Intended for healthcare professionals

Practice Essentials

Preliminary management of acute onset right sided abdominal pain in women

BMJ 2022; 376 doi: (Published 08 February 2022) Cite this as: BMJ 2022;376:e068020
  1. Molly Borthwick, senior registrar in emergency medicine1,
  2. Ayman Bannaga, ST7 in gastroenterology and general internal medicine2 3,
  3. Ayisha A Ashmore, ST4 specialist registrar in obstetrics and gynaecology4,
  4. Charles H N Johnson, ST6 in general surgery5,
  5. Ramesh P Arasaradnam, professor and consultant gastroenterologist2 3
  1. 1Queensland Health, Brisbane, Australia
  2. 2University Hospitals Coventry and Warwickshire NHS Trust, UK
  3. 3University of Warwick, Warwick Medical School, UK
  4. 4University Hospitals of Leicester NHS Trust, Leicester, UK
  5. 5Health Education England North East, UK
  1. Correspondence to: R P Arasaradnam Ramesh.Arasaradnam{at}

What you need to know

  • Consider ectopic pregnancy in any patient with childbearing potential who is presenting with abdominal pain. Use urine βhCG to confirm or exclude pregnancy with 95.3% sensitivity and 100% specificity

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  • Targeted history taking may help diagnose ileocolic Crohn’s disease, which can be overlooked in the acute setting. Consider the symptomatic triad: chronic mucoid watery diarrhoea without blood, weight loss, and intermittent colicky abdominal pain, often related to eating

A 23 year old woman presents to the emergency department with a 24 hour history of abdominal pain that is worse in her right lower quadrant. She has had one episode of loose stool and feels nauseated. She has a pulse rate of 97 beats/min and a blood pressure of 123/67 mm Hg. Her temperature is 37.7°C.

When assessing a patient, early recognition of pathology is key to initiating appropriate management and improving patient outcome. Emergency doctors and primary care practitioners have to decide when to refer and which specialist team to refer to. This can be daunting when several potentially life threatening differential diagnoses need consideration, and delay in treatment or referral to the incorrect specialist team can negatively affect patient care. This article explores the case of a young woman with acute abdominal pain and helps to formulate an approach that ensures thorough assessment and referral, and timely decision making.

The article refers to “young women,” to reflect the clinical vignette. The guidance applies to any patient with childbearing potential—ie, those of reproductive age, with female reproductive organs.

Initial assessment and management

When faced with an unwell patient, it is useful to go back to basic principles (ABCDE). …

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