Abdominal pain is a collective term to describe pain or discomfort occurring in abdominal region, from lower margin of chest bone (sternum) to upper margin of pubic bone. The character of abdominal pain can be of varying sensation ranging from burning, cramping, throbbing and spasmodic. Abdominal pain usually describes the pain arising from internal abdominal organs, but it also can arise from skin, subcutaneous tissue or abdominal muscles.
Common visceral organs that are responsible for abdominal pain are,
• Appendix – acute appendicitis, chronic appendicitis, appendicular abscess
• Stomach – gastritis, peptic ulcers, carcinoma of stomach
• Small and large bowel- colitis, colonic cancer, diverticulitis, intestinal obstruction
• Gall bladder – acute cholycystitis, chronic cholycystitis, gall bladder cancers
• Pancreas- acute pancreatitis, chronic pancreatitis, pancreatic abscess, carcinoma of pancreas
• Liver – hepatitis, hepatoma, liver cancers
• Kidney – infections of kidney, glomerulonephritis, kidney cancers, cystic conditions of the kidney
• Bladder – urinary tract infections, cystitis, bladder cancer
• Ovaries – ovarian cyst, ovarian cancers
• Uterus- inflammatory conditions, endometriosis, cancers
Pain can be either acute or chronic in onset. Some abdominal pains are medical/surgical emergency conditions requiring urgent intervention (e.g. appendicitis, intestinal obstruction etc.). First aid training should be aimed at providing first hand experience in identifying these conditions early as possible to direct the patient to proper care urgently. Also it has to be kept in mind that, sometimes these conditions cannot be identified clinically even by most experienced doctors without performing necessary investigations.
Associated signs and symptoms helps to determine the site of origin of abdominal pain,
• Appendix- mild fever, pain when coughing, referred pain around umbilical area, rebound tenderness in abdominal examination.
• Stomach – central abdominal pain, burning epigastric sensation, nausea, vomiting, loss of appetite.
• Small and large bowel – alteration of bowel habits, diarrhea, loss of appetite, per rectal bleeding.
• Gall bladder – pain in right upper quadrant of the abdomen, referred pain in shoulder tip region, sometimes jaundice (yellowish discoloration of eyes/skin)
• Pancreas – central abdominal pain referred to back
• Liver – yellowish skin discoloration, loss of weight and loss of appetite.
• Kidney – urinary symptoms ( increased frequency in passing urine, pain during passing urine, frothy urine, blood in urine), fever
• Bladder – painful urination, blood in urine
• Ovaries – abdominal swelling, irregular menstruation
First aid management
1. First reassure the patient, allow him/her to sit or lie down in a position they find most comfortable. Sometimes the positioning only can reduces or relieve the pain and discomfort. For example bending forward in pancreatitis (inflammation of pancreas) will reduce the pain.
2. Prop up the patient if complaining difficulty in breathing.
3. Get an inquiry on onset, progression, character, radiation, aggravating/relieving factors and other associated symptoms of pain to get an idea on probable cause.
4. Give boiled and cooled water to drink and maintain adequate hydration. But if there is any suspicion of conditions requiring emergency surgery (e.g. appendicitis, intestinal obstruction etc) keep the patient fasting and do not give anything by mouth.
5. Use heating pads over painful areas to relive pain. But do not keep one too long on skin to prevent burns.
6. Give over the counter antacid if a known patient with peptic ulceration or complaining of epigastric burning sensation related to meals.
7. If patient is vomiting; check the color, amount and whether there is any blood in vomitus.
8. Check whether patient has opened bowels. Can try with a mild laxative (e.g. lactulose) to begin with. But if patient has not passed stools, not even flatus in some cases for several days, plus there is vomiting, abdominal swelling and abdominal pain; it may be a case of intestinal obstruction, do not give any laxatives and refer to medical care immediately.
9. Ask the patient to check the color, amount of stools. If passing blood refer to medical care.
10. Avoid aspirin and ibuprofen as these may cause gastric ulceration and bleeding.
11. Do not give red colored drinks as it will confound on color of vomitus.
12. If patient is in shock, make him/her lie down, elevate the legs and cover with a blanket. Call for emergency services.
13. Monitor breathing, pulse and if possible blood pressure until help arrives and be ready to give CPR.
Seek medical attention if,
• Persistent abdominal pain.
• Rigid abdomen.
• Exacerbating pain after first aid management.
• Pain localized to one region.
• Presence of other associated symptoms mentioned above.
• Persistent vomiting.
• Profuse diarrhea.
• Blood in stool or urine.
• Blood in vomitus.
• Swelling of the abdomen.
• High fever.
• Urinary symptoms.
• Recent abdominal injury.