R10.0-4
DESCRIPTION
Abdominal pain is a common symptom, which may be non-specific. It is frequently benign, but may indicate a serious acute pathology. A thorough evaluation is necessary to exclude a surgical abdomen or other serious conditions.
The history should include:
- duration, location, type, radiation and severity of pain
- relieving or aggravating factors e.g. food, antacids, exertion
- associated symptoms e.g. fever or chills, weight loss or gain, nausea, vomiting, diarrhoea, cramps, fresh blood per rectum, melaena stools, jaundice, change in stool or urine colour, vaginal discharge
- past medical and surgical history
- medication history
- alcohol intake or intake of other recreational substances
- family history of bowel disorders
- menstrual and contraceptive history in women
- associated vaginal discharge in women with lower abdominal pain
Examination should emphasise detection of:
- tachycardia
- fever
- jaundice or pallor
- abdominal masses, distension, tenderness
- signs of peritonitis (rebound tenderness and guarding)
- features of possible associated diseases (e.g. HIV)
MEDICINE TREATMENT
Urinary tract infection:
See: Kidney and urological disorders.
Dyspepsia:
See: Dyspepsia, heartburn and indigestion, in adults.
Cancer pain e.g. pancreatic, gastric cancer
See: Chronic cancer pain.
Renal and biliary colic, or acute surgical abdomen:
- Morphine, IM/IV, 10 mg as a single dose and refer (Doctor prescribed).
- For IV morphine: dilute in 10 mL sodium chloride, 0.9%.
- Administer slowly over 5 minutes.
Symptomatic treatment if no specific cause or indication for referral is found:
Pain relief (adults):
Analgesia as appropriate. See: Pain control.
Abdominal cramp-like pains (adults):
- Hyoscine butylbromide, oral, 10 mg 6 hourly for a maximum of 3 days.
REFERRAL
- Severe pain that cannot be managed at primary level of care.
- Signs of acute abdomen.
- Associated bloody non-diarrhoeal stools. (Red currant jelly stools in children).
- Associated abdominal mass.