The acute abdomen - a surgical emergency
An acute abdomen is a surgical emergency in which the patient must be seen urgently by a doctor - DON'T WASTE TIME WITH THIS WEBSITE TRYING TO DO IT YOURSELF! GET MEDICAL HELP.
An acute abdomen is indicated by severe constant abdominal pain, sometimes with colicky exacerbations during which the patient is obviously ill, distressed and often frightened.
An acute abdomen should always been considered with any bowel symptom. The early warning symptoms are often the same as for milder problems.
Suspect an acute abdomen if:
- The symptoms are severe and unremitting (i.e. they don't go away)
- The symptoms are getting progressively worse
- The patient lies very still and dare not move because of pain (I often used to ask my children with tummy pain if they can hop on one leg without pain: if they can, it makes appendicitis unlikely)
- There is blood in the vomit, stool, urine or in vaginal discharge
- Urine goes brown (early sign of jaundice)
- There is systemic upset, such as shock (low blood pressure, fast heart rate, shortness of breath, fever)
- The patient feels ill, does not want to eat or drink, often vomits
- There is severe colic. Colic is a pain which comes and goes in a "wave". Once experienced, never forgotten!
- The patient is frightened
Common causes of acute abdomen
There may be several causes, with a further array of symptoms:
Starts with central colicky pain which settles in the right lower tummy, usually there is one vomit, loss of appetite, perhaps diarrhoea, slight temperature.
Lower tummy pain, late period, sometimes vaginal discharge. Sometimes there is pain in the shoulder - this is a referred pain.
Colicky pain, wind, gas, bloating, nausea, vomiting, constipation and sometimes no farting (Examples: cancer, hernia, after an operation)
Sudden onset of severe abdominal pain. The patient knows something nasty has happened. Systemic upset.(Examples: ulcer, diverticulitis, cancer)
Same as appendicitis but usually on the left side of the tummy - (a "left sided appendicitis")
Blood either vomited (often looks like black flecks or coffee grounds) or passed in the motion as a black, sticky, foul smelling stool.
Confusing because there may be no pain in the testicle but pain in the tummy. The testicle may be a bit tender and high in the scrotum.
Gall bladder disease
Colicky pain under the right ribs radiating round to the back, painful to touch, with vomiting, sometimes dark urine and pale stools.(Examples: cholecystitis, gall stones)
A nasty central abdominal pain radiating through to the back. Painful to lie down, easier to sit up or lean forwards.
This refers to blood supply cut off. Sudden onset of severe abdominal pain. Often there are other arterial problems such as angina.
Inflammatory bowel disease
Crohn's disease or ulcerative colitis.
Pelvic inflammatory disease
i.e. infection of the womb. Lower abdominal pain, fever, sometimes vaginal discharge.
Classically causes a very severe loin to groin pain, desire to pee, possibly blood in the urine.
Acute urinary retention
No doubt about this diagnosis: severe pain but can't pee.
Are often very painful. Kidney pain is in the back behind the lower ribs - so called "loin".
All doctors get caught out by this at some stage in their career!
AND... other things which I have forgotten!
THE ACUTE ABDOMEN IS ALWAYS DIFFICULT, EVEN FOR EXPERIENCED DOCTORS. GET HELP!
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