Large numbers of patients with abdominal pain present to their general practitioners and emergency departments every year. Most require no specific medical intervention but some will require urgent hospital admission. The elderly and paediatric patient present particular challenges. The very young often give a poor history or can very quickly deteriorate. The elderly may have a very complicated medical history and misleading signs. A longitudinal study found that 50% of elderly patients (65 or over) with abdominal pain required admission.¹ Because of the difficulty of assessment in these groups of patients you should have a lower threshold for referral.

Abdominal pain has numerous causes but it is not necessary to reach a specific diagnosis. The aim is to decide on a management plan, to know when to monitor a patient at home, and to rule out the more serious pathology. Most patients can be adequately assessed by the simple techniques described and an accurate plan formed for the patients further management.

This article will focus on initial assessment and management and not on specific conditions. There are numerous texts that will give the basic outline of symptoms for different pathologies.^2,3 More than 30 women die each year in the UK as a direct consequence of pregnancy. The Confidential Enquiry into Maternal Deaths 1997–99⁴ stated that “Women are still dying of potentially treatable conditions where the use of simple diagnostic guidelines may help to identify conditions such as ectopic pregnancy, sepsis and pulmonary embolism”.

OBJECTIVES

• Recognise the severely ill patient and manage appropriately

• Evaluate and manage stable …