DPDoctor's PassportEducation
Gastroenterology and hepatology indexPassport
Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
Textbook/Gastroenterology and hepatology/Acute abdominal pain and the surgical abdomen/Rapid
RapidMLAMSRAFoundationMRCS

Acute abdominal pain and the surgical abdomen

Essential points for quick revision.

2 min synopsisUK scopeSources checked 27 Aug 2026Clinical review pending
!
Escalate

Shock, generalised peritonism, a pulsatile abdominal mass, pain out of proportion to examination, rigid distension with vomiting, incarcerated hernia, gastrointestinal bleeding with instability, or abdominal pain in pregnancy with collapse demands immediate ABCDE care and senior surgical, vascular or obstetric involvement. Imaging must not delay transfer or treatment when rupture or another immediately lethal diagnosis is clinically compelling.

Synopsis

Recognise physiological danger and time-critical surgical causes of acute abdominal pain, resuscitate in parallel with diagnosis, and choose examination and imaging that lead to a definitive disposition.

  • Decide whether the patient is unstable before refining the pain history: record respiratory rate, oxygen saturation, pulse, blood pressure, temperature, consciousness, perfusion and urine output.
  • Treat pain and nausea early while repeating examination; analgesia supports humane care and does not prevent competent recognition of peritonism or deterioration.
  • Pain beginning diffusely then localising can reflect evolving parietal irritation, while abrupt maximal-at-onset pain raises vascular rupture, ischaemia, perforation, torsion or renal colic.

Key red flags

Ruptured abdominal aortic aneurysm

Sudden abdominal, flank or back pain with syncope, shock or a known aneurysm should trigger immediate vascular consideration. The classic pulsatile mass may be absent, and transient response to fluid does not remove rupture risk.

Investigation priorities

01
Serial observations and NEWS2First step

Detect shock, sepsis, respiratory compromise and trajectory while diagnostic work continues.

Management branches

Unstable abdomenResuscitate while summoning definitive care

Abdominal pain accompanies shock, peritonism or another immediate physiological threat.

  1. Begin ABCDE, obtain large-bore venous access, send urgent bloods and group-and-save or crossmatch, monitor urine output and provide appropriate oxygen and warmed fluid or blood support.
  2. Call the relevant senior surgeon immediately and involve vascular, gynaecology, urology, anaesthesia or critical care according to the leading threat.
Stable severe painLocalise and discriminate

The patient is physiologically stable but pain is severe, focal or unexplained.

Key medicines

Titrated opioid or non-opioid analgesiaGive incremental analgesia using the current local acute-pain and BNF regimen, adjusted for frailty, kidney function, respiratory risk and previous exposure.
Empirical intravenous antimicrobialsUse the locally approved severe intra-abdominal infection regimen promptly after appropriate cultures, with allergy, renal function and likely source considered.
Open full textbook →Answer 2 questions
Sources and review status7 sources · checked 27 Aug 2026 · clinical review pending
Sources

Sources and review status

National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.

Authoring stateRapid draftClinical stateAwaiting reviewJurisdictionUnited Kingdom