Acute Abdomen Quiz

Understanding and Diagnosing the Acute Abdomen

The term “acute abdomen” refers to a sudden, severe abdominal pain of unclear etiology that is less than 24 hours in duration. It is a medical emergency that requires urgent and specific diagnosis, as it can often indicate a life-threatening condition requiring immediate surgical intervention.

Key Symptoms and Red Flags

While severe pain is the hallmark symptom, clinicians look for a constellation of signs. Recognizing these “red flags” is critical for timely intervention.

• Pain characteristics: Sudden onset, maximal at onset (“thunderclap”), migratory, or pain that awakens the patient from sleep.
• Systemic signs: Fever, tachycardia, hypotension (shock), altered mental status.
• Physical exam findings: Guarding (voluntary tensing) or rigidity (involuntary tensing of abdominal muscles), rebound tenderness, pulsatile abdominal mass.
• Associated symptoms: Persistent vomiting (especially bilious or feculent), hematemesis (vomiting blood), or hematochezia (fresh blood in stool).

Common Causes of Acute Abdominal Pain

The causes are numerous and vary by age and sex. They are often categorized by the affected organ system.

• Inflammatory: Appendicitis, cholecystitis, pancreatitis, diverticulitis, pyelonephritis.
• Obstructive: Small or large bowel obstruction (due to adhesions, hernia, or tumor), biliary colic, renal colic.
• Perforative: Perforated peptic ulcer, perforated diverticulum, ruptured appendix.
• Vascular: Ruptured abdominal aortic aneurysm (AAA), mesenteric ischemia, ovarian torsion.
• Gynecological: Ruptured ectopic pregnancy, pelvic inflammatory disease (PID).

The Diagnostic Process

Diagnosis is a systematic process involving a detailed history, a thorough physical examination, laboratory tests, and imaging studies.

• History: Onset, location, radiation, character, and timing of pain are crucial clues (e.g., pain migrating from periumbilical to RLQ suggests appendicitis).
• Physical Exam: Assessing for tenderness, rigidity, masses, and special signs (e.g., Murphy’s sign for cholecystitis).
• Lab Tests: Complete blood count (CBC), comprehensive metabolic panel (CMP), lipase, urinalysis, and a pregnancy test in women of childbearing age.
• Imaging: Abdominal X-ray (to look for free air or obstruction), ultrasound (for gallbladder and gynecological issues), and CT scan (often the definitive imaging modality).

Differentiating Pain Locations

The location of pain provides a strong initial clue to the underlying pathology.

• Right Upper Quadrant (RUQ): Cholecystitis, biliary colic, hepatitis, perforated duodenal ulcer.
• Epigastric: Pancreatitis, peptic ulcer disease, myocardial infarction (atypical).
• Right Lower Quadrant (RLQ): Appendicitis, ectopic pregnancy, ovarian torsion, inflammatory bowel disease.
• Left Lower Quadrant (LLQ): Diverticulitis, ectopic pregnancy, ovarian torsion.

Management Principles

The management of an acute abdomen focuses on resuscitation and reaching a specific diagnosis. Key steps include securing IV access, fluid resuscitation, pain management, and avoiding oral intake (NPO status). The definitive treatment depends on the cause, ranging from antibiotics for diverticulitis to emergency surgery for a ruptured aneurysm or perforated viscus.

This information is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.