How can I differentiate between abdominal pain due to AAA and other gastrointestinal conditions in a patient?

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 ¹,².

• 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 ¹.
• 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 ¹. AAAs are also more likely to rupture in women than men ¹.
• An aortic ultrasound should be offered to people with a suspected AAA on abdominal palpation ¹.

• 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 ². A change in bowel habit is also a key symptom ². Quantitative faecal immunochemical testing (FIT) is offered in these cases ²,³.
• 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 ². Treatment-resistant dyspepsia, especially with weight loss, in those aged 55 and over, also warrants consideration ².
• 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 ². Persistent or frequent abdominal distension and unexplained changes in bowel habit are also relevant ². Irritable bowel syndrome symptoms presenting for the first time in women aged 50 and over should prompt ovarian cancer tests ². Serum CA125 measurement is a primary care test for ovarian cancer ².
• Pancreatic Cancer: Abdominal pain with weight loss, or diarrhoea or constipation with weight loss, in those aged 60 and over, may suggest pancreatic cancer ².
• Chronic Pancreatitis: Disproportionate or unexpectedly worsening pain in a patient with chronic pancreatitis may indicate complications such as a pseudocyst or pancreatic malignancy ⁶.

• The NHS Abdominal Aortic Aneurysm (AAA) Screening Programme informs men aged 66 or over about screening, and they can self-refer ¹,⁴. Risk factors for AAA include chronic obstructive pulmonary disease (COPD), coronary, cerebrovascular or peripheral arterial disease, family history of AAA, hyperlipidaemia, hypertension, and smoking ¹,⁴.
• People of European family origin are at a higher risk of an AAA ¹.