Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
To differentiate abdominal pain caused by an abdominal aortic aneurysm (AAA) from other gastrointestinal (GI) conditions, it is important to consider the patient's symptoms, associated features, and risk factors NICE NG156,NICE NG12.
Key indicators for a ruptured Abdominal Aortic Aneurysm (AAA):- Think about the possibility of ruptured AAA in people with new abdominal and/or back pain, especially if accompanied by cardiovascular collapse or loss of consciousness NICE NG156.
- Ruptured AAA is more likely if the patient has an existing diagnosis of AAA, is over 60 years old, smokes or used to smoke, or has a history of hypertension NICE NG156. AAAs are also more likely to rupture in women than men NICE NG156.
- An aortic ultrasound should be offered to people with a suspected AAA on abdominal palpation NICE NG156.
- Colorectal Cancer: Abdominal pain with unexplained weight loss (aged 40 and over), unexplained abdominal pain with rectal bleeding (adults under 50), or unexplained abdominal pain (aged 50 and over) may indicate colorectal cancer NICE NG12. A change in bowel habit is also a key symptom NICE NG12. Quantitative faecal immunochemical testing (FIT) is offered in these cases NICE NG12,NICE CKS.
- Oesophageal or Stomach Cancer: Upper abdominal pain with weight loss (aged 55 and over), or upper abdominal pain with low haemoglobin levels, raised platelet count, nausea, or vomiting (aged 55 and over) are concerning NICE NG12. Treatment-resistant dyspepsia, especially with weight loss, in those aged 55 and over, also warrants consideration NICE NG12.
- Ovarian Cancer (in women): Persistent or frequent abdominal or pelvic pain (particularly more than 12 times per month), especially in women aged 50 and over, can be a symptom NICE NG12. Persistent or frequent abdominal distension and unexplained changes in bowel habit are also relevant NICE NG12. Irritable bowel syndrome symptoms presenting for the first time in women aged 50 and over should prompt ovarian cancer tests NICE NG12. Serum CA125 measurement is a primary care test for ovarian cancer NICE NG12.
- Pancreatic Cancer: Abdominal pain with weight loss, or diarrhoea or constipation with weight loss, in those aged 60 and over, may suggest pancreatic cancer NICE NG12.
- Chronic Pancreatitis: Disproportionate or unexpectedly worsening pain in a patient with chronic pancreatitis may indicate complications such as a pseudocyst or pancreatic malignancy NICE CKS.
- The NHS Abdominal Aortic Aneurysm (AAA) Screening Programme informs men aged 66 or over about screening, and they can self-refer NICE NG156,NICE CKS. Risk factors for AAA include chronic obstructive pulmonary disease (COPD), coronary, cerebrovascular or peripheral arterial disease, family history of AAA, hyperlipidaemia, hypertension, and smoking NICE NG156,NICE CKS.
- People of European family origin are at a higher risk of an AAA NICE NG156.