approach to abdo pain

abdominal-pain

Abdominal pain is a very common presentation to the ER, with diagnoses that range from benign to life-threatening. It’s easy to reduce abdo pain to the GI system and simply rely on the quadrant approach–missing other emergencies, from heart attacks to testicular torsions. Because the differential is so wide and potentially deadly, we need an approach that guides us through the body systems.

A: ABCDEFGHIJKLM

  • Anaphylaxis can present with GI complaints
  • Mono

B: CHEST

  • Sick pneumonia: lower lobe pneumonias can present as abdominal pain, especially in children

C: CARDIOVASCULAR

  • Dysfunctional LV: MI can present with epigastric pain, especially in the elderly
  • Outflow dissection: aortic dissection can present with chest and abdo pain
  • Abdominal bleed, e.g. liver/spleen
  • Soft tissue bleed, e.g. AAA
  • Child-bearing: ectopic
  • Urticaria: anaphylaxis
  • Lactate: sepsis from GI/GU source
  • Addisonian

D

E: ENDO

  • Electrolye: DKA, hypercalcemia,
  • Ormones: adrenal

F: CREATININE/PELVIS/TESTICLE

  • creatinine: Renal artery/vein thrombosis, Impacted stone, Enlarged prostate (retention)
  • female: Pregnant Ectopic Luteal cyst hemorrhage Vascular torsion Infection Structural (eg fibroid)
  • male: Torsion Epididymitis Structural (eg varicocele/hydrocele) Torsion of appendix Incarcerated hernia Cancer Lymph node (orchitis) Enoch-Schonlein

G: ABDOMINAL

  • Ammonia/ascites: hepatitis, ascites
  • Biliary: biliary disease
  • Dyspepsia: ulcer
  • Organomegaly: splenic injury/rupture
  • Mesenteric ischemia
  • Islets: pancreatitis
  • No motion: bowel obstruction
  • Appy
  • Loose stool: colitis

H: HEME

  • Hemoglobin: sickle cell
  • Early platelet plug: HSP

I: INTOX

  • Ingest: alcohol/withdrawal, marijuana
  • Naturopathic
  • Treatment: opioid withdrawl
  • OTC: NSAID
  • X poison: lead, isopropyl alcohol

J: joint, skin, bone

  • skin: painful rash, eg zoster

 

Putting this together gives a streamlined approach that doesn’t reduce abdo pain to the GI system but puts the GI system in the context of all the body systems that can cause pain, while focusing the history, physical, bedside ultrasound and investigations on emergent diagnoses:

  • A: ask about sore throat or exposures to new medications, consider rapid strep or mono spot
  • B: ask about fever/cough, listen to lungs, consider CXR
  • C: ask about chest pain, cardiac risks, trauma, pregnancy; get an ECG and perform bedside cardiac/abdo ultrasound; initiate early treatment
  • D
  • E: check electrolytes
  • F: examen pelvis/testicles, consider abdo/pelvic ultrasound
  • G: examen abdomen, check labs for liver enzymes, lipase, lactate; consider ultrasound or CT
  • H: check CBC
  • I: assess history of medications/drugs/toxins
  • J: look for zoster or other painful rashes

abdopain

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