First aid for abdominal pain
In this first aid guide we discuss a common symptom – abdominal pain! First aid for abdominal pain can seem confusing.
Abdominal pain is very common but the point at which a patient seeks medical attention varies wildly depending on the individual. As with pain localised to any part of the body, abdominal pain can be caused by any organ within the abdomen including stomach, bowel (small and large), gall bladder, liver, spleen, abdominal aorta, bladder, uterus and pancreas.
Pain in the stomach is often felt in the left upper quadrant of the abdomen. Any pain from a tubular or hollow structure like the stomach typically comes and goes in pulses, often referred to as a colicky type pain. Stomach pain is often related to food or drink and can either be made worse or better by eating. It may also feel like a burning pain as in heartburn.
Mild abdominal pain can be very difficult to find a cause for but it really isn’t your problem and can be followed up by a healthcare professional if it persists. If there are any signs of shock (tachycardia or a low blood pressure) then you need to get them to see a healthcare professional urgently.
Pain in the intestines is again often colicky in nature can vary greatly in severity. It may be related to food but not always and is often accompanied by feeling bloated or full. The things to look out for here are diarrhoea and vomiting either at the time of pain or in the last few days.
Wash your hands often with soap and water when dealing with these patients and keep them separate from others if you can.
Again it comes down to shock, if the patient has a normal pulse and blood pressure and you are confident of your diagnosis, send them home, they often don’t need to see a healthcare professional. They will need re-hydration though, lots of oral fluids!
By far the most common cause of bowel related pain is constipation. When did they last open their bowels? Beware of getting thrown off the scent by overflow diarrhoea. This is when hard faeces sits in the rectum for so long that it begins to suck water out of the bowel wall around it and patients have what looks like loose stools.
Pain in the gall bladder is, unsurprisingly by now, colicky and often in the right upper quadrant. It typically comes on after eating foods high in fat as the gall bladder tries to pump bile into the small intestine and a stone gets stuck in the bile duct. It is often accompanied by vomiting which may improve the pain slightly. The patient may well have had this pain before. In severe cases the patient may be yellow (jaundiced) and/or shocked.
If the patient is shocked, has a temperature, yellow or the pain is uncontrolled send them to hospital immediately.
Pain in the appendix can look like any of the above but classically presents as pain in the centre of the abdomen which then moves to the right lower area (right iliac region).
Pain in the bladder is often felt much lower down in the pelvis and is normally a dull ache. It is worse on urination. They may be urinating more often than normal and may complain of urgency (needing to go NOW) and foul smelling urine.
Pain in the uterus, ovaries, ovarian ducts and just about anywhere else that you can hide a growing embryo (unborn baby). First off, this is only an issue in female patients and you have to think about it in ALL women. Could she be pregnant? This can be an awkward question to ask but it is very important. If you are in doubt, pass it on to a medical professional.
If an embryo implants into one of the tubes, there isn’t enough space for it to grow, so it starts to cause pain. Normally it’s a sharp pain, in the lower quadrant. Eventually, the embryo runs out of space, and ‘pops’ (ruptured ectopic pregnancy). Patients can die from this. It’s really important – if you’re not sure, send them in to hospital.
Rarer causes of abdominal pain
Abdominal aortic aneurysms (AAAs) are often painless and go unnoticed until they rupture or rapidly enlarge. This is an emergency and needs to be operated on as soon as possible (Albert Einstein died of this).
50% of ruptured AAAs die before they reach hospital and of those who get there the outcome is still very poor with a risk of lifelong disability. They often present with loin to groin pain or back pain, sometimes with sudden collapse.
If anyone presents with any history of collapse, low blood pressure, loin to groin or back pain or a pulsatile abdominal mass, consider an aneurysm. If in doubt – call an ambulance.
AAAs are more common in men over 50 than in younger people or women. Shock may or may not be present. Shock in this instance is a very bad sign and the patient needs urgent medical attention.
Pain in the pancreas is most commonly related to excessive alcohol intake and gall stones. It results in a very severe pain, normally in the upper abdomen, that radiates to the back, often some hours after eating and is accompanied by profound vomiting. Patients get some relief from curling forward into a ball and the pain is worse on any movement. These patients will need medical attention.
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