The abdominal cavity is the largest cavity in the body, housing many vital organs. For this reason, many calls EMS providers respond to involve abdominal pain. Although it is not always clear what might be going on when someone presents with abdominal pain, it is important to know the anatomy of the abdomen so you have an idea of what organ system might be affected. The abdomen is divided into four quadrants anatomically. You can determine what organ system might be affected based on which quadrant the pain is located.

Types of Pain

There are three types of pain associated with the abdomen: visceral, parietal, and referred. Visceral pain is experienced when the walls of an organ are stretched and the nerves send signals to the brain. Due to the lack of nerves, the pain is poorly localized and often described as an ache or cramp. Parietal pain is caused by irritation of the peritoneal lining that surrounds the abdominal cavity. Patients with this type of pain will usually present in a guarding position and have shallow respirations in order to minimize tension on the membrane.  Referred pain is visceral pain that is felt in other areas of the body than where the organ is located. This occurs when organs share common nerve pathways. For example, when the spleen is ruptured or inflamed, the pain will sometimes be felt in the left shoulder, this is often referred to as Kehr’s Sign.

Assessment

When assessing a patient with abdominal pain, expose the abdomen, then visually examine it and palpate it. Check for distension, scars, bruising, or any signs of trauma. Palpate the abdomen starting away from the pain and palpating towards it. Push firmly with your fingers, feeling for rigidity or masses that may indicate a tumor or blockage in the bowel. Pay attention to the patient's reaction during palpation to identify the location of the pain.

Use the OPQRST pneumonic to find out about the patient's pain. Ask questions pertaining to bowel movements and urination. Ask if they have been using the bathroom regularly and if they’ve noticed any abnormal odor or blood in their urine or stool. Blood in the stool that has been partially digested will be dark and tarry in appearance. Ask if they have been feeling nauseous or have vomited. If the patient is female, ask if there is a possibility she is pregnant.

Treatment

Since there is no way to know what is really going on in the abdomen while in the field, treatment of abdominal pain is typically always the same. Oxygen should be administered when appropriate and an IV should be established if it’s in your scope of practice. Treat the pain with an opioid such as Fentanyl, and monitor the patient’s heart rhythm as abdominal pain can sometimes indicate an MI. Administer Zofran if the patient is feeling nauseous. Routinely check vital signs and treat for shock if the blood pressure is below 90 mmHg systolic as per your shock protocols. Remember, above all else, ALWAYS FOLLOW YOUR LOCAL PROTOCOLS.