Red flags and abdominal pain

Abdominal pain can present itself for a huge number of reasons. Many of the causes behind such pain are benign, but red flags should be taken seriously and further investigated.

Here we look at what these specific red flags are and how to take an effective patient history.

What are the red flag symptoms?

If your patient is presenting with one or more of the following symptoms further examination is required. Sometimes they can be a sign of a more serious underlying condition.

They are: 

  • Abdominal pain that has come on very suddenly
  • Haematemesis
  • Fever
  • Change in bowel habit for > 3 weeks
  • Weight loss that is unintentional and/or unexplained
  • Unexplained PV bleeding
  • Bleeding after sex
  • Dysphagia
  • Shortness of breath
  • Increased vaginal discharge, or discharge that is bloodstained
  • Pre-syncopal symptoms
  • Haematuria
  • New onset dyspepsia
  • Amenorrhoea
  • Vomiting that is persistent yet unexplained
  • Testicular pain

History taking: Key points to note

Abdominal pain is common in primary care settings. However, a focused history and thorough examination is crucial in identifying the cause.

Start by locating the pain and ask the patient how and when it began. Were they doing anything specific like sport or running when the pain came on and do they have any related underlying conditions? Also find out how severe the pain is and whether it radiates elsewhere.

Next, ask about the pain itself. Is it a constant pain or does it come and go? Is it worse after food or after a bowel movement? Perhaps it’s accompanied by heartburn, odynophagia, dysphagia, vomiting or rectal bleeding?

If the patient does mention diarrhoea and vomiting, ask if they have changed their diet recently or if they’ve been abroad. Do they work with food and has anyone else they live with or been close to also felt unwell? 

It’s also important to consider the patient’s weight. Are they over or under weight and are they presenting with any weight-related issues such as oedema or diabetes? Has the pain been investigated before, for example via an ultrasound or CT scan?

Sometimes abdominal pain can be the result of a water infection, particularly if the patient is elderly, vulnerable or has recently undergone surgery or childbirth. In women, pay close attention to any gynaecological concerns and ascertain potential pregnancy. Cardiac pain can also present as epigastric pain, so if the patient does mention shortness of breath and/or vomiting then this may be relevant. For both men and women, it’s worth asking about sexual history too, to rule out any sexually transmitted infections.

Finally, it’s essential to find out what – if any – medications the patient is already taking, whether related to the pain or not. Do they smoke, drink excessively or take recreational drugs? Many of these can aggravate the stomach, as can over the counter drugs such as bisphosphonates, SSRIs or NSAIDs.

Can you confidently spot the red flags?

An effective triaging process right from the beginning can make a huge difference to your patient’s outcome. At PDUK we offer three particularly useful CPD courses aimed at nurses and other allied healthcare professionals wishing to refresh their diagnostic and history taking skills.

The first one is our Minor ailments essentials course. This course is designed for practitioners confident in taking a history and physical examination but wanting to focus on the common and not so common patient complaints seen in primary health care.

It’s held completely online and is aimed at nurse practitioners, practice nurses, NMPs, pharmacists, paramedics and other allied healthcare professionals. It’s a 3-day course worth 21 hours of CPD. 

Then there’s our Minor illness triage essentials course, worth 7 hours CPD. Interactive and highly flexible, it focuses on how to take an effective patient history when triaging patients. Covering all of the major body systems it’s ideal for healthcare professionals who regularly encounter patients with undifferentiated conditions.

Finally, don’t forget our Minor ailments online: gastrointestinal conditions for the primary care practitioner course too. It’s aimed at nurses and other allied healthcare professionals looking to boost their confidence around diagnosing and treating gastrointestinal conditions. Again held entirely via Zoom, the course is worth 4 hours of CPD.

All course materials are included but spaces are booking up fast so make sure you sign up today!

Check our web site for all course dates.

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