Abdominal Pain (HB)

Abdominal pain is one of the hardest things to diagnose with a patient. We don’t have a magic window into the abdomen so we really have to ask good questions during SAMPLE History.

We have two main concerns: solid and hollow organs.

Solid organs are most prone to damage from trauma. These organs include the liver, kidneys, and spleen. Massive internal bleeding is likely to originate from one of these organs if there is trauma to the abdomen. Be on the lookout for positive mechanisms and signs of volume shock (increased heart rate and respirations while at rest). Damage to any of these organs requires surgical intervention as soon as possible.

Hollow organs present another set of problems. Pain to hollow organs typically comes from stretching due to gas, fluid, or other temporary causes. Once the gas or fluid passes, the pain goes away (though it may return intermittently). This type of pain is generally more of a “cramp” than anything else.

When we get an obstruction in a hollow organ is when things get dangerous. Appendicitis is an infection from an obstruction of the appendix. Severe constipation is a blockage of the colon.

One upside is that we really cannot treat many things, so we should immediately refer any red flags for a rapid evacuation.

Signs and Symptoms

Signs and symptoms can be really varied here. Pain can be acute and pinpoint, or diffuse and achy. Problems could manifest with a fever or a change in vital signs.  The patient could also be dehydrated.

Pay very close attention to patient complaints and do a good job with patient history.

Treatment

Depending on the cause you should let the problem run its course. Try and keep up with hydration, nutrition, and hygiene.

If the patient has gas, tell them to let it out. If they haven’t had a bowel movement, encourage them to do so. If they are having diarrhea, push water and keep up with hygiene.