3.1. ABDOMINAL PAIN

Related terms

None

Purpose of care

1. To improve the patient’s health.
2. Identify life-threatening causes of abdominal pain.

Patient description

Inclusion criteria

Abdominal pain or discomfort not caused by trauma.

Exclusion criteria

1. Pain due to trauma (see General Trauma guideline).
2. Abdominal pain due to or associated with pregnancy (see the OB/GYN guideline).

Patient management

Assessment

1. Assess the airway according to the guideline “Airway management”.

2. Assess vital signs – pulse, respiratory rate, pulse oximetry, blood pressure.

3. Assess and treat pain according to the Pain Management guideline.

4. Provide intravenous access (if necessary) for administration of analgesics and/or infusion therapy.

5. Assess for life-threatening causes of abdominal pain, including:

a) ischemia (thrombosis), necrosis, or perforation of the intestine:

• • • • hyperesthesia;
      • abdominal pain with simultaneous abdominal movement/tremors;
      • fever
      • blood in the stool
      • nausea and vomiting;
      • possible absence of stool/no gas passage;
      • abdominal tension with possible tympanitis to percussion;

b) tearing or rupture of an abdominal aortic aneurysm:

• • • • unequal pulse on femoral arteries and distal arteries of the lower extremities;
      • pulsation in the abdominal area;
      • radiation of pain to the back and/or chest pain;
      • known information about the presence of an aortic aneurysm;

c) ectopic pregnancy:

• • • • vaginal bleeding;
      • recently diagnosed pregnancy;

d) menstrual irregularities/absence of menstruation in women of childbearing age in recent years;

e) appendicitis:

• • • • localized sensitivity in the right lower quadrant with possible muscle tension;
      • sensitivity in the right lower quadrant during palpation of the left lower quadrant (positive Rovzing’s symptom);
      • tenderness around the navel or diffuse sensitivity in the abdomen during abdominal/pelvic palpation;
      • fever
      • nausea, vomiting;
      • lack of appetite;

e) acute cholecystitis:

• • • • sensitivity in the right upper quadrant or in the epigastric region;
      • fever
      • nausea, vomiting;
      • history of gallstones in the gallbladder;

f) pyelonephritis:

• • • • fever
      • nausea, vomiting;
      • frequent urination/urinary incontinence;
      • dysuria
      • hematuria;
      • pain in the back/side;
      • sensitivity in the lumbar region during percussion.

6. Assess for signs of shock.
If shock is present, treat according to the Shock guideline.

7. Assess for other non-life-threatening causes of abdominal pain.
Kidney stones (renal colic):

• • • • pain on one side only;
      • nausea, vomiting;
      • possible hematuria.

Administration of medications:

a) provide pain relief according to the Pain Management guideline;
b) administer antiemetics according to the Nausea/Vomiting guideline;
c) provide transportation to the appropriate emergency department.
Consider transport to a tertiary care center for conditions such as suspected abdominal aortic aneurysm;
d) reassess vital signs and responses to therapeutic interventions during transportation.

No recommendations.

Useful information for training

Key points

1. Assess for life-threatening causes of pain.
2. Provide appropriate care for pain, vomiting, and shock.
3. If an aortic aneurysm is suspected, ensure that the patient is transported to a specialized unit.

Relevant assessment results

1. Positive Shotkin-Blumberg symptom.
2. Tension in the abdominal muscles.
3. Abdominal distension.
4. Tenderness during percussion.
5. Sensitivity in a certain quadrant of the abdomen.
6. The presence of pulsation in the abdominal area.
7. Absence or significant difference between the pulse on the femoral arteries or distal arteries of the lower extremities.
8. Hypo/hyperthermia.
9. Rectal bleeding, blood in vomit, vaginal bleeding.

Key elements of documentation

1. Abdominal examination, which should include all findings of palpation/percussion, including the presence or absence of tumors and the presence and nature of pain.
2. Treatment and response to treatment.

Criteria for the effectiveness of care

1. Assessment of life-threatening conditions.
2. Reduction of pain according to the guideline “Pain Management”.