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Abdominal pain (Signs of shock? (Yes (IV access fluid administration …

- - - - intra-abdominal hemorrhage (hemodynamic compromise + US evidence of intraperitoneal fluid), suspected aortic aneurysm rupture, or free air within peritoneum.
        
        Early surgical consultation
  - - - Yes
        
        Consider early surgical consultation or expedited imaging
        Cecil: Early consultation obtained, even in doubtful cases, rather than awaiting confirmation via lab or radiology
        
        Pain location? Generalized (can't localize in a quadrant; all pains in midline) or localized?
        
        the onset?; sudden (vascular or perforation) or insidious (inflammatory: sterile or infectious)?
        
        Generalized
        
        Acute onset: peritoneal signs
        
        No
        
        Acidosis? Incr lactate?--> CT
        
        Gradual onset: amylase, lipase, LFTs
        
        Pancreatitis: evaluate severity
        
        Fever, abnormal LFTs, cholangitis
        
        Localized
        
        RUQ
        
        LFTs, amylase, lipase, US
        
        LUQ
        
        CT
        
        RLQ
        
        Female: gyn hx?, UTI?, appendicitis--> CT
        
        Male: presentation consistent w/ appendicitis--> OR; equivocal presentation--> CT
        
        LLQ: peritonieal signs?
        
        No: diverticulitis--> ABs; equivocal--> CT
        
        Cecil: CBC w/ diff, U/A, serum amylase, lipase, bili, and electrolytes necessary
        WBC extremely high: typical of acute intestinal ischemia; An elevated serum amylase u indicates acute pancreatitis, although a perforated ulcer or mesenteric thrombosis can also cause hyperamylasemia
      - No
        
        Pregnant, or high suspicion for pregnancy?
        
        Yes
        
        Immediate ultrasound to identify ectopic pregnancy or spontaneous abortion
        
        No
        
        Peritoneal signs on examination?
        (severe tenderness to palpation, w/ or w/o rebound tenderness, and guarding)
        (and/or pain that worsens when lightly bumping stretcher)
        
        Yes
        
        Consider upright CXR for early
        id of free air or early expedited CT
        
        1 more item...
        
        No
        
        Location of maximal
        tenderness?
        
        3 more items...
- - - - Clinical suspicion for infection?
        Administer broad spectrum antibiotics for polymicrobial coverage
        
        Signs of volume depletion?
        Administer crystalloid fluids
        
        Diagnosis unknown?
        Symptoms resolved?
        Consider discharge with close follow-up