrium, with guarding and rebound
tenderness. Bowel sounds are sluggish.

So, what do you this of this patient

HYDRATION status?
5. Interpret Full Blood
Count (FBC) results.
Syaripuddin Daring (A168478)
Azureen Binti Zulkifli ( A169070)
Hemalagan A/L Loganathan ( A168523)
Full Blood Count (FBC)
• FBC is the single most common investigation performed in medical and trauma patients
• This investigation can detect wide range of disorders such as anemia,infections and
leukemia
• FBC test measures several important components and feature in patients blood including
:
Red Blood Cell(RBC) - which carry oxygen
White blood cell (WBC) - which fight infection
Hemoglobin (HB) - the oxygen-carrying protein in red RBC
Hematocrit (HCT) - the proportion of red blood cells to the fluid component,or plasma in
the blood
Platelets - which helps with blood clotting.
Interpret FBC results?
• Haemoglobin > 14.7g/dL (11.7-15.7g/dL)
• White Blood Count > 12.0 x 10⁹/L
(3.5-11.0 x 10⁹/L)
• Platelet > 239 x 10⁹/L (150-440 x 10⁹/L)
Haemoglobin > 14.7g/dL (11.7-15.7g/dL)

- Normal
- The results are related with RBC,HB and HCT because
they measure aspects of RBC
- If the measure of these 3 areas are lower then normal it
may considered as Anemia
- Anemia causes fatigue and weakness
- This are due to low levels of certain vitamins or
iron,blood loss or other underlying conditions
White Blood Count > 12.0 x 10⁹/L (3.5-11.0
x 10⁹/L)

- High
- Lower then normal range is consider as leukopenia which is caused by
some medical condition such as autoimmune disorder that destroys
WBC,bone marrow problems
- Higher then normal can be considered as infection or inflamation.It
also could indicate any autoimmune system disorders.
Platelet > 239 x 10⁹/L (150-440 x 10⁹/L)

- Normal
- Lower count of PLT is Thrombocytopenia,are firstly associated with
increased PLT cosumption and secondly those causing bone marrow
failure.(immune,systemic sepsis,viral infection,massive
transfussion,alcohol,multi-organ failure)
- Higher count of PLT is Thrombocytosis,this condition commonly seen
as reactive phenomenon in patients with active chronic infection or
malignancy
- Chronic bleeding and iron deficiency anemia is frequantly associated
with this condition.
Summary
• Abnormalities in FBC may be informative in all conditions of patient
• Anemia,Infections,thrombocytosis and thrombocytopenia is a
common finding in FBC for medical and trauma patient
• It is important to recognise common reactive FBC changes in patients
presenting with active systemic diseases
• Certain reactive phenomena such as eosinophilia may help direct
investigation to achieve a specific diagnosis
• Persisting abnormalities in FBC that remain unexplained should
prompt an opinion from Haematolgist.
CBL : ACUTE ABDOMINAL PAIN

6. Why Do You Think There Is A

Significance Rise In Blood
Urea?

Mahadir Bin Shabuddin

Dian Nastiti Binti Andi
Mohd Salim Bin Ali
Why Do You Think There Is A
Significance Rise In Blood Urea?
• Urea is the final breakdown product of the amino acids found in
proteins 
• Nitrogen in the form of ammonia is produced in the liver when
protein is broken down
• The nitrogen combines with other chemicals in the liver to form the
waste product urea
• The urea is released into the bloodstream and carried to the kidneys
where it is filtered out of the blood and excreted in the urine.
Scenario
A 66-year-old man presented to ED complaining of abdominal pain of 1 day duration.
The pain originates in the upper abdomen which progressively worsen. It radiates to
the back. He feels nauseated and feverish. Her past medical history is notable for
duodenal ulcer which was successful treated with Helicobacter eradication therapy 5
year earlier. He smoke 10 cigarettes a day. He has a history of long standing
hypertension and diabetes mellitus on medication.

Examination
The patient looks unwell and dehydrated. He weights 115kg. He is febrile, 38.5
degree Celsius, his pulse is 120/min and BP: 90/60mmHg. Cardiovascular and
respiratory system examination is normal. She is tender in the right upper quadrant
and epigastrium, with guarding and rebound tenderness. Bowel sounds are sluggish.
Blood Investigations
Blood parameter Lab value Normal value

Haemoglobin 14.7g/dL 11.7-15.7g/dL

White cell count 12.0 x 109/L 3.5-11.0x 109/L

Platelet 239 x 109/L 150/440 x 109/L

Sodium 137 mmol/L 135-145 mmol/L

Potassium 4.8 mmol/L 3.5-5.0 mmol/L

Urea 10.6 mmol/L 2.5-6.7 mmol/L

Creatinine 116 umol/L 70-120 umol/L

Bilirubin 14 umol/L 3-17 umol/L

Alkaline phosphatase(ALP) 58 IU/L 30-300 IU/L

Alanine Aminotransferase(ALT) 35 IU/L 5-35 IU/L

CRP Pending  
Reduce oral intake
• Abdominal pain Nauseated
• Feverish Dehydrated
• Bowel sounds sluggish

Fever
• Unwell
• Lethargy
• No appetite

Smoke 10 cigarettes
• Hyperglycemic - glucose from adrenaline and the inhibition of insulin
• Appetite suppressant – smokers feel no hungry

Decrease perfusion
• BP – 90/60/mmHg
• PR – 120/min
Why Do You Think There Is A
Significance Rise In Blood Urea?
• Deteroriation of renal function leads to an excessive accumulation of
nitrogenous waste products in serum and significant electrolyte
abnormalities
• Acute Kidney Injury (AKI) – pre renal failure
• Decrease renal perfusion
• Hypovolemic state – loss of appetite,
• Fluid sequestration – cirrhosis, pancreatitis,
 Acute abdomen
GROUP MEMBERS
Deshaleney a/p Loganathan
Ady Ridzuan bin Oyong
Muhammad Faisal bin Mohamed Ameen
• c/o : abd pain day 1
• Upper abdomen pain progressively worsen radiates to the back
• Nauseated and feverish
• PMH : duodenal ulcer treated with h.pylori eradication therapy 5 yrs
ago
• Smoke 10 cigarettes/day
• k/c/o : HPT and DM
• Examination : unwell and dehydrated
wt: 115kg temp: 38.5 PR: 120/min BP: 90/60
- Tender in RUQ and epigastrium with guarding & rebound tenderness
- Bowel sound sluggish
Blood parameter Lab value Normal value

Haemoglobin 14.7g/dL 11.7-15.7g/dL

White cell count 12.0 x 109/L 3.5-11.0x 109/L

Platelet 239 x 109/L 150/440 x 109/L

Sodium 137 mmol/L 135-145 mmol/L

Potassium 4.8 mmol/L 3.5-5.0 mmol/L

Urea 10.6 mmol/L 2.5-6.7 mmol/L

Creatinine 116 umol/L 70-120 umol/L

Bilirubin 14 umol/L 3-17 umol/L

Alkaline phosphatase(ALP) 58 IU/L 30-300 IU/L

Alanine Aminotransferase(ALT) 35 IU/L 5-35 IU/L

CRP Pending  
7. What radiological
investigations are helpful in
this patient?
INVESTIGATIONS RATIONALE

X ray Renal stone and gallbladder stone detection

ultrasound abdominal pain or distention (enlargement)

abnormal liver function
enlarged abdominal organ
Kidney stones
gallstones
Abdominal aortic aneurysm

CT scan Detailed investigation

Sharma, P., Sidharth, -, Singh, B., Singh, D., & Gupta, A. (2013).
Comparative Study between Plain Radiography and Ultrasound
Abdomen in Non Traumatic Surgical Acute Abdominal
Conditions. Nepalese Journal of Radiology, 2(2), 20-27.
References
van Randen, A., Laméris, W., van Es, H. W., van Heesewijk, H. P., van
Ramshorst, B., Ten Hove, W., … OPTIMA Study Group (2011). A
comparison of the accuracy of ultrasound and computed tomography
in common diagnoses causing acute abdominal pain. European
radiology, 21(7), 1535–1545

Sharma, P., Sidharth, -, Singh, B., Singh, D., & Gupta, A. (2013).
Comparative Study between Plain Radiography and Ultrasound
Abdomen in Non Traumatic Surgical Acute Abdominal
Conditions. Nepalese Journal of Radiology, 2(2), 20-27.
8. Does 12-lead ECG has a role in this patient? Give
reasons why?

YES..!!
To eliminate cardiac causes

• Clinical presentation of inferior MI comes with symptoms

abdominal pain

• Sometimes may have changes like:

• T waves inversion, ST segment depression and St segment elevation
(cholecyctitis, perforated duodenal ulcer, pancreatitis)

• Study showed that the ECG played important role in the treatment
and diagnosis of patients presenting with abdominal pain.
REFERENCE
• Oguzturk, H., Turtay, M., Tekin, Y. and Tekin, G. (2011).
The Evaluation of Electrocardiogram Findings in Acute
Abdominal Pain Patients Admitted to the Emergency
Department. Journal of Primary Care & Community
Health, 2(3), pp.163-166.

• Tintinalli’s Emergency Medicine 8th Edition.

Gastrointestinal Emergencies; page 217 - 221.
 QUESTION 9

What other simple bedside investigations that you can do beside

12 lead ECG?

Lecturer :
Dr Azlan Helmy

Group members :
Tan Yi Hao
Nazeri Jutais
Siti Hajar Jafri
 BEDSIDE INVESTIGATIONS
• Ultrasound

- Primary imagine technique

- Low cost, low radiation

- to see any intraperitoneal fluid (appendicitis)

- to detect abdominal aortic aneurysm

- to detect any cholecystitis (dilated gall bladder)

- Patient with raised wcc and LFT – possible positive dx on ultrasound

- Patient with localised abdominal pain – positive dx on ultrasound

- To detect any biliary duct dilatation, pancreatic mass,

• POCT (Point of care testing)

Blood glucose/ketone (reflo, glucometer, dextrostix)

-To measure glucose level (Diabetic/DKA patient)

Urinalysis

- Detect urologic condition (UTI), calculi

QUESTION 10
PREPARED BY :
IFFAH ZULAIKHA, IQBAL HAKIMI, SYAFIQ SOFIYAN
 DESCRIBE THE INITIAL
MANAGEMENT OF THIS PATIENT
IN
EMERGENCY DEPARTMENT (ED)
PRINCIPLE MANAGEMENT OF ABC
AIRWAY
• Make sure the airway is pattern
• Unlikely to have any airway compromised since
patient is well conscious

BREATHING
• Monitor respiratory rate
• 100% O2 saturation if SPO2 < 95%
• Institute oxygen supplementary if patient
appeared tachypneic
• KIV for assisted ventilation if deteriorate
PRINCIPLE MANAGEMENT OF ABC
CIRCULATION
• CCRTV: Colour,
Capillary refill time,
Pulse rate,
Temperature,
Volume
• Close monitoring vital sign (Q:5min)
• Put on cardiac monitor and 12 leads ECG
• Keep vein open with branula, if patient deteriorate, set
2 IV line on central line ( ante cubital with at
least 18G )
• Fluid administration (assess the hydration status)
• Fluid challenge 200mls over 1 hour
• If BP persistent low, start fluid resuscitation ( 10-30mls/kg) – Body weight ( 115kg x 30mls/kg
= 3450mls (3.45L)
• Monitor patients for signs of volume overload, such as dyspnoea, elevated
jugular venous pressure, crackles on auscultation, and pulmonary oedema on
the chest radiograph. Improvements in mental status, heart rate, MAP, capillary
refill, and UOP (urine output) indicate adequate volume resuscitation.
• Administer vasopressors for hypotension that does not respond to initial fluid
resuscitation to maintain a mean arterial pressure (MAP) of 65 mm Hg or higher
(Recent studies showed the validity of the 70-75 mm Hg lower mean arterial
pressure target or 80-85 mm Hg in those patients with pre-existing hypertension.)
• KIV or start IV noradrenaline 0.2 to 1.5 µg/kg/min, can up to 3.3 µg/kg/min maximum.
 PRINCIPLE MANAGEMENT
LABORATORY FINDINGS

• FBC – HB, HCT, WBC • Lipase

• Electrolytes • β-Human chorionic gonadotrophin
• sodium, potassium, magnesium, phosphate • Coagulation studies (prothrombin
• LFT time/partial thromboplastin time)
• RP • Glucose
• Cardiac Biomarkers • Gonococcal/chlamydia test
• PT/INR • Lactate
• GSH • Urinalysis
• Amylase • ECG
PRINCIPLE MANAGEMENT
RADIOLOGICAL FINDINGS

• Plain Radiographs : CXR / AXR

• Ultrasound : Abdominal
• Abdominal Pelvic CT Scan
 SYMPTOM TREATMENT
• Provide symptomatic relief. Opioid analgesia relieves pain and
will not obscure abdominal findings, delay diagnosis, or lead to
increased morbidity/mortality.
• Administer antiemetics as needed :
IV ondansetron 4mg/8mg
IV metoclopramide 10mg, given slowly
IV diphenhydramine 25-50mg – prophylaxis
• Administer proton pump inhibitor
iv omeprazole 40mg
• Consider placement of nasogastric.
• Put on urinary catheters for i/o monitoring ( 0.5ml/kg/hour)
THANK
YOU