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Updated: Dec 15 2021

Acute Abdomen

5.0

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(4)

  • Snapshot
    • A 30-year-old G0P0 woman presents to the emergency room for acute onset abdominal pain and nausea. She recently had unprotected sex with 2 different partners. On physical exam, she has involuntary guarding and tenderness to percussion. A urine pregnancy test is positive, and a transvaginal ultrasound shows a ruptured ectopic pregnancy.
  • Introduction
    • Overview
      • acute abdomen is characterized by acute onset of severe abdominal pain that requires urgent surgical evaluation
        • management depends on etiology
  • Epidemiology
    • Incidence
    • Subtypes
      • hemorrhage
        • abdominal aortic aneurysm rupture
        • bleeding gastric ulcer
        • ruptured ectopic pregnancy
      • ischemia
        • ischemic bowel disease
      • perforated bowel/peritonitis
        • perforated peptic ulcer
        • bowel obstruction
        • diverticular disease
        • inflammatory bowel disease
        • perforated appendicitis
  • ETIOLOGY
    • Pathogenesis
      • mechanism
        • hemorrhage will often lead to hypovolemic shock, requiring swift intervention
        • ischemia results in elevated lactate and also requires early intervention
        • perforated bowel causes inflammation of the peritoneum or peritonitis
  • Presentation
    • Symptoms
      • common symptoms
        • dehydration
        • sudden-onset abdominal pain
        • pain out of proportion to exam
          • ischemic bowel disease
    • Physical exam
      • inspection
        • pallor
        • hypovolemia
        • tachycardia
      • motion
        • rigid abdomen
        • tenderness to percussion
        • involuntary guarding
        • may have reduced or absent bowel sounds
  • Imaging
    • Chest radiograph
      • indications
        • to look for free air under the diaphragm
      • findings
        • free air under the diaphragm, indicating bowel perforation
    • Abdominal radiograph
      • indications
        • if bowel obstruction is suspected
      • findings
        • dilated loops of bowel
    • Abdominal ultrasound
      • indications
        • if biliary or hepatic etiology is suspected
        • if tubo-ovarian pathology is suspected
        • if appendicitis is suspected
        • if aneurysm is suspected
        • evaluate for hemorrhage
    • CT abdomen and pelvis
      • indications
        • if mesenteric ischemia, diverticulitis, or bowel perforation are suspected
  • Studies
    • Serum labs
      • lactate
      • arterial blood gas
      • urinalysis
      • pregnancy test
      • blood cultures
        • to rule out infection
      • amylase and lipase
        • if pancreatitis is suspected
      • complete blood count
      • electrolytes
      • liver function panel
  • Differential
    • Differential by Location of Abdominal Pain
      Generalized
      • Bowel obstruction
      • Mesenteric ischemia
      Right Upper QuadrantEpigastricLeft Upper Quadrant
      • Acute cholecystitis
      • Hepatitis
      • Liver abscess
      • Acute cholangitis
      • Peptic ulcer disease
      • Myocardial infarction
      • Pancreatitis
      • Gastric ulcer
      • Splenic rupture
      Right Lower QuadrantPeriumbilicalLeft Lower Quadrant
      • Appendicitis
      • Bowel obstruction
      • Appendicitis
      • Abdominal aortic aneurysm
      • Diverticulitis
      Lower Abdomen
                    • Inguinal hernia
                    • IBD
                    • UTI
                    • Pelvic inflammatory disease
                    • Ectopic pregnancy
                    • Testicular torsion
  • Treatment
    • Management approach
      • depends on the etiology of acute abdomen
    • Medical
      • supportive care
        • indications
          • all patients
        • modalities
          • intravenous hydration
          • analgesia
          • anti-emetics
          • nasogastric decompression if necessary
          • bowel rest
          • NPO
          • blood transfusion if necessary
    • Surgical
      • surgical intervention
        • indications
          • irreversible pathologies such as appendicitis, mesenteric ischemia, and perforated bowel
  • Complications
    • Septic shock
    • Death
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