4

Abdominal pain

Acute abdominal pain: overview

ABCDE

Evidence of shock?

Yes

Resuscitate, urgent surgical review

Consider ruptured AAA / ectopic pregnancy / spleen

No

Generalised peritonitis?

Yes

Likely perforated viscus

Erect CXR
Urgent surgical
review

No
Full clinical assessment, FBC, U+E, CRP

Features of intestinal obstruction?

Yes

Abdominal
X-ray

Intestinal obstruction

No

Acute and/or bloody diarrhoea?

Yes

Gastroenteritis / colitis

No

Unilateral loin or flank pain?

Yes

Likely renal colic

CT Kidney,
ureter and
bladder

No

Pain localised to upper or lower

abdomen?

Yes

See Assessment of upper abdominal pain

or lower abdominal pain

No

30

Consider mesenteric ischaemia, Crohns disease, gastroenteritis, irritable bowel syndrome,

medical causes. Surgical review CT abdomen if any concern