Abdominal Pain Basics

Elderly people die from abdominal pain Step 1: Risk Stratify * Certain patient groups have VERY high mortality when having abdominal pain* Geriatrics* Immunocompromised* Diabetics Step 2: Consider Genitourinary Causes * Be especially cautious with lower abdominal/flank pain* Mention that you performed or considered performing GU exam during presentation!* Common GU causes of abdominal pain* Testicular/ovarian torsion* Prostatitis/pelvic inflammatory disease* Ectopic pregnancy Step 3: High-Yield Tests to Consider * CBC and Electrolytes* EKG and Troponin* Liver Panel and Lipase* Urinalysis and Urine pregnancy Step 4: Order Appropriate Imaging * CT scan is most useful test with abdominal pain in adults* Need to give IV contrast if concerned for vascular pathology* Usually performs just as well as ultrasound (even in cases where ultrasound is the classic, initial test)* 3 “exceptions” to the CT first rule* If concerned for biliary pathology* RUQ ultrasound* If concerned for genitourinary pathology* Testicular/Pelvic ultrasound* Renal ultrasound (kidney stone)* If concerned for Abdominal Aortic Aneurysm* Bedside Aorta ultrasound Step 5: Disposition * Classic teaching is that patients discharged with undifferentiated abdominal pain need follow up in 12-24 hours* It’s ok to have them come back to the ED if necessary Additional Reading * Abdominal Pain History (EM Clerkship)* Abdominal Pain Exam, Plan, and Disposition (EM Clerkship)