The table below shows the most common causes of abdominal pain that EMT’s and Paramedics encounter in the field. It also specifies which abdominal quadrants and areas of the body might be painful to the patient. If you would like to make a correction or suggestion, please contact us.

	RUQ	LUQ	RLQ	LLQ	Epigastric	Midline	Diffuse	Flank	Shoulder	Back
AAA
AMI
Aortic dissection
Appendicitis
CHF
Cholecystitis
Diabetes
Diverticulitis
Ectopic pregnancy
Endometriosis
Esophageal disease
Gastric ulcer
Gastritis
Gastroenteritis
Heartburn
Hepatitis

	RUQ	LUQ	RLQ	LLQ	Epigastric	Midline	Diffuse	Flank	Shoulder	Back
Hepatomegaly
Hernia
Herpes zoster
Intestinal obstruction
Ischemic bowel
Kidney stones
Ovarian cyst
Pancreatitis
Pericarditis
Peritonitis
PID
Pneumonia
Pyelonephritis
Sickle cell crisis
Splenic rupture
UTI

There are three different types of abdominal pain: visceral pain, parietal pain and referred pain. The type of pain varies depending on the organ involved.

Visceral Pain

Visceral pain is directly related to the organ involved. The majority of organs do not have an abundance of nerve fibers, so the patient might experience mild or less severe pain that is poorly localized. It’s important to understand this does not mean the patient is experiencing a mild or less severe condition.

Characteristics:

• Less severe pain
• Poorly localized
• The pain is usually dull or aching and constant or intermittent

Parietal Pain

Parietal pain occurs when there is an irritation of the peritoneal lining. The peritoneum has a higher number of sensitive nerve fibers, so the pain is generally more severe and easier to localize. The patient will typically present in a guarded position with shallow breathing. This minimizes the stretch of the abdominal muscles and limits the downward movement of the diaphragm, which reduces pressure on the peritoneum and helps ease the pain.

Characteristics:

• More severe pain
• Easily localized
• The pain is usually sharp, constant and on one side or the other

Referred Pain

Referred pain is visceral pain that is felt in another area of the body and occurs when organs share a common nerve pathway. For this reason, it is poorly localized but generally constant in nature. An example is a patient with liver problems that experiences referred pain in the neck or just below the scapula.

Characteristics:

• Poorly localized
• The pain is usually constant

Review the most common causes of abdominal pain that EMT's and Paramedics encounter in the field.