Important causes of abdominal pain
Abdominal (tummy) pain is one of the most common presentations to the emergency department. The causes lie on a spectrum that ranges from harmless to life-threatening. Having a differential diagnosis (ddx) in mind helps guide medics through assessment, triage appropriately, and choose relevant investigations.
Pain in the tummy does not point accurately to its source, as on the hand or face, which makes things a little more tricky. The abdomen can be mentally divided into a 3x3 grid, and important diagnoses considered based on the anatomy lying under each section. It can also be helpful to think across three systems:
Gastrointestinal - the path from mouth to anus, including the liver and pancreas
Urogenital - the path from kidneys to urethra, including the sex organs
Cardiorespiratory - the heart, lungs, and extended blood vessels
Below are my visual summaries of the important causes for each:
For the love of glob do not forget about diabetes! We were told of a terrible case where a teenager was sent home from an emergency department with a diagnosis of constipation, and found dead in bed the following morning by their parents. Their tummy pain and other symptoms were the first presentation of a diabetic ketoacidosis. The blood sugar had not been checked. This is a rapid test that can reassure, or direct further investigation.
Testing the urine, including a pregnancy test for women, are basic but incredibly helpful tests for filtering through diagnoses to ensure you don’t miss something big. This helps decisions about the best speciality to refer for review or taking over a case.
Cardiovascular and respiratory
Don’t forget about referred abdominal pain from the heart, aneurysms, and chest infections. The basics of an ECG and chest xray can go a long way to reassure or catch important diagnoses.
A structured approach can be helpful to interpret and investigate abdominal pain. A good history, examination, and simple investigations can catch or exclude most of the scary things, and if needed - get the patient to the right speciality and treatment faster.
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