Acute Abdominal Pain

Abdominal disorders, both chronic and acute, can cause abdominal pain in adults and children alike. Often the pain is due to a minor or temporary issue, but sometimes it can be much more serious. For example, ruptured abdominal aortic aneurysm (AAA), perforated viscus, mesenteric ischemia, and ruptured ectopic pregnancy would be emergencies requiring immediate treatment. Although slightly less urgent, other conditions such as intestinal obstruction, appendicitis and severe acute pancreatitis are also extremely serious.

Types of pain

These are the different types of pain to be aware of:

Visceral pain

Visceral pain is typically due to distention and/or muscular contraction. It is therefore not due to cutting, tearing, or local irritation. Visceral pain is also usually a vague, dull, nauseating pain that isn’t easy to locate and can feel like it covers a wide area.

Foregut structures (the stomach, liver, duodenum, and pancreas) tend to cause upper abdominal pain. Midgut structures (small bowel, appendix and proximal colon) cause pain around the navel. Hindgut structures (genitourinary tract and distal colon) typically cause lower abdominal pain.

Referred pain

Referred pain is pain that is perceived a long way from its source due to neural connections. Common examples include groin pain due to renal colic, scapular pain due to biliary colic, and shoulder pain due to blood or infection irritating the diaphragm.

Somatic pain

Somatic pain is caused by inflammation. This can be the result of an infection, allergy or poisoning. It’s a sharp, focussed pain (unlike visceral pain) and is therefore easy to pinpoint.

Diagnosing the source of the pain

Regardless of the type of pain your patient is presenting with, it’s essential to ask the right questions and undertake a physical examination in order to ascertain the cause. If the abdominal pain is very severe then it should be treated as urgent as some conditions like appendicitis require emergency action. Patients that are less severely in pain or who have a chronic condition will likely require longer term evaluation and support.

Physical examination

Focus on the abdomen, beginning with inspection and auscultation before carrying out palpation and percussion. Pelvic and/or rectal examinations may be required to locate tenderness and any masses. Look out too for involuntary contractions of the abdominal muscles. These are slightly slower and more sustained than the rapid, voluntary flinches exhibited by sensitive or anxious patients.

Red flags

If the patient is presenting with any of the below then they should be treated as an emergency case:

• Extremely severe pain
• Abdominal distention
• Signs of shock (for example, hypotension, confusion, tachycardia or diaphoresis)
• Signs of peritonitis

Abdominal pain is extremely common but identifying the cause and treatment is typically not straight-forward

If you’re a nurse, junior doctor, medical student, paramedic or other allied health professional who regularly sees patients presenting with abdominal pain then you may find our Minor Ailments Essentials CPD course helpful. It’s designed for practitioners confident in taking a history and physical examination but who wish to focus on the common and not so common patient complaints seen in primary health care.

Held over 3 days, the course is worth 21 hours of CPD on is entirely online. There are two starting dates to choose from: 16th December 2020 (finishing on the 18th) and 21st April 2021, finishing on the 23rd. 

Additionally, there’s our popular Minor Illness Triage course too. It’s an interesting and highly interactive course that will provide the tools for competent basic triage. It also focuses on history taking and essential observations for safe patient management in triage.

This popular online course is specifically designed for practitioners who see patients with undifferentiated illnesses, and is lasts one day (7 hours of CPD).

Finally, our Minor ailments: GI conditions for the primary care practitioner is also well worth considering. Offered entirely online, it’s ideal for flexible, socially distanced learning that’s still highly interactive.

Set to run on the 11th December, this one is aimed at community nurses, practice nurses, registered nurses and other allied health professionals. Worth 4 hours of CPD, the course is a half-day session that looks at a range of gastro-intestinal conditions, including their diagnosis, treatment and cure.

Sign up and secure your place today. Or of course, if you have any questions feel free to contact us.