Emergency dept appproach to Abdomen Pain.... The most common presentation in ER is Abd pain, a just simplified approach towards this...

1. Approach to Acute Abdomen Pain
Runal Shah
MEM-PGY1
KDAH,
Mumbai

2. 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.

3. 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

4.  “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

5. 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

6. Ref. Rosen 8/e

7. Early Interventions
 Pain Management
 NSAIDs vs. Opioids
 Anti-Spasmodic
 Symptomatic
 Drugs
 Invasive Interventions (RT, Flatus Tube)
Antibiotics
 Definitive – Surgery (Elective vs. Emergency)

8. Imaging in Abd. Pain ??
 USG Abdomen+Pelvis  Billiary Tract Ds specific
 CT Whole Abdomen  Definitive !!Radiation Risk
 X-Ray Erect Abdomen  Air fluid level ?

9. Extra Abdominal Causes of Abd. Pain
Ref. Rosen 8/e

10. 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.

11. Thank You…