Last Updated on August 19, 2026
“Abdominal pain — medical causes / surgical causes / O&G causes”
History Taking
Site: Ask patient to use one finger to point to the most painful region of the abdomen
Additional history in females
• LMP? Period regularity? may be related to infected IUCD Why do we concern about pregnancy in the case of abdominal pain? Abbreviation: UPT Urine pregnancy test ===== Notes: • Taking oral contraceptive pills / on intrauterine contraceptive device DOES NOT rule out patient is not pregnant. • Therefore remember to check UPT for female patients in reproductive age, prior to X-rays / CT scan
• Mode of contraception e.g. oral contraceptive pills,
IUCD
(Note: contraception does not rule out
pregnancy
• To prevent unnecessary exposure to radiation / may require additional counseling regarding exposure to radiation during pregnancy (for chest X rays / abdominal X rays / CT abdomen)
• ddx of (lower) abdominal pain in females e.g. rupture ectopic pregnancy
• Any dysmenorrhoea?
• Any PV bleeding? Any PV discharge?
Differential Diagnosis
O&G causes of abdominal pain
• Ruptured ectopic pregnancy
• Ruptured ovarian cyst
• Endometriosis
• Endometritis / Pelvic inflammatory disease / Tubo-ovarian abscess (e.g. secondary to infected IUCD)
Medical causes of abdominal pain
• Diabetic ketoacidosis
Investigations
Imaging
(i) Chest X-rays
– Air under diaphragm ≈ perforated viscus
(ii) Abdominal X-rays
– To look for bowel dilatation
(iii) CECT Abdomen
=====
Others
IUCD in abdominal X-ray
Management (ED approach)
- Pain management — analgesia
- Fluid resuscitation e.g. if GI loss / shock
-
POCT
e.g. dxt×POCT
Abbreviation: POCT
, ECG, urine dipstick, UPT×dxtDxt
An abbreviation of Dextrostix, commonly referred to capillary blood glucose
, bedside USG×UPTAbbreviation: UPT
Urine pregnancy test
=====
Notes:
• Taking oral contraceptive pills / on intrauterine contraceptive device DOES NOT rule out patient is not pregnant.
• Therefore remember to check UPT for female patients in reproductive age, prior to X-rays / CT scan
×Some findings to look for e.g.
• Free fluid
• Hydronephrosis e.g. in urinary tract stone
• Bulky uterus
• Intrauterine gestational sac - Laboratory tests e.g. FBC, RP, Ca, Mg, PO4, VBG
- Imaging —
CXR
, abdominal X rays/ KUB X-rays×
e.g. bowel dilatation in intestinal obstruction / faecal impaction
×e.g. stone if suspect urolithiasis
- Referral to primary team for disposition
Q&A
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