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FOCUSED SHIFT VIEW

Abdominal Pain

Age, location, pregnancy status, and the vascular exam.

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Educational first-pass aid. Reassess the patient, confirm doses and use local protocols.

1 · First minutes

  1. hCG in every patient of childbearing potential.
  2. Killers first: AAA, mesenteric ischemia, ectopic, perforation, torsion.
  3. Localise by embryology and migration; then image (US for biliary/GYN, CT as the workhorse).

2 · Escalate now if

  • Hypotension or syncope with abdominal pain
  • Pain out of proportion to exam findings
  • Rigid abdomen or positive peritoneal signs
  • GI bleeding with known AAA repair (aortoenteric fistula)
  • Acute scrotal pain — treat as torsion until proven otherwise
  • Immunosuppressed with mild findings (can decompensate fast)

3 · Immediate workup

  • Urine hCG in all patients of childbearing potential
  • POCUS: AAA size, free fluid, gallbladder wall/stone, intrauterine pregnancy

4 · Don’t miss

  • Ruptured AAA
    Age >60 + pain/hypotension/pulsatile mass — bedside US, straight to OR/vascular; do not wait for a perfect CT.
  • Mesenteric ischemia
    Pain out of proportion, AFib or vasculopathy; lactate and WBC may be normal early — CTA is the test.
  • Ruptured ectopic pregnancy
    Every patient of childbearing potential with abdominal pain gets a pregnancy test.
  • Perforated viscus
    Sudden severe pain, rigid abdomen, free air (upright CXR or CT).
  • Ovarian / testicular torsion
    Acute one-sided pain — Doppler US. Testicular salvage is highest if detorsion is within ~6 h, but operate on suspicion — do not wait out a clock.

5 · Disposition lane

Admit / surgical consult

Appendicitis (early laparoscopic appy, or antibiotics-first per local protocol), cholecystitis, diverticulitis, obstruction without strangulation.

Emergency surgery / IR / ICU

Ruptured AAA, perforation, mesenteric ischemia, strangulated obstruction, torsion.