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Presentation

Abdominal Pain

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)

  1. Pain management — analgesia
  2. Fluid resuscitation e.g. if GI loss / shock
  3. POCT e.g. dxt, ECG, urine dipstick, UPT, bedside USG
  4. Laboratory tests e.g. FBC, RP, Ca, Mg, PO4, VBG
  5. Imaging — CXR, abdominal X rays / KUB X-rays
  6. Referral to primary team for disposition

Q&A

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