Evaluation of a patient with acute abdominal pain requires careful history, physical examination by skilled physician, in conjunction with selective diagnostic testing. Common causes of upper abdominal pain are:
- Acid peptic disease.
- Acute cholecystitis.
- Acute pancreatitis.
- Myocardial ischaemia.
- If pain started within seconds then it may be due to perforation of peptic ulcer or infarction.
- If pain is sudden in onset and accelerating then suspect biliary colic or pancreatitis.
- If pain is gradual in onset and increasing in intensity over several hours then it may be due to acute cholecystitis.
Overall appearance of the patient should be assessed.
Vitals should be noted.
- See the shape of abdomen,
- Look for tenderness, guarding, rigidity (features of peritonitis), and tender mass suggestive of acute cholecystitis.
- Note area of tenderness and rebound tenderness.
- Murphy’s Sign: It is usually present in biliary colic
- Absent bowel sounds indicate paralytic ileus.
- S/Creatinine and Blood Urea.
- Liver Function Tests.
- Pancreatic enzymes (Amylase and Lipase).
- Urine Exam.
- Keep the patient Pain-Free.
- H2-Blockers to prevent Stress Ulcer.
- Treat the Cause after Resuscitation.
- Pass NG Tube and Foley’s Catheter if indicated
- Resuscitate the patient with I/V Fluids if indicated
- Consider I/V Antibiotics.
- Surgery if indicated.