Assessing Risk

There are very few specific risk assessment tools for patients with abdominal pain. One of the few conditions to have a widely used risk assessment tool is pancreatitis.

At risk groups are:

• Patients with comorbidities (e.g. diabetes)
• Elderly patients

It is necessary to maintain a low threshold for admission in patients from these ‘at risk’ groups.

Elderly patients have an increased mortality due to comorbidities, increased incidence of serious and rapidly progressive pathology and atypical signs [1]. They are also much less likely to have non-specific abdominal pain.

When assessing patients with acute abdominal pain, it is important to be aware that not all patients follow all the rules. Certain diagnoses can be notoriously variable in their clinical presentation. For example, pain from a ruptured abdominal aortic aneurysm can be felt in a variety of locations including the back, flanks and legs. Pregnancy distorts the normal anatomy and can cause pain from appendicitis or other acute pathologies to be experienced in atypical sites. It is important therefore to keep an open mind when formulating your differential diagnoses.

Learning bite

Any elderly patient with abdominal pain is much more at risk of a poor outcome.