The management of abdominal pain depends on many factors, including the etiology of the pain. In the emergency department, a person presenting with abdominal pain may initially require IV fluids due to decreased intake secondary to abdominal pain and possible emesis or vomiting. Treatment for abdominal pain includes analgesia, such as non-opioid (ketorolac) and opioid medications (morphine, fentanyl). Choice of analgesia is dependent on the cause of the pain, as ketorolac can worsen some intra-abdominal processes. Patients presenting to the emergency department with abdominal pain may receive a "GI cocktail" that includes an antacid (examples include omeprazole, ranitidine, magnesium hydroxide, and calcium chloride) and lidocaine. After addressing pain, there may be a role for antimicrobial treatment in some cases of abdominal pain. Butylscopolamine (Buscopan) is used to treat cramping abdominal pain with some success. Surgical management for causes of abdominal pain includes but is not limited to cholecystectomy, appendectomy, and exploratory laparotomy. Emergencies Below is a brief overview of abdominal pain emergencies. + Condition Presentation Diagnosis Management Appendicitis Abdominal pain, nausea, vomiting, fever Periumbilical pain, migrates to RLQ Clinical (history & physical exam) Abdominal CT Patient made NPO (nothing by mouth) IV fluids as needed General surgery consultation, possible appendectomy Antibiotics Pain control Cholecystitis Abdominal pain (RUQ, radiates epigastric), nausea, vomiting, fever, Murphy's sign Clinical (history & physical exam) Imaging (RUQ ultrasound) Labs (leukocytosis, transamintis, hyperbilirubinemia) Patient made NPO (nothing by mouth) IV fluids as needed General surgery consultation, possible cholecystectomy Antibiotics Pain, nausea control Acute pancreatitis Abdominal pain (sharp epigastric, shooting to back), nausea, vomiting Clinical (history & physical exam) Labs (elevated lipase) Imaging (abdominal CT, ultrasound) Patient made NPO (nothing by mouth) IV fluids as needed Pain, nausea control Possibly consultation of general surgery or interventional radiology Bowel obstruction Abdominal pain (diffuse, crampy), bilious emesis, constipation Clinical (history & physical exam) Imaging (abdominal X-ray, abdominal CT) Patient made NPO (nothing by mouth) IV fluids as needed Nasogastric tube placement General surgery consultation Pain control Upper GI bleed Abdominal pain (epigastric), hematochezia, melena, hematemesis, hypovolemia Clinical (history & physical exam, including digital rectal exam) Labs (complete blood count, coagulation profile, transaminases, stool guaiac) Aggressive IV fluid resuscitation Blood transfusion as needed Medications: proton pump inhibitor, octreotide Stable patient: observation Unstable patient: consultation (general surgery, gastroenterology, interventional radiology) Lower GI Bleed Abdominal pain, hematochezia, melena, hypovolemia Clinical (history & physical exam, including digital rectal exam) Labs (complete blood count, coagulation profile, transaminases, stool guaiac) Aggressive IV fluid resuscitation Blood transfusion as needed Medications: proton pump inhibitor Stable patient: observation Unstable patient: consultation (general surgery, gastroenterology, interventional radiology) Perforated Viscous Abdominal pain (sudden onset of localized pain), abdominal distension, rigid abdomen Clinical (history & physical exam) Imaging (abdominal X-ray or CT showing free air) Labs (complete blood count) Aggressive IV fluid resuscitation General surgery consultation Antibiotics Volvulus Sigmoid colon volvulus: Abdominal pain (>2 days, distention, constipation) Cecal volvulus: Abdominal pain (acute onset), nausea, vomiting Clinical (history & physical exam) Imaging (abdominal X-ray or CT) Sigmoid: Gastroenterology consultation (flexibile sigmoidoscopy) Cecal: General surgery consultation (right hemicolectomy) Ectopic pregnancy Abdominal and pelvic pain, bleeding If ruptured ectopic pregnancy, the patient may present with peritoneal irritation and hypovolemic shock Clinical (history & physical exam) Labs: complete blood count, urine pregnancy test followed with quantitative blood beta-hCG Imaging: transvaginal ultrasound If patient is unstable: IV fluid resuscitation, urgent obstetrics and gynecology consultation If patient is stable: continue diagnostic workup, establish OBGYN follow-up Abdominal aortic aneurysm Abdominal pain, flank pain, back pain, hypotension, pulsatile abdominal mass Clinical (history & physical exam) Imaging: Ultrasound, CT angiography, MRA/magnetic resonance angiography If patient is unstable: IV fluid resuscitation, urgent surgical consultation If patient is stable: admit for observation Aortic dissection Abdominal pain (sudden onset of epigastric or back pain), hypertension, new aortic murmur Clinical (history & physical exam) Imaging: Chest X-Ray (showing widened mediastinum), CT angiography, MRA, transthoracic echocardiogram/TTE, transesophageal echocardiogram/TEE IV fluid resuscitation Blood transfusion as needed (obtain type and cross) Medications: reduce blood pressure (sodium nitroprusside plus beta blocker or calcium channel blocker) Surgery consultation Liver injury After trauma (blunt or penetrating), abdominal pain (RUQ), right rib pain, right flank pain, right shoulder pain Clinical (history & physical exam) Imaging: FAST examination, CT of abdomen and pelvis Diagnostic peritoneal aspiration and lavage Resuscitation (Advanced Trauma Life Support) with IV fluids (crystalloid) and blood transfusion If patient is unstable: general or trauma surgery consultation with subsequent exploratory laparotomy Splenic injury After trauma (blunt or penetrating), abdominal pain (LUQ), left rib pain, left flank pain Clinical (history & physical exam) Imaging: FAST examination, CT of abdomen and pelvis Diagnostic peritoneal aspiration and lavage Resuscitation (Advanced Trauma Life Support) with IV fluids (crystalloid) and blood transfusion If patient is unstable: general or trauma surgery consultation with subsequent exploratory laparotomy and possible splenectomy If patient is stable: medical management, consultation of interventional radiology for possible arterial embolization
symptom of Gastroparesis
symptom of Gastritis
symptom of Vomiting
symptom of Short bowel syndrome
symptoms of Short bowel syndrome
symptom of Gastroenteritis
symptom of Gastroesophageal reflux disease
symptom of Peptic ulcer disease