Abdominal Pain
Description Medicine Treatment Referral ICD-10 code: R10.0-4 DESCRIPTION Abdominal pain is a common symptom, which may be non-specific. It is frequently benign, but may indicate a serious acute pathology. A thorough evaluation is necessary to exclude a surgical abdomen or other serious conditions. The history should include: duration, location, type, radiation and severity of pain. relieving
ICD-10 code: R10.0-4
DESCRIPTION
Abdominal pain is a common symptom, which may be non-specific. It is frequently benign, but may indicate a serious acute pathology. A thorough evaluation is necessary to exclude a surgical abdomen or other serious conditions.
The history should include:
- duration, location, type, radiation and severity of pain.
- relieving or aggravating factors e.g. food, antacids, exertion.
- associated symptoms e.g. fever or chills, weight loss or gain, nausea, vomiting, diarrhoea, cramps, fresh blood per rectum, melaena stools, jaundice, change in stool or urine colour, vaginal discharge.
- past medical and surgical history.
- medication history.
- alcohol intake or intake of other recreational substances.
- family history of bowel disorders.
- menstrual and contraceptive history in women.
- associated vaginal discharge in women with lower abdominal pain.
Examination should emphasise detection of:
- tachycardia.
- fever.
- jaundice or pallor.
- abdominal masses, distension, tenderness.
- signs of peritonitis (rebound tenderness and guarding).
- possible associated diseases (e.g. HIV).
MEDICINE TREATMENT
Urinary tract infection:
Dyspepsia:
See Dyspepsia, heartburn and indigestion, in adults.
Cancer pain e.g. pancreatic, gastric cancer:
See Chronic cancer pain.
Renal and biliary colic or acute surgical abdomen:
- Morphine, IM, 5–10 mg, (Doctor prescribed)
- May be repeated after 4–6 hours if needed or until patient is referred.
OR
- Morphine, IV, (Doctor prescribed).
- Dilute 10 mg up to 10 mL with sodium chloride, 0.9%.
- Administer morphine, IV, 3–5 mg as a single dose, then further boluses of 1–2 mg/minute and monitor closely.
- Total maximum as a single dose: 10 mg.
- Repeat after 4 hours if needed or until the patient is referred.
- Monitor response to pain and effects on respiration and BP.
Symptomatic treatment if no specific cause or indication for referral is found:
Pain relief (adults):
Analgesia as appropriate. See Pain control.
Abdominal cramp-like pains (adults):
- Hyoscine butylbromide, oral, 10 mg 6 hourly for a maximum of 3 days.
REFERRAL
- Severe pain that cannot be managed at primary level of care.
- Signs of acute abdomen.
- Associated bloody non-diarrhoeal stools (Red currant jelly stools in children).
- Associated abdominal mass.
Click here for the NEMLC Recommendations for medicine amendments (2020-4 review cycle).
Standard Treatment Guidelines And Essential Medicines List For South Africa, Primary Healthcare, 2020-4_Version 1_June 2024
Chapter 2: Gastro-intestinal Conditions, 2.1 Abdominal Pain