Abdominal Pain 🤢

Clinical guide for assessing abdominal pain. Differential diagnosis, red flags, surgical abdomen, investigations, and management for on-call doctors.

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📋 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 🤢

    Note Template

    Ready-to-use clinical note structure

    🕒 25 / 02 / 2026 — 13:20

ATRP re: abdominal pain
Patient: [age] [sex]
Admission Dx: [reason for admission]
PMHx: [GI disease, surgeries, medications]

🧾 Hx:
• Onset, duration, and character of pain
• Location and radiation
• Associated symptoms: [nausea, vomiting, diarrhoea, constipation, fever, urinary symptoms]
• Last bowel movement and flatus
• Appetite and oral intake
• Medications and allergies

🩺 Exam:
• Vitals: HR __ BP __ Temp __ RR __ SpO₂ __
• Abdominal exam: tenderness, guarding, rebound, masses, bowel sounds
• PR exam: [performed / not performed]
• Hernial orifices, groin exam if indicated

📋 Impression:
Likely cause: [appendicitis / diverticulitis / obstruction / gastritis / other]

📌 Plan:
• NBM, IV fluids
• Bloods: FBC, U&E, LFTs, amylase/lipase, CRP
• Urinalysis and β-HCG if applicable
• Imaging: AXR/US/CT as indicated
• Analgesia (avoid opioids if uncertain diagnosis)
• Escalate to senior / surgical review

👤 [Your Name], [Role]
IMC: _______
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    Abdominal Pain 🤢 - BetterCall.ie