Abdominal pain or pain in the belly is the reason for around 5% of all emergency department visits. It is a symptom but may signify a life-threatening condition underneath.

Types of abdominal pain

• Sometimes the pain may be acute among patients with an existing condition including those with peptic ulcer disease, acute pancreatitis among alcoholics etc.
• Sometimes there may be acute pain in an otherwise normal person. This includes examples like appendicitis, gastritis, biliary colic, gastroenteritis etc.
• Acute pain following injury to the abdomen which includes rupture of the liver, spleen etc.

Examination and diagnosis

Examination, level of emergency and urgency of diagnosis and management depends on the cause of the pain. All patients with abdominal pain do not require diagnostic tests.  Sometimes, clinical evaluation alone is sufficient for diagnosis and management.

Some of the major factors that are assessed by emergency physicians include:-

• Degree of pain - severity is best evaluated with a familiar 1-10 scale.
• Changes in vital signs like heart rate, blood pressure, respiratory rate. If the vitals are abnormal with heart rate over 100 beats per minute, blood pressure less than 100 (systolic), respiratory rate over 20 per minute etc. a deeper cause should be suspected.
• History of any disease like diabetes, alcoholism, or injury that may provide clues for diagnosis.
• Location of the pain - there are six anatomic locations. These include – right hypochondriac region, epigastrium, left hypochondriac region, right lumbar, left lumbar, umbilical, right iliac, left iliac and hypogastric region.
• Nature of onset of the pain. Pain may originate abruptly or may begin slowly over time.
• Nature of pain.
• Radiation of the pain or if the pain moves to the back or to the groin.
• Any presence of aggravating and reliving factors. For example, some pains may be relieved after eating and some after sitting or lying in a particular position.
• Presence of other symptoms such as vomiting, diarrhea, dizziness, pain on urination etc.

Diagnosis of cause

If the cause cannot be ascertained and the patient appears ill, laboratory diagnostic methods may be employed to detect the cause. Usual tests include complete blood counts, electrolytes assessment, creatinine and BUN levels in blood, liver and renal function tests etc.

Next imaging studies are prescribed. These include ultrasonography, abdominal CT scan, abdominal MRI scan etc. Abdominal ultrasound is one of the commonest used and best non-invasive techniques to detect cause of abdominal pathology.

Urine and stool examination in the laboratory are also prescribed to detect pathology. Other ancillary tests include Electrocardiography (ECG), Arterial Blood gas analysis (ABG) etc.

Management of abdominal pain

Pain is managed right away usually with morphine sulfate at 0.5-0.1 mg/kg or 2-4 mg IV or IM.  Fluids mainly via intravenous routes are offered to patients with severe abdominal pain. This is because most patients with serious abdominal pain are dehydrated.

Antibiotics are prescribed for acute inflammatory processes such as cholecystitis, appendicitis and diverticulitis. A nasogastric tube may be placed in the stomach and some patients may require blood transfusion as well.

Those with surgical causes of pain abdomen like cholesystitis (gall bladder stone), appendicitis etc. may require emergency surgery for management.