Patient handout

Abdominal pain (ED workup)

PRODUCTION

1. Your condition

This handout is for abdominal pain (ed workup). Your care team identified this based on: acute abdominal pain presenting to ed — drives quadrant-anchored differential (brun review pmid 35543712).

Other reasons your team may use this plan: ruq pain — cholecystitis / cholangitis / hepatitis (tokyo 2018 cholangitis pmid 29032610); rlq pain — appendicitis / tubo-ovarian / hernia (alvarado/ripasa pmid 32468754); llq pain — diverticulitis / sigmoid volvulus (brun 2016).

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Flank or abdominal pain + hypotension + pulsatile abdominal mass + age >65 (especially male smoker with vascular risk) — STAT CTA aorta if hemodynamically stable, OR direct if not (Sakalihasan PMID 15866312)(life-threatening)
Pain out of proportion to exam + AF or atherosclerotic risk + elevated lactate >2 (often >4) + metabolic acidosis — STAT CTA mesenteric (Kärkkäinen 2016 PMID 40513642)(life-threatening)
Sudden-onset severe abdominal pain + peritonitis (rigidity, rebound, guarding) + free air on upright CXR or CT — immediate surgical consult (Brun 2016)(life-threatening)
Positive β-hCG + abdominal pain + hypotension + free fluid on FAST or pelvic US — emergent OR (Brun 2016)(life-threatening)
Sudden unilateral pelvic pain + nausea + adnexal mass on US + decreased or absent Doppler flow — emergent OR (Brun 2016)
Sudden lower abdominal or scrotal pain + high-riding/horizontal lie testis + negative cremasteric reflex (referred abdominal pain in 25%) — emergent urology / OR within 6 h salvage window
Tokyo 2018 cholangitis criteria — Charcot triad (fever + jaundice + RUQ pain) or Reynolds pentad (+ hypotension + AMS); severity grade I/II/III (PMID 29032610)
Atlanta 2012 pancreatitis (2 of 3: epigastric pain radiating to back + lipase >3× ULN + cross-sectional imaging) + BISAP ≥3 OR persistent organ failure >48 h (PMID 23100216)
Intra-abdominal infection suspected + qSOFA ≥2 OR lactate >2 OR SBP <100 → sepsis pathway (SSC 2026)
Epigastric pain in elderly (>60) or diabetic + nausea/diaphoresis ± dyspnea + abnormal ECG or hs-cTn — atypical ACS presentation (Gulati 2021 PMID 34709879)
Tearing thoracoabdominal pain + BP differential between arms >20 mmHg + risk factors (HTN, Marfan, bicuspid AV, prior dissection, pregnancy) — STAT CTA chest/abdomen (AHA 2022)(life-threatening)
Known cirrhosis + new abdominal pain + ascites tenseness + fever or AMS — SBP / variceal bleed / portal vein thrombosis (Brun 2016)

5. Follow-up

Discharged nonspecific abdominal pain: PCP within 48-72 h + return precautions (worsening pain, vomiting, fever, blood in stool, syncope); discharge bundle for diverticulitis (liquid diet → low-residue + outpatient colonoscopy 4-8 wks); cholecystitis post-op (lap chole 7-10 day follow-up); pancreatitis (alcohol/lipid counseling + outpatient MRCP if biliary)

6. Sources

Guideline: 2007 Pines AAP analgesia + 2016 Brun review undifferentiated abdominal pain + 2012 Atlanta + BISAP (Banks Gut 2013) + 2018 Tokyo cholangitis + 2018 Sakalihasan AAA + 2016 Kärkkäinen mesenteric ischemia + 2021 Gulati AHA/ACC Chest Pain + SSC 2026 sepsis + AHA 2022 Acute Aortic Disease