Abdominal Pain

Prehospital assessment and management of abdominal pain patients

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   Paul Murphy, MA, MSHA, is a paramedic with administrative and clinical experience in healthcare organizations.

   Chris Colwell, MD, is medical director for Denver Paramedics and the Denver Fire Department, as well as an attending physician in the emergency department at the Denver (CO) Health Medical Center.

   Gilbert Pineda, MD, FACEP, is medical director for the Aurora Fire Department and Rural/Metro Ambulance (Aurora, CO) and an attending physician in the emergency department at The Medical Center of Aurora and Denver Health Medical Center.

   Tamara Bryan, BS, EMT-P, has more than a decade of healthcare experience, including clinical and project management roles. She is currently pursuing her Physician Assistant credentials.

Table 1: Abdominal Anatomy and Location
Abdominal quadrant Anatomy
Left upper Spleen, pancreas, stomach, kidney, colon
Right upper Liver, gallbladder, pancreas, duodenum, kidney, colon
Right lower Appendix, ascending colon, small intestine, ovary, fallopian tube
Left lower Small intestine, descending colon, ovary, fallopian tube
Three central areas of the abdomen: epigastric (above the umbilical area), periumbilical (around the umbilical area), suprapubic (above the pubic area)
Table 2: Solid and Hollow Organ Comparison
Solid organs Liver, spleen, pancreas, kidneys, adrenals, ovaries
Hollow organs Stomach, intestines, gallbladder, urinary bladder, ovaries
Table 3: Abdominal Quadrant Pain & Possible Condition
Right lower quadrant Ascending colon, appendix, ovary, fallopian tube. Ectopic pregnancy, appendicitis
Left upper quadrant Pancreas, spleen, kidney. Gastritis, pancreatitis, splenic involvement
Left lower quadrant Sigmoid and descending colon, ovary, fallopian tube. Diverticulitis, ectopic pregnancy, ovarian torsion
Midline or periumbilical Appendicitis, gastroenteritis, myocardial infarction, pancreatitis
Flank pain Abdominal aortic aneurysm, renal colic
Pain originates in front and radiates posteriorly Pancreatitis, appendicitis, posterior duodenal ulcer, ruptured abdominal aortic aneurysm
Suprapubic or lower abdominal discomfort Ectopic pregnancy, ruptured ovarian cyst, others