abdominal pain is one of the most common complaints we see in the ER so in this video we're going to walk through the exact questions you should ask what each one tells you how it helps you triage and when it's time to escalate after the video if you're looking to keep growing as a new ER nurse check out our ER nurse essentials book and if you want to go even further our PDF bundle includes critical thinking scenarios a charting guide and everything you need to hit the ground running in the ER a discount code for the PDF bundle is available at the end of the video links are below so as a new ER nurse your questions are crucial for helping the provider narrow things down you're gathering highquality information fast so the team can make quicker and better decisions the questions you ask help guide how urgent the situation is and what kind of imaging the provider orders and how closely we need to monitor the patient when it comes to abdominal pain we're not just thinking about gas or constipation we're on the lookout for lifethreatening emergencies a ruptured appendix perforated bowel or a leaking abdominal aortic aneurysm cannot be fatal if missed we also have to think about conditions like bowel obstruction that are leading to eskeeia or perforation or messenteric eskeemia where the bowel is dying from lack of blood flow or even sepsis from a perforated organ or torsion of an ovary that needs immediate surgery don't forget about ectopic pregnancies as they can also be fatal and bottom line anything perforated or ruptured is an emergency that must be prioritized so be on the lookout for signs of peritonitis by asking the right question you help identify these high-risk patients early so they don't sit in the waiting room and that they get the timely care that they need let's talk about peritonitis one of the biggest red flags in abdominal pain peritonitis is inflammation of the peritonium the thin tissue layer that lines the abdominal cavity and organs it usually means something ruptured or leaked like a bowel perforation ruptured appendix or ulcer and here's the key peritonitis is a medical emergency it's often the first sign of a lifethreatening process that can lead to sepsis shock and death if not caught on early so how do you recognize it you're going to look for severe diffuse abdominal pain you're going to look for guarding the patient tightens their abdomen when you touch you're going to look for rebound tenderness when the pain when you release the pressure and most importantly a rigid board like abdomen late signs include hypotension alternal status or shock and you might also see absent bowel sounds fever teicardia and nausea or vomiting if you see these signs escalate immediately especially the guarding and the board like rigid abdomen again if you see these signs escalate immediately these patients should never be left waiting for questioning start with where is the pain the location gives you huge clues for example right lower quadrant makes us think about appendicitis upper right could be gallbladder epigastic pain might point to the pancreas or ulcers then ask when did when did the pain start a sudden onset can mean something ruptured or twisted gradual pain may point to an infection or inflammation does the pain radiate anywhere pain in the right shoulder might be gallbladder back pain could point to pancreatitis or even a triple A ask what makes it better or what makes it worse if the pain worsens with food that can mean gallbladder or or ulcer issues if it improves with passing gas an obstruction might be the issue ask them to describe the pain is it sharp is it dull is it cramping is it burning constant or comes and goes cramping pain might suggest an obstruction while a sharp pain could mean peronitis or perhaps even something ruptured then you have to dig into the context what were you doing when it started did you eat something spicy fatty food or were you even drinking alcohol that could point us to gastritis gallbladder issues or pancreatitis also ask has this happened before what were you told chronic issues like gird IBS or gallstones might already have a diagnosis and finally any recent travel sick contacts or antibiotics this opens the door to things like infectious diarrhea or cadiff or other things once you've covered the pain itself you shift your focus to associated symptoms you can start with do you have a fever or chills fever points again towards infection or inflammation maybe something like diverticulitis appendicitis or even again a perforated organ then ask about nausea vomiting diarrhea or constipation each of these gives you a critical insight but you have to go beyond just a yes or no you need to ask how many times a day what color when was your last valve movement and importantly have you passed gas not passing gas could signal an obstruction and then also color matters black stool or black vomit suggests an upper GI bleed bright red think lower GI bleed green vomit may be villious a clue toward a bowel obstruction gray or pale stool might mean liver or gallbladder dysfunction yellow or green diarrhea could suggest an infection and constipation isn't just about being backed up again ask what does it look like if they're passing hard pellet-like lumps that's a sign of severe constipation and when nausea vomiting constipation and abdominal pain shove together your mind should start thinking of a bowel obstruction finally assess for signs of dehydration especially if the patient has been vomiting or having diarrhea frequently look at mucous membranes skin trigger and orthostatic vital signs one of the first things you ask your patient is where exactly is your pain and that location can give us some valuable clues if you're looking at the abdomen visually divided into the right upper quadrant left upper quadrant right lower quadrant left lower quadrant epigastric flames and super pubic regions you can begin to map possible causes to each area pain in the right upper quadrant might mean a problem with the gallbladder or liver but it could also be referred from a right lower lobe pneumonia which can mimic abdominal pain epigastic pain can come from gird gastritis ulcer pancreatitis or it can even point to acute coronary coronary syndrome especially in older patients or those with cardiac risk factors right lower quadrant pain is a red flag for appendicitis while left lower quadrant pain is often points to diverticulitis pain in the lower quadrants or super pubic region can signal gynecological emergencies like ectopic pregnancies or ovarian torsion and even testicular issues can present here flame pain you got to you got to think of the kidneys either an infection or a stone trying to pass but here's the catch also abdominal pain doesn't always follow these rules because because of the way the abd abdomen is innervated pain is often referred which means the source of the problem isn't always where the pain is felt but having a basic understanding of where the organs lie and where the pain is can give us more clues and can guide us towards u assisting the provider in gathering information so that it can guide their imaging so again while the location helps guide you always keep an open mind and look at the whole clinical picture when assessing abdominal pain in female patients you have to ask a few extra questions and then can make all the difference in catching time-sensitive conditions you need to start with is there any chance you could be pregnant why because an autotopic pregnancy where a fertilized egg implant outside the uterus is a lifethreatening emergency it often presents with lower abdominal pain and spotting and if it ruptures it can lead to internal bleeding and shock so follow that up with when was your last menstrual cycle are you experiencing any vaginal bleeding or spotting are you having any vaginal discharge again discharge may suggest a pelvic infection which can also manifest as lower abdominal pain and requires treatment and then you got to also think about the urinary symptoms you have to ask do you have pain with urination are you going more frequently any unusual order again a UTI can easily present as lower abdominal pain especially in younger patients if it spreads to the kidneys the pain may radiate to the flames and be accompanied by fever and vomiting and kidney stones they can also cause severe sudden flame pain nausea and hematuria and can be easily missed if you don't ask so again when it comes to the abdominal pain ask about pregnancy if it's a female and then don't forget to ask about urinary symptoms because a UTI can also present with lower abdominal pain and asking about a patient's history can feel routine but it's packed with information that helps you understand what might be going on and how concerned you should be and if you need to escalate so you need to start with have you ever had this kind of pain before if they say yes their previous diagnosis might guide to date scare if it's new it could point toward a more acute or emergent issue then ask about past medical history and surgical history a patient with the history of abdominal surgeries like a C-section bowel resection or hernia repair is at an increased risk for bowel obstructions due to scarred tissue and adhesions medication history is also important if they're regularly taking NSAIDs like ibuprofen or neproxin they're at a higher risk for stomach ulcers which can perforate and again cause peritonitis and if nothing is down keeps worsening keeps worsening eventually shock and death you need to also ask about alcohol use chronic alcohol use puts patients at risk for liver disease pancreatitis GI cancers and ulcers it's a major factor that often gets overlooked in the fast-paced environment of the ER and don't forget about smoking and drug use these can contribute to a range of issues like poor wound healing increased GI inflammation or even complications from delayed care all of these history questions give context to the pain they guide labs imaging and urgency and help you communicate effectively with the provider and don't forget to pair all of these questions with a GI assessment look listen feel and pair that again with your vital signs and overall the patient presentation i remember how hard it was trying to keep up worrying about making mistakes and constantly feeling behind that's exactly why I created these resources to help you gain confidence and take control faster our ER nurse essentials book is your no fluff guide to essential ER knowledge covering triage ABCs advanced life support and the most critical conditions all in a clear easy to understand format if you want to take it even further our PDF bundle includes the essentials book plus our charting guide to help you document quickly safely and with confidence you'll also get our scenario book packed with realistic high pressure cases to sharpen your critical thinking and prepare you for the unexpected you can use the discount code ER ready 15 to save 15% on the bundle thank you for your time and as always teamwork makes the dream work and here at Emergency Chaos we are proactive not reactive