Management

The management of a patient presenting with abdominal pain might include the following:

• It may be necessary to resuscitate if signs of sepsis or haemodynamic instability are shown, furthermore if there are any concerns or patient is unwell, discuss with ED senior
• Morphine IV titrated to effect. A Cochrane review states that there is no evidence that opiates mask the signs of peritonism or lead to a delay in diagnosis. Analgesia should never be withheld until ‘the patient has seen the surgeon’ [7]
• There is no evidence for anti-spasmodics like Buscopan in the management of acute pain [8]
• IV anti-emetics Metoclopramide theoretically increases gastric emptying so other anti-emetics such as cyclizine and ondansetron have been favoured although there is little evidence to support this.
• Antipyretics
• Nasogastric tube may be necessary if bowel obstruction present
• Urinary catheter may be necessary if patient is unwell/peritonitis suspected
• Broad spectrum IV antibiotics if signs of sepsis or peritonitis
• Keep nil by mouth if acute surgical pathology suspected and give IV crystalloid fluids where required (eg. dehydrated, shocked).
• Refer to surgical team, if indicated.