Abdominal pain is one of the most common reasons people come to emergency departments and clinics. Most causes are minor, but some, such as appendicitis, bowel obstruction, perforation, ectopic pregnancy and bleeding, need urgent surgery. Nurses at triage and on surgical wards play a key role in recognising deterioration and preparing patients.
Red flags
- Signs of shock or sepsis: rising pulse, falling BP, fast breathing, fever, confusion.
- Rigid, board-like abdomen or guarding: possible peritonitis.
- Severe pain that came on suddenly.
- Vomiting blood or passing black or bloody stools.
- Abdominal distension with vomiting and no stool or wind passed.
- A pregnant woman, or a woman who may be pregnant: always do a pregnancy test and consider ectopic pregnancy.
- Older patients: pain from a heart attack, ruptured aortic aneurysm or ischaemic bowel can present as abdominal pain, often with fewer signs.
Assessment
- Vital signs and early warning score.
- Pain: site, onset, character, radiation, severity (use SOCRATES).
- Nausea, vomiting (what it looks like), bowel habit, urinary symptoms, last menstrual period.
- Inspect the abdomen for distension, scars and hernias.
- Fluid balance and urine output.
- Blood glucose (DKA can cause abdominal pain), urinalysis.
Common surgical causes
| Condition | Typical features |
|---|---|
| Appendicitis | Pain starting around the umbilicus, moving to the right lower abdomen; loss of appetite, nausea, low-grade fever. Can be atypical in children, older adults and pregnancy |
| Bowel obstruction | Colicky pain, distension, vomiting (may be faeculent), no stool or wind. Causes include adhesions from previous surgery, hernias, tumours, volvulus |
| Perforation (e.g. peptic ulcer, typhoid) | Sudden severe pain, rigid abdomen, signs of shock and sepsis |
| Cholecystitis | Right upper abdominal pain, fever, often after fatty meals |
| Pancreatitis | Severe upper abdominal pain radiating to the back, vomiting; linked to gallstones and alcohol |
| Strangulated hernia | Painful, tense, non-reducible lump with signs of obstruction |
Don’t withhold pain relief
It was once taught that analgesia should be withheld until a surgeon examined the patient. Evidence shows that appropriate analgesia, including opioids, does not mask the diagnosis. Give prescribed analgesia promptly and reassess.
Nursing care before surgery
- Nil by mouth as instructed.
- IV access, bloods (including group and save, and amylase or lipase if indicated), and IV fluids as prescribed.
- Nasogastric tube for decompression in bowel obstruction, as prescribed. See our NG tube guide.
- Urinary catheter for accurate output in very unwell patients.
- Antibiotics for suspected perforation or sepsis, as prescribed. See our sepsis guide.
- Pre-operative checks: consent, allergies, site marking, fasting, medications such as anticoagulants and insulin.
- Frequent observations; escalate deterioration.
In low-resource settings
Delays in reaching surgical care are a major cause of deaths from acute abdominal conditions in sub-Saharan Africa. Recognising a surgical abdomen early and referring promptly, with IV fluids, antibiotics and a nasogastric tube where indicated, can make the difference.
Related: Typhoid perforation · Post-operative care · WHO Surgical Safety Checklist
Based on standard emergency and surgical nursing practice and published evidence on analgesia in acute abdominal pain. Educational content: follow your local protocols.