Initial assessment
- ABC’s
- Pain out of control – may need to give small doses of narcotic in order to be able to take a history and do a physical exam
- IV, O2
History
- Onset: sudden (specific event – torsion, rupture, stone, obstruction) versus gradual
- Location
- RUQ
- LUQ
- Epigastric
- RLQ
- LLQ
- Suprapubic
- Duration
- Severity
- Character
- Alleviating/Aggravating factors
- Radiation
- Symptoms associated – GI, urinary, gynaecologic (LMP)
Physical exam
- Obviously a complete abdominal exam is necessary in all cases
- Rectal exam
- Pelvic exam
- Genitalia
- Respiratory
- Cardiovascular
Differential diagnosis
By system
- GI
- Urinary
- Gynecologic/Genitalia
- Respiratory
- Cardiovascular
- MSK
By process
- Vascular (ischemia, embolism, infarction, hemorrhage)
- Infection
- Perforation
- Obstruction
- Inflammation
- Torsion
By location (not exhaustive…)
- RUQ
- Gallbladder and biliary tree
- Biliary colic
- Acute cholecystitis
- Ascending cholangitis
- Pancreas
- Pancreatitis (i.e.gallstone)
- Liver
- Lung
- RLL pneumonia
- Bowel
- Appendix (high)
- Gallbladder and biliary tree
- Epigastric
- Stomach and duodenum
- Gastritis
- PUD
- Pancreas
- Heart
- MI inferior
- Aorta
- AAA, rupture
- Stomach and duodenum
- LUQ
-
- Stomach
- Pancreas
- Lung
- RLQ
- GI
- Appendix
- GU
- Stone
- Pyelonephritis
- Ectopic
- Torsion/Epididymitis
- Cyst rupture
- GI
- LLQ
- GI
- Diverticulitis
- GU
- GI
Investigations
- Investigations should be guided by the history and physical exam
- Bloodwork
- CBCD, electrolytes, glucose, urea, Cr
- LFTs, lipase, lactate (increases during underperfusion/ischemia)
- Quantitative serum beta HCG
- Type/Screen, crossmatch
- Urinalysis
- Imaging
- 3 views of the abdomen
- Ultrasound
- CT
Pain management and symptom control
- Buscopan 10-20mg IV
- Morphine 2.5-10mg IV
- Hydromorphone (Dilaudid) 0.5-2mg IM/SC/IV
- NSAIDS: Toradol 30mg IV, Voltaren supp.
- Gravol or Maxeran for nausea and emesis
- PO – Tylenol #3, percocet, Ibuprofen