Last Updated on July 18, 2022
“Abdominal pain — medical causes / surgical causes / O&G causes”
History Taking
Site: Ask patient to use one finger to point to the most painful region of the abdomen
Additional history in females
• LMP? Period regularity?
• Mode of contraception e.g. oral contraceptive pills, IUCD
(Note: contraception does not rule out pregnancy. Thus UPT should be performed, and/or confirmed by bedside abdominal USG)
• Any dysmenorrhoea?
• Any PV bleeding? Any PV discharge?
Differential Diagnosis
O&G causes of abdominal pain
• Ruptured ectopic pregnancy
• Ruptured ovarian cyst
• Endometriosis
• Endometritis / Pelvic inflammatory disease / Tubo-ovarian abscess (e.g. secondary to infected IUCD)
Medical causes of abdominal pain
• Diabetic ketoacidosis
Investigations
Imaging
(i) Chest X-rays
– Air under diaphragm ≈ perforated viscus
(ii) Abdominal X-rays
– To look for bowel dilatation
(iii) CECT Abdomen
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Others
IUCD in abdominal X-ray
Management (ED approach)
- Pain management — analgesia
- Fluid resuscitation e.g. if GI loss / shock
- POCT e.g. dxt, ECG, urine dipstick, UPT, bedside USG
- Laboratory tests e.g. FBC, RP, Ca, Mg, PO4, VBG
- Imaging — CXR, abdominal X rays / KUB X-rays
- Referral to primary team for disposition
Q&A
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