Abdominal Pain 🤢

📋 Key Questions to Ask

• Onset, duration, and character of pain (sharp, dull, colicky, etc.)
• Location and radiation (RUQ, LUQ, epigastric, flank, etc.)
• Associated symptoms: nausea, vomiting, fever, bowel habit changes, dysuria, PV bleeding/discharge
• Past medical/surgical history including previous abdominal surgery
• Medications (NSAIDs, anticoagulants), alcohol intake
• Last bowel movement and passing of flatus
• Urinary symptoms or last menstrual period in females

🧪 Investigations

• Baseline bloods: FBC, U&E, LFTs, CRP, amylase/lipase
• Urinalysis ± pregnancy test (if relevant)
• ECG in older patients or if epigastric pain
• Erect CXR if perforation suspected
• AXR if obstruction suspected (note: limited sensitivity)
• Ultrasound abdomen or CT AP if warranted

🔍 Differential Diagnoses

• Appendicitis, cholecystitis, pancreatitis, diverticulitis
• Bowel obstruction or perforation
• Gastroenteritis, constipation
• UTI or pyelonephritis
• Ectopic pregnancy, ovarian torsion, PID
• AAA (especially in elderly patients with hypotension and back pain)
• Mesenteric ischaemia

📞 When to Escalate

• Haemodynamic instability or peritonitis
• Severe pain unrelieved by analgesia
• Signs of sepsis
• Suspicion of surgical pathology
• Elevated lactate or worsening inflammatory markers

💊 Initial Management

• Discuss early with senior/surgical team if concern for acute abdomen
• IV access and fluid resuscitation if needed
• Analgesia: [paracetamol ± opioids] (contraindicated in perforation or obstruction)
• NBM if surgical pathology suspected
• Antiemetics as required

• 🔗 Analgesia 💊
• 🔗 Antiemetics 🤢