![]() Treatment of Mild to Moderate Abdominal Painĭespite the broad differential diagnosis for abdominal pain, management is relatively universal. Additionally, diligence and high suspicion of dangerous etiologies are required among older patients, patients with prior abdominal surgeries, psychiatric patients, and women of reproductive age who have an increased pretest probability of surgical pathology. 3,4 The patient description of pain severity should still be considered the gold standard. ![]() 2 However, research has shown that vital signs are a poor correlator to pain and that patients in severe pain can present with otherwise normal vital signs. For example, hypotension and relative bradycardia should raise a red flag for the parasympathetic reflex seen in ectopic pregnancy rupture or free fluid in the abdomen. The presence or absence of fever, tachycardia, and hypotension are essential clues to the severity and etiology of the pain. Association with food or defection, last bowel movement, last menstrual period and current sexual activity, prior surgical procedures, and passage of gas are essential components of history that can aid in focusing the differential diagnosis. Asking about medications taken before arrival – what, when, the quantity taken - will also play a role in determining what analgesic option is the most appropriate for use in the ED. The location, onset, severity, provoking features, and associated symptoms can assist emergency physicians in better understanding the pathophysiology behind the pain. History and Physical of Abdominal PainĪ thorough history and physical is of the utmost importance when assessing abdominal pain. A woman of childbearing age with acute abdominal pain should be considered pregnant until proven otherwise. 1 Serious diagnoses must be considered, including, but not limited to, appendicitis, cholecystitis, pyelonephritis, pancreatitis, bowel obstruction or malrotation, diverticulitis/colitis, abdominal aortic aneurysm, ovarian or testicular torsion, ectopic (ruptured or unruptured) pregnancy, atypical acute coronary syndrome, diabetic or alcoholic ketoacidosis, and mesenteric ischemia. An over-reliance on physical exam findings, vital signs, or lab tests can often lead to missed diagnoses. Similar to many pain presentations, abdominal pain is a symptom, not a diagnosis – pain may diminish with effective treatment, but identification of the underlying source and ruling out of life-threatening pathology is essential. 1 The pathology encompassing abdominal pain is vast and ranges from mild, transient conditions to severe, life-threatening abdominal catastrophes. 1 Abdominal pain provides unique diagnostic and pain management challenges, as the severity of illness may be unrelated to the degree of pain.Ī definitive diagnosis can also be difficult, with up to 25% of all abdominal pain evaluated in the ED receiving a diagnosis of "undifferentiated" abdominal pain. ![]() Joseph' University Medical Center Abdominal pain is one of the most common chief complaints among patients in the emergency department, comprising approximately 5% of all ED visits. Joseph's University Medical CenterĪlexis M.
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