CanadiEM Frontline Primer

CanadiEM Frontline Primer – Abdominal Pain

In Medical Concepts by Afsheen MeharLeave a Comment

Can’t Miss Diagnoses

  • Acute MI or ACS
  • Aortic Dissection
  • Appendicitis
  • Bowel obstruction, Volvulus
  • Cholangitis, Cholecystitis
  • Ectopic pregnancy or Ovarian Torsion/ Ovarian cyst /TOA (FAST-US, Beta)
  • Ischemic bowel
  • GI Bleed, Pancreatitis
  • Perforated viscus
  • Ruptured AAA
  • Testicular torsion
CanadiEM Primer Abdominal Pain
Graphic reference for causes of abdominal pain by abdominal region.

Investigations

  • CBC, BUN, Cr, Lytes, Glucose, VBG/Lactate
  • Serial Troponin and Chest x-ray where warranted
  • ECG – Remember to compare an old ECG
  • Consider telemetry
Tips on tests

hs-troponin T – the 2h delta to rule-out is <4ng/L and the delta to rule-in is >= 10ng/L. (1)
CXR – looking for alternative diagnoses (Pneumothorax, pneumonia) or incidental findings (ground-glass opacities, suggestive of COVID-19)

Points to focus upon

  • Hx of Surgeries, Past STIs, cancer can lead you to R/O obstruction
  • ECG for any older pt, and diabetic pts with chest or Abdo pain R/O cardiac cause
  • Aortic Disease in the elderly can present with vague complaints, high level of suspicion is required
  • Have a low threshold for imaging in the elderly, immunosuppressed, patients with past Abdominal surgeries. These are the patients you would want to reassess again soon
  • Childbearing age female, always R/O Ectopic, Beta hCG sent early with other baseline labs
  • Antibiotic use in the past 14 days if presenting with diarrhea, Fever – consider C-diff toxin in stool
  • Consider gall stone pancreatitis ( Lipase >3 times normal)
  • Viscus lidocaine may contribute to your data synthesis in undifferentiated epigastric pain
  • Consider NPO & IVF where necessary, consult surgery/ OBGYN where needed

Recommended readings, videos, and podcasts

The following is part of the CanadiEM Frontline Primer. An introduction to the primer can be found here. To return to the Primer content overview click here.

This post was copyedited and uploaded by Evan Formosa.

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Afsheen Mehar

Afsheen Mehar

Dr. Afsheen Mehar is a resident physician at the University of Toronto in the RCPSC Emergency Medicine Training Program. Her greatest passions are medical education, POCUS and austere medicine. She holds an RDMS certification in ultrasound.
Afsheen Mehar
- 2 days ago
Teresa Chan

Teresa Chan

Senior Editor at CanadiEM
Emergency Physician. Medical Educator. #FOAMed Supporter, Producer and Researcher. Chief Strategy Officer of CanadiEM. Associate Professor, Division of Emergency Medicine, Department of Medicine, McMaster University.
Teresa Chan
- 46 mins ago