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Assessment of Abdominal Pain

Assessment of Abdominal Pain. Multiple Aetiologies. Bowel Hepatic system Spleen Renal tract Vascular Reproductive tract Musculoskeletal Above the diaphragm Other - biochemical - endocrine. Abdo Pain. Type of pain: Visceral - ill defined, diffuse - midline - stretching

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Assessment of Abdominal Pain

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  1. Assessment of Abdominal Pain

  2. Multiple Aetiologies • Bowel • Hepatic system • Spleen • Renal tract • Vascular • Reproductive tract • Musculoskeletal • Above the diaphragm • Other - biochemical - endocrine

  3. Abdo Pain Type of pain: • Visceral - ill defined, diffuse - midline - stretching • Somatic - parietal peritoneum is inflamed - constant and localised • Referred

  4. Emergency department’s job is to recognise life threats and potential life threats through focused history and exam. • TREAT PAIN while doing this!!!!

  5. History PAIN CHARACTERISTICS • ONSET - sudden and severe suggests perforation/ rupture, ischaemia,duct or tube blockage. • NATURE: - colicky suggestive of obstruction of hollow viscus. - constant suggests inflammation • LOCATION • REFERRAL: - classic patterns • EXACERBATING/RELIEVING FEATURES - enquire about association with movement, coughing, lying position, passing urine, opening bowels

  6. ASSOCIATED SYMPTOMS - nausea/ vomiting – non specific but persistence of same suggests GIT. - anorexia – GIT but also inflam. process - stool frequency/consistency - urinary symptoms - reproductive tract symptoms and sexual history - cardio /resp. symptoms

  7. Previous episodes • Previous abdo ops • Brief past medical history • Medications – which ones

  8. Examination • General - demeanor, colour, diaphoresis, positioning • Vitals • Abdomen - inspection - palpation - position correctly - use distraction - auscultation??? - hernias - genitals - PV /PR • Rest of Body

  9. Investigation • Bedside – U/A,+/- BHCG, BSL,VBG, ECG, FAST scan • Bloods – FBC,UEC, LFTs, Lipase • XRAYS ???? • Ultrasound - gynae /testicular - hepatic /biliary tree - renal - appendicitis??? • CT scan - time consuming - contrast - radiation

  10. Treatment • Analgesia - opioids - NSAIDS - paracetamol • Anti emetics • IV fluids • Antibiotics

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