Abdominal Pain 🤢
Clinical guide for assessing abdominal pain. Differential diagnosis, red flags, surgical abdomen, investigations, and management for on-call doctors.
📋 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
Note Template
Ready-to-use clinical note structure
🕒 26 / 05 / 2026 — 17:09 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: _______