Abdominal Pain, Emergency Medicine

Reviewed 06/2017
 


Basics

Description

  • Parietal pain:

    • Irritating material causing peritoneal inflammation

    • Pain transmitted by somatic nerves

    • Exacerbated by changes in tension of the peritoneum

    • Pain is sharp, well localized wi...

Diagnosis

Signs and Symptoms

History

  • Pain

    • Nature of onset of pain

    • Time of onset and duration of pain

    • Location of pain initially and at presentation

    • Extra-abdominal radiations

    • Quality of pain (sharp, dull, cr...

Treatment

Ed Treatment/Procedures

  • Nasogastric tube decompression and bowel rest

  • IV fluids and electrolyte repletion

  • Antiemetics are important for comfort.

  • Narcotics or analgesics should not be withheld.

  • Se...

Follow-Up

Disposition

Admission Criteria

  • Surgical intervention

  • Peritoneal signs

  • Patient unable to keep down fluids

  • Lack of pain control

  • Medical cause necessitating in-house treatment (MI, DKA)

  • IV antibiotics...

Pearls and Pitfalls

  • Elderly patients are more likely to present with atypical presentations and life threatening etiologies requiring admission.

  • Do not consider constipation if stool is absent in the r...

Additional Reading

  • Flasar  MH, Cross  R, Goldberg  E. Acute abdominal pain. Prim Care.  2006;33(3):659–684.

  • McNamara  R, Dean  AJ. Approach to acute abdominal pain. Emerg Med Clin North Am.  ...

Codes

ICD9

  • 789.00 Abdominal pain, unspecified site

  • 789.06 Abdominal pain, epigastric

  • 789.07 Abdominal pain, generalized

  • 789.09 Abdominal pain, other specified site

  • 789.01 Abdominal pain, right upper quadra...

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