Abdominal Pain

Last updated 20.09.12

 

Definition

-  Pain arising between xiphisternum & pubic symphysis on the anterior aspect

 

Type of Pain

-  Sudden: perforation, rupture

-  Rapid: torsion: testicular torsion

-  Midline: consider unpaired structures

-  Lateralising: paired structures

-  Constant &/or dull: capsule stretching or inflammation

-  Colicky: hollow viscus obstruction

-  Localising &/or sharp: involvement of peritoneum: peritonitis

 

Pain Referral

-  Shoulder

-  Left: spleen, pancreatitis (tail), stomach

-  Right: gall bladder, liver

-  Either/both: pneumoperitoneum, diaphragm

-  Scapular

-  Left: spleen, pancreatitis (tail)

-  Right: gall bladder, biliary tree

-  Back

-  Pancreatitis, PUD +/- perforation, AAA

 

Regional Classification

-  By Quadrants

-  By Nine Regions

-  By Embryological Origin

 

 

 

 

By Quadrants

 

RUQ

LUQ

RLQ

LLQ

 

 

By Nine Regions

 

-  Epigastric

 

By Ebryological Origin

 

-  Upper abdomen: foregut

-  Lower oesophagus

-  Stomach

-  Duodenum

-  Pancreas

-  Spleen

-  Liver

-  Middle abdomen: midgut

-  Distal duodenum

-  Small bowel

-  Large bowel (to splenic flexure)

-  Lower abdomen: hindgut

-  Descending colon

-  Sigmoid colon

-  Back: retroperitoneal

-  Aorta

-  Pancreas

-  Kidney

-  Ovary

-  Testicle

 

 

Ix

-  Urine: dipstick +/- MSU for MCS: UTI

-  Abdo US

-  +/- ECG if no abdominal signs: exclude AMI/ACS

 

Mx

-  Analgesia

-  Do Not withhold for Dx

-  Does not hamper Ix & Dx

-  NBM, IV access & IV fluids