Abdominal Pain

Table of Contents

Aliases

None

Patient Care Goals

1. Improve patient comfort
2. Identify life-threatening causes of abdominal pain

Patient Presentation

Inclusion Criteria

Abdominal pain or discomfort related to a non-traumatic cause

Exclusion Criteria

1. Abdominal pain due to trauma [see General Trauma Management guideline]
2. Abdominal pain due to or related to pregnancy [see OB/GYN guidelines]

Patient Management

Assessment

1. Perform airway assessment and management per the Airway Management guideline
2. Obtain vital signs including pulse, respiratory rate, pulse oximetry, and blood pressure
3. Provide evaluation and management of pain per the Pain Management guideline
4. Obtain vascular access as necessary to provide analgesia and/or fluid resuscitation
5. Assess for life-threatening causes of abdominal pain, which may include:
   1. Ischemic, necrotic, or perforated bowel
      1. Severe tenderness
      2. Abdominal pain with motion or “jiggling” of the abdomen
      3. Fever
      4. Bloody stool
      5. Nausea and vomiting
      6. Possible absence of passage of stool or gas
      7. Abdominal distention, with possible tympany to percussion
   2. Dissecting or ruptured abdominal aortic aneurysm (AAA)
      1. Unequal femoral or distal lower extremity pulses
      2. “Pulsatile” abdominal mass
      3. Associated back pain and/or chest pain
      4. Known history of abdominal aortic aneurysm
   3. Ruptured ectopic pregnancy
      1. Vaginal bleeding
      2. Recently diagnosed pregnancy
      3. Recent missed period/menstrual cycle in women of childbearing age
   4.  Appendicitis
      1. Focal right lower quadrant tenderness, possibly with rebound and guarding
      2. Right lower quadrant tenderness noted during palpation of the left lower quadrant (positive Rovsing’s sign)
      3. Peri-umbilical or diffuse abdominal tenderness with palpation or “jiggling” of the abdomen/pelvis
      4. Fever
      5. Nausea, vomiting
      6. Lack of appetite
   5. Acute Cholecystitis
      1. Right upper quadrant or epigastric tenderness
      2. Fever
      3. Nausea and vomiting
      4. Possible history of gallstones
   6.  Pyelonephritis
      1. Fever
      2. Nausea, vomiting
      3. Urinary frequency/urgency
      4. Dysuria
      5. Hematuria
      6. Back/flank pain
      7. Costovertebral angle tenderness to percussion
6. Assess for signs of shock
   1. If shock is present, provide treatment per appropriate Shock guideline
7. Assess for other non-life-threatening causes of abdominal pain
   1. Kidney stone
      1. Unilateral flank pain
      2. Nausea, vomiting
      3. Possible Hematuria

Treatment and Interventions

1. Medication Administration:
   1. Provide analgesia per the Pain Management guideline
   2. Administer antiemetics per the Nausea-Vomiting guideline
2. Provide transport to an appropriate receiving facility. Consider specialty destination centers for conditions such as suspected abdominal aortic aneurysm or ectopic pregnancy
3. Reassess vital signs and response to therapeutic interventions throughout transport

Notes – Abdominal Pain