All EMS presentations
GIClinical presentation

Abdominal pain

A streamlined, differential-led presentation for rapid clinical review.

Clinical snapshot

Twenty-second review

  • Abdominal pain arises from inflammation, obstruction, ischemia, distension, bleeding, or referred thoracic, vascular, urinary, or reproductive disease.
  • Peritonism, pulsatile mass, GI bleeding, shock, severe sudden pain, pregnancy, or pain out of proportion requires rapid transport.
  • Keep acs or renal colic in the differential; overlapping or concurrent illness remains possible.
  • For abdominal pain, trends and combinations of findings are more informative than one isolated vital sign.
Differentials

Compare the clinical patterns

The repeated material is grouped inside each possibility. Open only the condition you need.

Serious3 conditions
Mesenteric ischemiaTime-sensitive high-risk possibility

HPI

Clarify onset/location; sudden vs gradual; migration/radiation.

Signs & symptoms

Severe pain, vascular risk, bleeding, syncope, or shock.

Focused exam

Inspect for distension, scars, hernia, emesis, or blood; auscultate and palpate gently for focal tenderness, guarding, or rigidity; Assess hydration, perfusion, and relevant chest, flank, pelvic, or rectal-history clues.

Brief pathophysiology

Mesenteric ischemia may cause abdominal pain through a time-sensitive process capable of rapid physiological deterioration.

Vital-sign pattern

What the trend may show

Possible pattern

Serious abdominal disease may initially have normal vitals. Tachycardia, tachypnea, fever or hypothermia, and falling pressure support systemic compromise but are not required.

Heart rate (bpm)

May rise

Pain, dehydration, inflammation, or shock can cause tachycardia.

Blood pressure (mmHg)

May fall

Hypotension suggests dehydration, hemorrhage, sepsis, or late disease.

Respiratory rate (breaths/min)

May rise

Tachypnea may reflect pain, acidosis, sepsis, or diaphragmatic irritation.

Temperature (°C)

High, normal, or low

Fever supports infection; normal temperature does not exclude a surgical abdomen.

Front-load in the triage report

  • Mesenteric ischemia: Severe pain, vascular risk, bleeding, syncope, or shock.
  • Onset/location.
  • Sudden vs gradual.
Ruptured AAATime-sensitive high-risk possibility

HPI

Clarify sudden vs gradual; migration/radiation; tenderness/guarding/distension.

Signs & symptoms

Severe pain, vascular risk, bleeding, syncope, or shock.

Focused exam

Assess hydration, perfusion, and relevant chest, flank, pelvic, or rectal-history clues; Inspect, auscultate, then palpate for focal tenderness, guarding, rigidity, distension, masses, and associated flank or chest findings.

Brief pathophysiology

Ruptured AAA may cause abdominal pain through a time-sensitive process capable of rapid physiological deterioration.

Vital-sign pattern

What the trend may show

Possible pattern

Hemorrhage is a trend diagnosis: tachycardia and narrowing pulse pressure may precede hypotension. Age, pregnancy, medications, and pacing can blunt expected responses.

Heart rate (bpm)

Often rises

Tachycardia is a common compensatory response but may be absent.

Pulse pressure (mmHg)

May narrow

Narrowing pulse pressure can reflect reduced stroke volume.

Blood pressure (mmHg)

May fall late

A normal pressure does not exclude significant compensated hemorrhage.

MAP (mmHg)

May fall

A falling trend supports worsening perfusion; interpret with mental status and skin signs.

Front-load in the triage report

  • Ruptured AAA: Severe pain, vascular risk, bleeding, syncope, or shock.
  • Sudden vs gradual.
  • Migration/radiation.
Ectopic pregnancyTime-sensitive high-risk possibility

HPI

Clarify migration/radiation; tenderness/guarding/distension; vomiting/diarrhea.

Signs & symptoms

Severe pain, vascular risk, bleeding, syncope, or shock.

Focused exam

Assess hydration, perfusion, and relevant chest, flank, pelvic, or rectal-history clues; Inspect, auscultate, then palpate for focal tenderness, guarding, rigidity, distension, masses, and associated flank or chest findings.

Brief pathophysiology

Ectopic pregnancy may cause abdominal pain through a time-sensitive process capable of rapid physiological deterioration.

Vital-sign pattern

What the trend may show

Possible pattern

Hemorrhage is a trend diagnosis: tachycardia and narrowing pulse pressure may precede hypotension. Age, pregnancy, medications, and pacing can blunt expected responses.

Heart rate (bpm)

Often rises

Tachycardia is a common compensatory response but may be absent.

Pulse pressure (mmHg)

May narrow

Narrowing pulse pressure can reflect reduced stroke volume.

Blood pressure (mmHg)

May fall late

A normal pressure does not exclude significant compensated hemorrhage.

MAP (mmHg)

May fall

A falling trend supports worsening perfusion; interpret with mental status and skin signs.

Front-load in the triage report

  • Ectopic pregnancy: Severe pain, vascular risk, bleeding, syncope, or shock.
  • Migration/radiation.
  • Tenderness/guarding/distension.
Common2 conditions
Gastrointestinal inflammationCommon presentation pattern

HPI

Clarify onset/location; sudden vs gradual; migration/radiation.

Signs & symptoms

Location, migration, vomiting, bowel function, and prior surgery help distinguish patterns.

Focused exam

Inspect for distension, scars, hernia, emesis, or blood; auscultate and palpate gently for focal tenderness, guarding, or rigidity; Assess hydration, perfusion, and relevant chest, flank, pelvic, or rectal-history clues.

Brief pathophysiology

Gastrointestinal inflammation may explain the presenting symptoms through a common clinical mechanism, while serial assessment checks for complications or an alternate cause.

Vital-sign pattern

What the trend may show

Possible pattern

Gastrointestinal differentials may remain physiologically quiet early. Rate, pressure, respiratory response, and temperature help expose dehydration, bleeding, inflammation, or sepsis.

Heart rate (bpm)

May rise

Pain, dehydration, bleeding, or systemic illness can increase rate.

Blood pressure (mmHg)

May fall

Falling pressure suggests volume loss or systemic compromise.

Respiratory rate (breaths/min)

May rise

Pain, acidosis, sepsis, or diaphragmatic irritation can increase rate.

Temperature (°C)

Variable

Fever supports infection or inflammation but may be absent.

Front-load in the triage report

  • Location, migration, vomiting, bowel function, and prior surgery help distinguish patterns.
  • Onset/location.
  • Sudden vs gradual.
ObstructionCommon presentation pattern

HPI

Clarify sudden vs gradual; migration/radiation; tenderness/guarding/distension.

Signs & symptoms

Location, migration, vomiting, bowel function, and prior surgery help distinguish patterns.

Focused exam

Assess hydration, perfusion, and relevant chest, flank, pelvic, or rectal-history clues; Inspect, auscultate, then palpate for focal tenderness, guarding, rigidity, distension, masses, and associated flank or chest findings.

Brief pathophysiology

Obstruction may explain the presenting symptoms through a common clinical mechanism, while serial assessment checks for complications or an alternate cause.

Vital-sign pattern

What the trend may show

Possible pattern

Gastrointestinal differentials may remain physiologically quiet early. Rate, pressure, respiratory response, and temperature help expose dehydration, bleeding, inflammation, or sepsis.

Heart rate (bpm)

May rise

Pain, dehydration, bleeding, or systemic illness can increase rate.

Blood pressure (mmHg)

May fall

Falling pressure suggests volume loss or systemic compromise.

Respiratory rate (breaths/min)

May rise

Pain, acidosis, sepsis, or diaphragmatic irritation can increase rate.

Temperature (°C)

Variable

Fever supports infection or inflammation but may be absent.

Front-load in the triage report

  • Location, migration, vomiting, bowel function, and prior surgery help distinguish patterns.
  • Sudden vs gradual.
  • Migration/radiation.
Mimics2 conditions
ACSImportant alternative presentation

HPI

Clarify onset/location; sudden vs gradual; migration/radiation.

Signs & symptoms

Referred or extra-abdominal disease may dominate the presentation.

Focused exam

Inspect for distension, scars, hernia, emesis, or blood; auscultate and palpate gently for focal tenderness, guarding, or rigidity; Assess hydration, perfusion, and relevant chest, flank, pelvic, or rectal-history clues.

Brief pathophysiology

ACS can resemble abdominal pain through overlapping symptoms or referred physiology despite a different primary mechanism.

Vital-sign pattern

What the trend may show

Possible pattern

Acute coronary syndrome frequently presents without a diagnostic vital-sign pattern. Abnormal observations suggest complications; normal observations do not exclude ischemia.

Blood pressure (mmHg)

High, normal, or low

Pain may elevate pressure; hypotension suggests major infarction or complication.

Heart rate (bpm)

High, normal, or low

Ischemia, conduction disturbance, medication, and autonomic response all affect rate.

Respiratory rate (breaths/min)

May rise

Tachypnea can reflect pain, heart failure, or shock.

Oxygen saturation (SpO₂)

Often preserved

Low SpO₂ suggests pulmonary edema or concurrent respiratory disease; normal does not exclude ACS.

Front-load in the triage report

  • Referred or extra-abdominal disease may dominate the presentation.
  • Onset/location.
  • Sudden vs gradual.
Renal colicImportant alternative presentation

HPI

Clarify sudden vs gradual; migration/radiation; tenderness/guarding/distension.

Signs & symptoms

Referred or extra-abdominal disease may dominate the presentation.

Focused exam

Assess hydration, perfusion, and relevant chest, flank, pelvic, or rectal-history clues; Inspect, auscultate, then palpate for focal tenderness, guarding, rigidity, distension, masses, and associated flank or chest findings.

Brief pathophysiology

Renal colic can resemble abdominal pain through overlapping symptoms or referred physiology despite a different primary mechanism.

Vital-sign pattern

What the trend may show

Possible pattern

Uncomplicated renal colic often has normal physiology apart from pain-related sympathetic changes. Fever, hypotension, or persistent tachycardia raises concern for infected obstruction or another diagnosis.

Temperature (°C)

Usually normal

Fever with obstruction is a high-risk finding.

Heart rate (bpm)

May rise with pain

Persistent tachycardia after analgesia or rest warrants reassessment.

Blood pressure (mmHg)

May rise with pain

Hypotension is not expected in uncomplicated renal colic.

Respiratory rate (breaths/min)

May rise with pain

Persistent tachypnea suggests systemic illness or another cause.

Front-load in the triage report

  • Referred or extra-abdominal disease may dominate the presentation.
  • Sudden vs gradual.
  • Migration/radiation.
Red flags

Findings that should escalate concern

  • Peritonism, pulsatile mass, GI bleeding, shock, severe sudden pain, pregnancy, or pain out of proportion requires rapid transport.
  • Mesenteric ischemia, ruptured AAA, or ectopic pregnancy: Severe pain, vascular risk, bleeding, syncope, or shock.
Related medications

Medication recognition

ApixabanRivaroxabanClopidogrelWarfarin
Related EMS presentations

Continue the clinical pathway

CardiacChest pain / suspected ACSGeneral MedicalNausea / vomitingGIGI bleedGU/RenalFlank pain / renal colicGIConstipation / fecal impactionObstetric/GynecologicEarly-pregnancy pain / bleeding
References

Clinical and academic sources

Curated clinical guidance and peer-reviewed evidence supporting this presentation. Current BCEHS guidance, medical direction, and local policy remain authoritative for practice.

BCEHS Handbook — specific CPGs

  1. E05: Abdominal PainBC Emergency Health Services Handbook

    Official BCEHS clinical practice guidance for abdominal pain.

Supporting clinical and academic evidence

  1. Acute mesenteric ischemia: updated guidelinesWorld Society of Emergency Surgery

    Evidence-based recognition, diagnosis, and time-sensitive management of acute mesenteric ischemia.

  2. Management of Abdominal Aorto-Iliac Artery AneurysmsEuropean Society for Vascular Surgery

    2024 clinical practice guidance for abdominal aortic and iliac aneurysms, including ruptured aneurysm.

  3. Practice Bulletin No. 193: Tubal Ectopic PregnancyAmerican College of Obstetricians and Gynecologists

    Evidence-based diagnosis and management guidance for tubal ectopic pregnancy.

  4. Guideline for the Management of Patients With Acute Coronary SyndromesACC/AHA/ACEP/NAEMSP/SCAI

    2025 evidence-based acute coronary syndrome recognition and management guidance.

  5. Appropriateness Criteria: Acute Nonlocalized Abdominal PainAmerican College of Radiology

    Evidence-based diagnostic context for acute nonlocalized abdominal pain.

  6. CEDIS Presenting Complaint List updateCanadian Association of Emergency Physicians

    Presenting-complaint terminology and categorization context. It does not establish a prehospital “top 100” ranking.

  7. ACR Appropriateness Criteria: Acute Nonlocalized Abdominal PainJournal of the American College of Radiology · 2018

    Evidence-based diagnostic context for undifferentiated acute abdominal pain and serious pathology.