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Acute Abdomen

Clinical evaluation of abdominal pain

Visceral pain is characterized by deep, diffuse acute abdominal disease, acute abdomen, abdominal pain, appendicitis and poorly localized pain. Visceral pain can be crampy and colicky when caused by obstruction.

Referred pain occurs when a stimulus at one region is perceived at another. Diaphragmatic irritation, caused by inflammation or bleeding, frequently is referred to the ipsilateral shoulder or neck. Splenic rupture can irritate the diaphragm, causing pain in the left shoulder (Kehr's sign). Biliary colic can cause pain at the inferior right.

Somatic abdominal pain is caused by irritation of the parietal peritoneum by pus, blood, or GI contents. Peritoneal somatic pain is sharp, persistent, well-localized.

Onset and duration of the pain

The duration, acuity, and progression of pain acute abdominal disease, acute abdomen, abdominal pain, appendicitis should be assessed, and the exact location of maximal pain at onset and at present should be determined. The pain should be characterized as diffuse or localized. Time course of pain should be characterized as either constant, intermittent, decreasing.

Acute exacerbation of long-standing pain suggests acute abdominal disease, acute abdomen, abdominal pain, appendicitis a complication of chronic disease such as peptic ulcer disease, inflammatory bowel disease, or cancer. Sudden, intense pain often represents an intraabdominal catastrophe (eg, ruptured aneurysm, mesenteric infarction, or intestinal perforation). Colicky abdominal pain of intestinal or ureteral obstruction tends.

Pain Character

Intermittent pain is associated with spasmodic increases in pressure within hollow organs.

Bowel ischemia initially causes diffuse crampy pain due to spasmodic contractions of the bowel. The pain becomes constant and more intense with bowel necrosis, causing pain out of proportion to physical findings. A history of intestinal angina can be elicited in half of patients.

Constant pain. Biliary colic from cystic or common bile duct obstruction usually is constant. Chronic pancreatitis causes constant pain. Constant pain also suggests parietal peritoneal inflammation, mucosal inflammatory conditions, or neoplasms.

Appendicitis initially causes intermittent periumbilical pain. Gradually the pain becomes constant in the right lower quadrant as peritoneal inflammation develops.

Associated symptoms

Constitutional symptoms (eg, fatigue, weight loss) suggests underlying chronic disease. acute abdominal disease, acute abdomen, abdominal pain, appendicitis

Gastrointestinal symptoms

Anorexia, nausea and vomiting are commonly associated with acute abdominal disorders. The frequency, character, and timing of these symptoms in relation to pain and time of the last flatus or stool should be determined.

Constipation, obstipation, crampy pain and distention usually predominate in distal small-bowel and colonic obstruction. Paralytic ileus causes constipation and distention.

Diarrhea is suggestive of gastroenteritis or colitis but may also be seen in partial small-bowel obstruction or fecal impaction.

Small amounts of bleeding may accompany esophagitis, diverticulitis, inflammatory bowel disease, and left colon cancer. Right colon cancers usually present with occult blood loss. Severe abdominal pain accompanied by melena or hematochezia suggests ischemic bowel. Pain is often absent in massive GI bleeding.

Jaundice with abdominal pain usually is caused by biliary stones. Obstruction of the common bile duct by cancer may also cause pain and jaundice.

Urinary symptoms. Urinary tract infections may cause pain in the lower abdomen (cystitis) or flanks (pyelonephritis). Urinary tract infections are characterized by dysuria, frequency, and cloudy urine.

Recent menstrual and sexual history should be determined in women with acute abdominal pain.

Menstrual cycle. Lower abdominal pain and recent amenorrhea in a young woman suggests ectopic pregnancy. Pelvic inflammatory disease tends to occur early in the menstrual cycle. Ovarian torsion may cause intense, acute pain and vomiting. A ruptured corpus luteum cyst may cause acute lower abdominal pain at the onset of menses. Chronic pain at the onset of menses suggests endometriosis.

Pregnancy. Ectopic pregnancy occurs in the first trimester. Threatened abortion, ovarian torsion, or degeneration of a uterine fibroid also may cause acute pain in pregnant women.

Nonsteroidal anti-inflammatory drugs predispose to peptic ulcer disease.

Antibiotic therapy may obscure the signs of peritonitis. Patients with abdominal pain and diarrhea who have received antibiotics may have pseudomembranous colitis.

Anticoagulants. Warfarin therapy predisposes to retroperitoneal or intramural intestinal hemorrhage and can cause bowel obstruction.

Thiazide diuretics may rarely cause of pancreatitis.