Abdominal Pain

Exam Cram

• Abdominal pain red flags include peritonism on examination, raised lactate and bloody stool

• Key differentials usually bowel perforation, intrabdominal sepsis or malignancy and often require a CTAP with contrast

• Management: analgesia- paracetamol if normal LFTs & treat underlying cause

Assessment

Background

From my experience the vast majority of unexplained abdominal pain in over 60yrs receive a CTAP with contrast. 

History

Location

• RUQ- biliary colic, hepatitis

• Epigastric- pancreatitis, peptic ulcer

• RIF- appendicitis

• LLQ- diverticulitis, faecal loading

Post prandial abdominal pain: Biliary colic, Pancreatic insufficiency, Mesenteric ischaemia

Severe: bowel perforation, pancreatitis, ischaemic colitis, bowel obstruction, AAA

Colic: episodic- biliary stone disease, constipation/ bowel obstruction

Examination

• A-E examination with observations

• Abdominal exam

  • Hepato/splenomegaly or organ masses

  • Rebound tenderness- peritonitis

  • Guarding- tensing abdominal muscles

Investigations

• Baseline: FBC, EUC, LFTs, CRP- surgeons often ask for CRP

• Lactate, B-HCG

• Imaging: usually CTAP with contrast, consider CT Angio (ischaemic colitis/ AAA) or erect CXR (bowel perforation)

• Urine analysis +- urine culture, blood cultures

Differential Diagnoses

Gastrointestinal, Liver & Pancreas System

• Biliary Stone Disease

• Diverticulitis

• Appendicitis

• Hernia- direct, indirect

• Ulcerative Colitis, Crohn's Disease 

• Colorectal Cancer

• Coeliac Disease

• Constipation, IBS

• Acute hepatitis

• Acute pancreatitis

Urine System

• Pyelonephritis

• Cystitis

• Renal cancer

Female Reproductive System

• Pelvic Inflammatory Disease (PID)

• Ectopic Pregnancy

• Ovarian torsion

• Ruptured ovarian cyst

Male Reproductive System

• Testicular torsion

• Epididymo-orchitis

Vascular

• AAA (Abdominal Aortic Aneurysm)

Management

Principles

• Treatment focuses around the underlying cause

• Stabilise using A-E approach 

• IVF if dehydrated

Analgesia

• Paracetamol - unless raised ALT/ AST

• NSAIDs (considering contraindications) & Opioids

References and Resources

Written in 2025