As we approach the peak of the coronavirus infection in the UK, it has become clear that admissions to hospital for other conditions such as abdominal pain have declined. Whilst it is imperative to avoid travel at this critical time, it is also necessary that we seek appropriate help for abdominal pain during the pandemic in order to avoid late presentation of surgical conditions. The majority of general surgical admissions to hospital in normal circumstances are due to the following:
nonspecific abdominal pain
bowel dysfunction including constipation
Whilst this list is not exhaustive, it accounts for 80% of the conditions which are normally seen on a daily basis by the surgical team.
HOW DO THESE CONDITIONS PRESENT?
The site of abdominal pain often gives a clue as to the organ from which the pain is arising. For example, gallstones usually present with pain in the upper abdomen, and this pain may travel through to the back or to the right side under the ribs. Appendicitis virtually always presents with pain in the right side of the lower abdomen, sometimes starting initially around the belly button.
Diverticulitis is an inflammation of the colon and is sometimes referred to as left sided appendicitis since the pain is typically on the left side of the lower abdomen.
Constipation, when severe, can cause significant abdominal pain and usually presents with cramping pain across the whole of the lower abdomen. Non specific abdominal pain is so called because there is usually no underlying serous problem and because it can mimic the other causes of abdominal pain.
WHEN DO I NEED TO SEEK HELP FOR ABDOMINAL PAIN DURING THE PANDEMIC?
Contact your GP or call 111 if:
abdominal pain persists for more than a few hours and gradually or suddenly increases in severity
pain is associated with tenderness to touch
the pain is associated with an elevated temperature
there is abdominal distension
there are associated symptoms including burning when passing urine, your body shaking uncontrollably, heavy rectal bleeding, persistent vomiting or uncontrollable diarrhoea
HOW WILL I BE TREATED IF I GO TO HOSPITAL?
During this pandemic, every effort is being made to avoid hospital admission and so GPs will only send you in if it is deemed absolutely necessary. It is highly likely that you would then be seen by a consultant surgeon whose main aim is to decide if you need surgery.
Most patients are not being admitted for observation currently and so you should expect that you will be sent home with reassurance painkillers, possibly laxatives or even antibiotics.
CT scanning is being widely used to help diagnosis and to determine whether patients require surgery or outpatient observation. If you are diagnosed with uncomplicated appendicitis, you may be treated with antibiotics and early regular review in outpatients rather than surgery.
The majority of patients with gallstones can be managed with painkillers and those with infected gallstones will require antibiotics. Inflammation of the pancreas due to gallstones (pancreatitis) may require hospitalisation as in a few cases this can be life threatening. This significant move away from operative treatment is designed to minimise your chances of contracting Covid 19 whilst on hospital premises.
HOW CAN WE AVOID THESE CONDITIONS?
Many of these conditions are influenced by lifestyle and it is therefore imperative that whilst we are at home for prolonged periods, we maintain our hydration with at least 8 glasses of water per day. It is essential to eat a healthy diet including 8 portions of fruit and vegetables per day, a low saturated fat intake and avoiding excessive alcohol intake. If possible, it is sensible to be active for an hour a day which can be as simple as going for a walk.
In spite of living a healthy lifestyle, surgical problems may still develop and it is important that you seek a medical opinion. Your local hospital is equipped to deal with emergency surgical issues as well as coping with Covid 19 admissions.
Look after yourselves.