How to Assess Abdominal Pain

Assessing Abdominal Pain – Abdominal pain is a very common paramedic case and, although many paramedics develop good diagnostic techniques and are capable of developing a fair idea of what is wrong with the patient, generally, it does not differ their treatment. Our main role in treating abdominal pain is to treat the pain – not diagnose the problem. Even good doctors, will still require other diagnostic tests, such as ultrasound, urinalysis, stool sample, etc to definitively confirm their diagnosis.

Assess Abdominal Pain Characteristics.

Palpate the area and determine where the pain is. Like all other forms of pain assessment, it’s a good idea to follow some form of pattern. I like the pneumonic OPQRST (but understand that there are many other pneumonic out there). So check the onset, provocation, quality, region/radiation of the pain, severity, and time of onset and any treatment prior to paramedic’s arrival, and if this has helped or not.

When palpating the abdomen, ensure that you gently apply pressure with your fingers so that you can feel any rigidity, guarding, mass, or spasms. This does require you to place a certain amount of pressure on the abdomen. You may assess the regions of the abdomen into 4 quadrants: right upper quadrant, left upper quadrant, right lower quadrant, and left lower quadrant or you may use the nine subdivisions system for more detailed descriptions, such as: right hypochondriac region, epigastric region, left hypochondriac region, right lumbar region, umbilical region, left lumbar region, right iliac region, hypogastric region and left iliac region.

Assess for asymmetry, scars, fullness of the abdomen, and any pulsations (query abdominal aortic aneurysm AAA).

Assess any associated conditions

1. Has the patient had nausea and been vomiting?

2. Has the patient had any trouble urinating today or recently? Pain, Stinging (dysuria), Difficulty, Lack of urine? Blood in the urine (haematuria)?

3. Has the patient had any trouble opening their bowels? Bloody stools, diarrhoea, pain constipation?

4. Anorexia

Assess Relevant past medical history.

Look for things such as:

1. Abdominal surgery or injuries

2. Colycystitis

3. Diverticulitis

4. Inflammatory bowel disease

5. Crohn’s disease

6. Appendicitis

7. Diabetes

8. Currently pregnant – how many weeks?

Assess Recent Events

1. Have they been travelling lately? Any chance of parasitic causes, such as tape worm?

2. Menstrual cycle? When was their last menstrual? Any chance they could pregnant? Any chance they could have an ectopic pregnancy?

3. Genitourinary – do they have a current UTI?

Assess their general appearance?

1. Are they acutely ill, or chronically ill?

2. Do they look malnourished? Do they look healthy?

3. Consider their positioning:

– Patients with a bowel obstruction appear restless and constantly moving to attempt to get comfortable.

– Patients with kidney stones or kidney infections (nephrolithiasis or pyelonephritis) – appear restless.

– Patients with peritonitis: often lie very still. These patients are very sick.

Assess bowel sounds:

1. Silent Abdomen – very bad, means paralytic bowel or surgical bowel, and needs immediate surgical interventions

2. Hyperactive peristalsis – diarrhoea

Return to paramedic notes page.