From the Guidelines
Evaluating abdominal pain after a fall requires prompt medical attention, especially if the pain is severe, persistent, or accompanied by other concerning symptoms, and bedside ultrasound should be the initial diagnostic modality performed in hemodynamically unstable patients with blunt abdominal trauma. First, assess the severity of the pain and look for warning signs such as:
- Increasing pain
- Abdominal tenderness
- Rigidity
- Bruising
- Nausea
- Vomiting
- Dizziness
- Blood in urine or stool These could indicate internal injuries like organ damage or internal bleeding. For mild pain without concerning symptoms, rest and over-the-counter pain relievers like acetaminophen (500-1000mg every 6 hours, not exceeding 4000mg daily) may be appropriate. However, avoid NSAIDs like ibuprofen if internal bleeding is suspected. Apply ice to visible bruising for 15-20 minutes several times daily. Most importantly, seek immediate medical care if pain worsens, spreads, or is accompanied by fever, fainting, or difficulty breathing. Medical evaluation typically includes physical examination, blood tests, and imaging studies like CT scans to detect internal injuries, as recommended by recent guidelines 1. The urgency of evaluation is higher for elderly individuals, those on blood thinners, or those with pre-existing medical conditions, as they face greater risk of serious complications from seemingly minor trauma. According to a study published in 2013, ultrasonography has been established as a rapid and non-invasive diagnostic approach for detection of intra-abdominal free fluid in the emergency room 1. Additionally, a study published in 2011 recommends the use of bedside ultrasound in hemodynamically unstable patients with blunt abdominal trauma 1.
In terms of diagnostic approach, the following steps can be taken:
- Bedside ultrasound as the initial diagnostic modality in hemodynamically unstable patients with blunt abdominal trauma
- CT scans to detect internal injuries and identify abdominal injuries
- Physical examination and blood tests to assess the severity of the pain and look for warning signs
- Consideration of the patient's medical history, including pre-existing medical conditions and medications, to determine the best course of treatment.
It is essential to prioritize the patient's safety and well-being, and to seek immediate medical attention if there are any concerns about the severity of the injury or the patient's condition, as recommended by a study published in 2020 1.
From the Research
Evaluation of Abdominal Pain after a Fall
To evaluate abdominal pain after a fall, the following steps can be taken:
- Ensure hemodynamic stability of the patient 2
- Take a thorough history and perform a physical examination to guide the workup 2
- Consider the location of the pain, as this can help narrow down the differential diagnosis 2
- Order relevant laboratory tests, such as a complete blood count, C-reactive protein, hepatobiliary markers, electrolytes, creatinine, glucose, urinalysis, lipase, and pregnancy testing 2
- Consider imaging studies, such as computed tomography with intravenous contrast media or ultrasonography, based on the location of pain and index of suspicion for specific etiologies 2
Laboratory Tests and Imaging Studies
The following laboratory tests and imaging studies may be ordered:
- Complete blood count 2
- C-reactive protein 2
- Hepatobiliary markers 2
- Electrolytes 2
- Creatinine 2
- Glucose 2
- Urinalysis 2
- Lipase 2
- Pregnancy testing 2
- Computed tomography with intravenous contrast media 2
- Ultrasonography 2
- Point-of-care ultrasonography 2
- Magnetic resonance imaging (in pregnant patients if ultrasonography results are inconclusive) 2
Considerations for Specific Patient Populations
In patients who have female reproductive organs, consider diagnoses such as: