Abdominal Pain Assessment

Abdo Pain

Assessment

JRCALC Dec 2025 · Adults & Children · v1.0

🚨 If TIME-CRITICAL features present — do not complete this assessment. Immediate transfer.

Time-Critical — Immediate Transfer

Tap if any present — ATMIST pre-alert and go

Suspected leaking / ruptured AAA — follow local vascular pathway

Torsion of the testis — nearest appropriate ED immediately

Ectopic pregnancy — refer to maternity guidelines

Sepsis from perforation — major ABCDE problems

Traumatic disruption of abdominal organs (liver, spleen)

Patient Demographics

♂ Male

♀ Female

👶 Child

<16 yrs

Under 50

50–69

AAA risk ↑

70+

Mandatory referral if non-convey

Unknown

Pain Location — Tap to Select

RUQ

Liver · GB · Duodenum

EPIGASTRIC

Stomach · Pancreas · Aorta

LUQ

Spleen · Kidney · Colon

RIF

Appendix · Ovary · Ureter

UMBILICAL

Small bowel · Aorta

LIF

Colon · Ovary · Ureter

R GROIN

Hernia · Lymph · Testis

SUPRAPUBIC

Bladder · Uterus · Bowel

L GROIN

Hernia · Lymph · Ovary

Radiation

Back

Shoulder tip

Loin

Groin / Genitalia

No radiation

Character of Pain

Sharp

Dull / Aching

Colicky / Cramping

Burning

Tearing / Ripping

Constant

Intermittent

Onset

Sudden / Abrupt

Rapid (<1hr)

Gradual

Chronic / Recurrent

Severity (1–10)

Associated Symptoms

Nausea / Vomiting

Fever >38°C

Low-grade temp >37.5°C

Loss of appetite

Diarrhoea

Constipation

Bloating / Distension

Haematemesis

Melaena / Blood PR

Dysuria / Frequency

Syncope / Collapse

Shoulder tip pain

Jaundice

PV bleeding

Unintentional weight loss

Change in bowel habit

History

Previous aortic repair / AAA

Cardiac / AF history

Gallstones

Alcohol misuse

Smoking history

Hypertension / High cholesterol

Recent immobility / long haul travel

Previous abdominal surgery

Marfan syndrome / aortic valve disease

Diabetes

Renal / dialysis

NSAIDs / Aspirin / Steroids

STI / PID history

Previous ectopic pregnancy

Recent foreign travel

Abdominal Examination

Patient supine where possible. Knees flexed 90° to relax abdominal wall.

Inspection

Distension

Surgical scars

Bruising

Visible peristalsis

Normal

Palpation

Tenderness

Guarding / Rigidity

Rebound tenderness

Palpable mass

Pulsatile mass (AAA)

Soft / Non-tender

Auscultation

Normal bowel sounds

Hyperactive bowel sounds

Absent bowel sounds

Tinkling (obstruction)

Special Tests

Murphy's Sign

Ask patient to breathe in deeply while you palpate the right subcostal area. Positive if patient cannot complete inspiration due to pain.

Positive → Acute cholecystitis

POSITIVE

NEGATIVE

NOT DONE

McBurney's Point Tenderness

Palpate two-thirds of the way along a line from the umbilicus to the anterior superior iliac spine (right side).

Positive → Appendicitis

POSITIVE

NEGATIVE

NOT DONE

Rovsing's Sign

Palpate the left lower quadrant. Positive if this causes or increases pain in the right lower quadrant.

Positive → Appendicitis (peritoneal irritation)

POSITIVE

NEGATIVE

NOT DONE

Psoas Sign

Patient in left lateral position. Extend the right thigh (hip extension). Positive if this causes pain in the right lower quadrant.

Positive → Appendicitis (retrocaecal)

POSITIVE

NEGATIVE

NOT DONE

Obturator Sign

Internally rotate the flexed right thigh. Positive if this causes pain in the right lower quadrant.

Positive → Appendicitis / Pelvic pathology

POSITIVE

NEGATIVE

NOT DONE

Hop Test (Children)

Ask the child to hop on one leg. In appendicitis, the child will refuse due to pain.

Refuses to hop → Appendicitis likely

REFUSES

HOPS OK

N/A

Aortic Dissection Detection Risk Score (ADD-RS)

⚠️ THINK AORTA — complete in any patient with aortic history, or severe sudden/tearing pain

Column A — Predisposing Conditions

Marfan syndrome

Family history of aortic disease

Known aortic valve disease

Recent aortic surgery

Known aortic aneurysm

Column B — Pain Features

Abrupt or rapid onset

Severe intensity

Ripping or tearing character

Column C — Examination Findings

Pulse deficit or BP differential between upper limbs

Focal neurological deficit with pain

New aortic regurgitant murmur with pain

Hypotension or shock

0

ADD-RS Score (0–3)
1 point per column with any positive

Red Flags Assessment

Immediate ED — Time-Critical

Suspected leaking / ruptured AAA

Torsion of the testis

Ectopic pregnancy

Sepsis from perforation

Severe pain with rigid abdomen

Persistent vomiting

Distended abdomen + absolute constipation

Bile-stained (green) vomiting in child

Suspected bowel obstruction — ED within 1 hour

Requires Senior HCP Discussion if Non-Conveying

Patient aged 70 or over — mandatory referral to registered HCP if non-conveyance

Unintentional weight loss

Blood in stool

Sudden change in bowel habit

Aortic history — low threshold to transfer (high risk)

New renal colic in patient >50 years — consider AAA

Indigestion-type pain with cardiac risk factors — 12-lead ECG

Differential Diagnoses

Based on symptoms selected. Tap any condition for key features and management notes.

Observations & NEWS2

Vital Signs

RR

SpO₂ %

Temp °C

BP Sys

HR

BM mmol

AVPU

O₂ Therapy

?

NEWS2 Score

Investigations Checklist

12-lead ECG — mandatory if upper abdo pain + cardiac risk / older patient

Blood glucose — hypo/hyperglycaemia

Blood ketones — if diabetic / unwell

Urinalysis — if urinary symptoms

Pregnancy test — if female of childbearing age (where available)

Pain score documented — SOCRATES recorded

Analgesia

If patient is in pain, adequate analgesia should be given. Do not withhold analgesia pending diagnosis.

Refer to Pain Management in Adults and Children guideline

Disposition

⚡ Immediate Transfer

AAA · Torsion · Ectopic · Sepsis-perforation · Bowel obstruction (within 1hr) · Bile-stained vomit in child · Rigid abdomen · Persistent vomiting

ATMIST pre-alert · Correct ABCDE en-route · Consider most appropriate centre (ED / SAU / SDEC)

🏥 Convey — Not Immediate

Red flags present · Unresolved pain · Uncertain diagnosis · Aortic history · Patient ≥70 · Relevant surgical history · Recent HCP contact for same condition

Consider SAU / SDEC / ED depending on local pathways

🏠 Community / Discharge

Minor illness only (e.g. gastroenteritis, single self-limiting episode) · No red flags · No special history

Must discuss with senior HCP if ≥70 · Document all advice given · Send clinical record to GP

Discharge Advice (if appropriate)

Rest and reassurance given

Regular paracetamol advised (if not vomiting)

Clear fluids encouraged

Bland food if hungry (crackers, rice, bananas, toast)

Worsening advice given — seek further care if symptoms persist or worsen

GP follow-up arranged / clinical record sent to GP

Documentation complete — all findings, advice and referrals recorded

🏥 Senior HCP discussion before leaving scene where: further advice needed · relevant surgical/PMH identified · HCP contact in last 72hrs for same condition · GP referral / urgent outpatient needed

Assessment

Summary

JRCALC Dec 2025 · Aide-memoire only — complete full PCR separately

⚠️ This is an aide-memoire. It does not replace full documentation on your patient care record.