Abdominal Pain

Symptoms:

1. Is the pain continuous or intermittent?

2. Is the pain precipitated by eating, coughing or intake via NG/ PEG?

3. Has the patient had any bowel movements or passed any flaetus?

4. How long has the pain been present?

5. Does the patient feel bloated or overfull?

6. Has there been any diarrhoea or vomiting?

 

Examination:

1. Is the patient pyrexial?

2. Is there any abdominal tenderness, either on palpation, rebound or with guarding?

3. Is the PEG pulled tight up against the abdominal wall?

4. Check for bowel sounds.

 

Special tests, consider any of the following:

1. FBC, U&E, LFT’s

2. Upright abdominal radiograph to check for air under the diaphragm

3. Blood cultures if you suspect infection

 

Possible causes:

1. Post operative ileus: lack of movement of the bowel post operatively. This effectively reduces gastric emptying. Symptoms include lack of bowel movements or sounds, a general feeling of bloating with possible reflux and vomiting. Treat with reduced intake via mouth, PEG or NG. Stop opiates. Consider regular metochlopramide to increase gastric motility and decrease nausea and vomiting. TLC. Ileus should stop spontaneously after 2—3 days but patients’ fluid and nutritional intake needs to be watched closely.

 

2. Acid Reflex/ Heart Burn: the patient may complain of pain ascending up the centre of their chest, but centred beneath the diaphragm. Stop NSAIDs and try to commence regular feed. You may need to start a H2 receptor antagonist e.g. cimetidine, ranitidine, famotidine. A favourite in ITU is Sucralfate to prevent gastritis prior to starting NG/ PEG feed. Another drug sometimes used for this purpose is Omeprazole.

 

3. If the patient has rebound tenderness or guarding they may have a form of peritonitis. If this is the case contact your 2nd on call for advice as the patient may need a referral to the General Surgeons.

 

 

The patient may complain of this at any stage post-operatively