Acute abdominal pain: evaluation and clinical guidelines

Acute Abdominal Pain -- Assessment

Nurses are very often the first medical aid providers that most patients see. In today's interprofessional healthcare set up, a nurse's approach in collecting a patient's history and diagnosing if the pain is acute or non-acute would assuredly help in providing the patient with appropriate treatment. It is therefore primary that nurses be fully equipped to diagnose the various ailments and start on the care to be provided. Nurses are also the first information gatherers and it is vital that they acquire the patient's past medical history. The importance of a structured approach in gathering this information is very vital as it forms the basis of analysis and also influences the care provided. Abdominal pain is one of the most common ailments that people complain of and seek medical care for. In most cases the pain's primary cause of pain may be ascertained almost immediately but on certain occasions, it is essential to correlate the pain with the patient's history and physiological examination.

70% of the time, a patient's history can give the nurse a fair idea of what the problem could be. (Birkitt and Quick 2002, Talley and O'Connor 2006). This theory however works only if the nurse has taken meticulous care in the compilation of the history. To be able to assess if the pain is acute or non-acute, the nurse would have to be proficient in describing the anatomy and physiology of the organs associated with the pain. When the nurse is able to collate pertinent facts regarding patient history, the reason for the abdominal pain may be deciphered and it would be possible to discuss the optimal treatment with the patient. Nurses would have to know about the organs that could be responsible for the abdominal pain as well as which other organs might be affected because of the pain. For this the anatomy and physiology of the abdominal cavity is primary.

The abdominal cavity houses, the stomach, liver, spleen, pancreas, gall bladder, kidneys, small intestine and large intestine. Some of the abdominal organs are also housed in the pelvis: the bladder, caecum, sigmoid colon, appendix, rectum and female reproductive organs. To assist in clinical analysis, the abdominal cavity is sectioned into four quadrants: the right upper quadrant, the left upper quadrant, the right lower quadrant and the left lower quadrant. When a patient is able to identify the pain as being localized in any of the quadrants, knowledge of the same will help in providing care instantly. Within the right upper quadrant are the gall bladder, duodenum, the right lobe of the liver, head of the pancreas and sections of the ascending and transverse colon. The left upper quadrant houses the stomach, spleen, left lobe of the liver, body of the pancreas and sections of the descending and transverse colon. The organs in the right lower quadrant are the caecum, the appendix and sections of the ascending colon. Within the left lower quadrant are the sigmoid colon and sections of the descending colon. All organs and viscera in the abdominal cavity are surrounded by a membrane known as the peritoneum. The kidneys and ureters are positioned behind the peritoneum and are known as retroperitoneal organs. When anyone experiences pain in these organs it is not always felt in the abdomen, rather it is manifest in the loin area of the patient.

General Causes of abdominal pain

Acute surgical emergencies make up more than 50% of emergency admissions of which about 25% complain of abdominal pain. While some cases require immediate surgery most of them are resolved with medication (Birkitt and Quick 2002). Some of the most common causes for abdominal pain are:

Appendicitis: The most common of surgical emergencies (Longmore et al. 2004) appendicitis is caused by the inflammation of the appendix. In the initial stages the pain is localized at the umbilicus or epigastrium but if it increases, the peritoneum is affected and the pain shifts to the lower right quadrant. It is most usually accompanied with vomiting, loss of appetite, constipation or occasional diarrhoea.

Biliary Colic: Biliary colic is a result of intermittent cystic duct or bile duct obstruction caused by gall stones. Typically affecting overweight women, pain in this case is usually colicky and localized in the right upper quadrant and in the epigastrium radiating towards the back. Vomiting is an associated symptom and the onset of pain is sudden and severe and it resolves as fast and spontaneously or after administering opiate analgesic.