A practical approach to a common problem

1. Approach to abdominal pain
To operate or not

2. Cause of abdominal pain
 Infection/inflammation of an intra-
abdominal organ
 Obstruction of a hollow viscus
 Ischemia- impaired blood supply
 Referred pain- chest/spine/genitalia
 Metabolic- uremia/DKA/porphyria/lead
poisoning/Black widow spider bite
 Neurogenic
 Psychogenic

3. Commonest cause
Irritable bowel syndrome

4. Characteristics of abdominal pain
 Inflammatory- constant, localised, worsens
with movement, guarding/rigidity
 Obstruction- intermittent, colicky, writhing,
radiates (scapula/umbilicus/groin)
 Vascular- sudden/severe or dull/constant

5. Acute abdomen
Sudden, severe, persistent abdominal
pain,
likely to require surgical intervention

6. Don’t forget
Pregnancy & its complications
causing acute abdomen in women
of childbearing age

7. Work-up
 History of pain & associated symptoms
 Vital sign
 Relevant general examination
 Abdominal examination-
looking for mass/collection/ascites,
guarding/rigidity, bowel sounds
 Rectal and/or pelvic examination,
when required

8. Investigation
 Relevant blood/serum investigation
 Urinalysis
 Pregnancy test
 ECG
 AxR- erect/lateral & supine, CxR
 Ultrasound
 CT scan
 Endoscopy- UGI, LGI, capsule

9. If all fail
Diagnostic
laparoscopy/laparotomy

10. Treatment
 NSAIDs- oral/IM
 Opioids- IM/IV
 Antispasmodics- for colicky pain
 Treat underlying cause