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What is meant by the term acute abdomen ?
- The classic definition refers to the sudden onset of severe abdominal pain of unclear cause.
- Acute abdomen refers to any abdominal condition that requires prompt diagnosis.
- Often acute abdomen is equated with inflammation of the peritoneum or peritonitis, but they are not identical.
- Although many cases may ultimately require surgical intervention, it is not inherently implied by the term.
What elements of a patient’s history are most important?
- Age
- Location of pain (what quadrant)
- Character (sharp, stabbing, dull, burning)
- Onset and duration
- Past surgical history and medical comorbidities
Which disorders are associated with specific age groups?
- Neonates: intussusception, appendicitis, Meckel’s diverticulitis, mesenteric adenitis, midgut volvulus, malrotation, hypertrophic pyloric stenosis, small bowel atresia
- Adults: cholecystitis, diverticulitis, gynecologic disorders, peptic ulcer disease (PUD), incarcerated hernia, ruptured spleen, renal or biliary stones, pancreatitis, small bowel obstruction
- Older adults: diverticulitis, colon cancer (perforation), appendicitis, aortic aneurysm, colonic (cecal or sigmoid) and small bowel volvulus, mesenteric ischemia
Pain in each of these locations is often associated with which disorders?
- Right upper quadrant: biliary tract disease, hepatitis, PUD, pneumonia
- Right flank: hepatitis, pyelonephritis, appendicitis
- Right lower quadrant: appendicitis (late), ectopic pregnancy, incarcerated inguinal hernia, rectus sheath hematoma, ovarian torsion, pelvic inflammatory disease, ruptured ovarian cyst, Meckel’s diverticulitis, Crohn’s disease
- Epigastrium: pancreatitis, PUD, cardiac disease, esophageal disease
- Central abdomen: bowel obstruction, bowel ischemia, midgut volvulus, appendicitis (early)
- Left upper quadrant: splenic rupture or infarct, PUD, pneumonia, leaking abdominal aortic aneurysm
- Left lower quadrant: diverticulitis, incarcerated inguinal hernia, ovarian torsion, pelvic inflammatory disease, colon cancer (perforated)
What associated problems can help to pinpoint the diagnosis?
- A complete medical, surgical, and family history are essential. For example, in premenopausal women, pelvic inflammatory disease and pregnancy-related issues must be screened as part of the initial assessment.
- Risk factors will often narrow a wide differential, such as chronic nonsteroidal antiinflammatory drug use in a patient with epigastric pain (peptic ulcer), or history of inflammatory bowel disease in a patient with obstipation and right lower quadrant pain (Crohn’s ileocecal stricture).