Acute Abdomen

Excerpt

Acute abdominal pain is one of the most common complaints of patients presenting to the emergency room. Although the underlying cause is often benign, serious underlying pathology may also be present, and clinicians must be able to recognize patients who require urgent evaluation and intervention. The causes of an acute abdomen are diverse, making the differential diagnosis complex. Some potential causes include infections, inflammatory processes, vascular occlusion, aortic dissection, or bowel obstruction. Less apparent sources may involve undiagnosed tumors or a ruptured viscous. Patients typically experience a sudden onset of abdominal pain potentially accompanied by fever, nausea, vomiting, or abdominal distension.

The evaluation of acute abdominal pain begins with obtaining a detailed description of the pain, including the location, presence of radiation, timing, quality, severity, aggravating or relieving factors, and associated symptoms. All patients should have their vital signs measured and undergo a complete abdominal examination, including inspection, auscultation, percussion, and palpation, with the remaining physical examination guided by the patient's history. Patients with an acute abdomen appear acutely ill with such features as shock, peritonitis, guarding, absent bowel sounds, and rebound tenderness. Other findings may include evidence of dehydration, dysuria, vomiting, and altered bowel activity.

Patients with unstable vital signs, signs of peritonitis, or suspected life-threatening conditions, such as acute bowel obstruction, mesenteric ischemia, perforation, or ectopic pregnancy, require urgent or surgical evaluation. In addition, patients presenting with fever, jaundice, or right upper quadrant pain should also undergo prompt assessment. A patient presenting with abdominal pain that does not appear acute should similarly undergo thorough questioning. Clinicians should determine further evaluation, including laboratory and imaging, based on symptoms. Appropriate analgesia should not be withheld during the assessment.