The Patient with Abdominal Pain

Key Points to Remember

  • Ask yourself “Is this patient really sick? Or do they look well” and check their observations
  • If they look sick, assess the patient in an ABCDE approach
    • Give oxygen (as determined by O2 saturations),
    • Get IV access early on
    • Take blood to send for FBC, CRP, U&Es, LFTs, Clotting, amylase and a VBG (for a lactate)
    • Give fluid challenge (20-30ml/Kg of crystalloid) if any sign of shock
    • Take a brief history of the presenting features during resuscitation
  • If the patient seems well and does not need resuscitation
    • Ask questions to ascertain the onset, severity, duration, associated symptoms and risk factors for certain conditions.
    • Take a good pain history and give analgesia appropriate to the patients pain score. If the patient is in severe pain, titrate IV morphine (+anti-emetic) if you are competent to do so.
    • When palpating the abdomen be specific when mapping out the patients area of tenderness
  • Use a system to think through a list of possible differential diagnoses.
  • Get a urine dip – this could clinch a diagnosis or UTI or renal stones.
    • Never forget to do a pregnancy test in the female patient!
  • If the patient has a surgical abdomen, you need to get a senior opinion early on. The next step might be the CT scanner or to go to theatre!
    • Make the patient is Nil by Mouth (NBM) and prescribe appropriate fluids.
    • Make sure a valid ‘Group and Save’ has been sent

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