Understanding Acute/Emergency Abdominal Pain

Creator: Dr. Krishanga
Keywords: Acute Abdominal Pain, Emergency Abdominal Conditions, Appendicitis, Cholecystitis, Pancreatitis, Diverticulitis, Symptoms of Acute Abdomen, Diagnosis of Acute Abdominal Pain, Treatment for Acute Abdomen, Abdominal Pain Emergency, Acute Peritonitis, Prevention of Acute Abdominal Conditions, Prognosis of Acute Abdominal Pain

Written by Dr. Krishanga, BDS

Medically Reviewed by Dr. Pavithra, BDS on Dec 27, 2023

About

Pain, whether acute or chronic, demands attention. Acute abdomen, marked by sudden, severe abdominal pain, signals potential emergencies. Prompt identification and intervention are crucial for optimal outcomes.

Common Causes of Acute Abdominal Pain

Common causes of an acute abdomen include appendicitis, cholecystitis, pancreatitis, and diverticulitis. If a hollow organ ruptures it spills its content into the abdominal cavity and causes acute peritonitis causing generalized acute pain(1^✔).

1. Appendicitis, Cholecystitis, Pancreatitis, and Diverticulitis

These conditions pose substantial risks, demanding swift diagnosis and intervention.
Rupture of a hollow organ can lead to acute peritonitis, causing generalized acute pain.

2. Urinary Causes

Stones obstructing the kidney, ureter, or bladder contribute to acute abdominal pain.
Prompt recognition is vital for preventing complications.

3. Urological Concerns in Adults

Blockages in urinary flow or sudden vascular events, such as aortic rupture, can result in an acute abdomen.
Vigilance is essential for immediate medical management.

4. Gynecological Factors in Young Women

Ruptured ectopic pregnancies and ovarian torsion can lead to acute abdominal distress.
Specialized attention is crucial for accurate diagnosis and timely intervention.

5. Pediatric Considerations

Newborns can present with necrotizing enterocolitis. Midgut volvulus is present 40% of the time in the first week of life, 50% in the first month, and 75% in the first year.
Infants and Children: Intussusception, typically occurring between nine to 24 months, requires timely intervention.
Torsion of testes in children and young adults requires prompt assessment and intervention.

Appendicitis remains a prevalent cause of acute pediatric abdomen, demanding swift medical attention(2^✔).

Demographics for Acute Abdominal Pain

Age and Gender

Appendicitis is more common in teens and 20s, while diverticulitis is prevalent in those over 60
Women and assigned females at birth (AFAB) may experience acute abdomen due to a ruptured ectopic pregnancy
Men and assigned males at birth (AMAB) may experience sudden pain due to testicular torsion.

Medical History: Individuals with a history of certain medical conditions, such as inflammatory bowel disease (IBD) or diabetes, may develop acute abdominal pain.

Prevalence: Abdominal pain accounts for 7-10% of emergency department visits.(3^✔)

Symptoms and Signs of Acute Abdominal Pain

Sudden, severe abdominal pain
Distended abdomen
Symptoms of shock (rapid heart rate, low blood pressure, sweating)
Signs of peritonitis (inflammation of the abdominal cavity)

Diagnosis of Acute Abdominal Pain

Medical History: Questions about medical history, pain location, onset, description, relieving/aggravating factors, past symptoms, medications, surgeries, bowel/urinary habits, and pregnancy status (for women/AFAB).

Physical exam: palpation, auscultation, and specific exams based on symptoms.

Laboratory Tests: Complete blood count (CBC), comprehensive metabolic panel (CMP), arterial blood gas (ABG), amylase test, liver function tests, kidney function tests, and urinalysis.

Imaging Tests: Abdominal ultrasound, abdominal CT scan, endoscopic ultrasound.

Diagnostic Laparoscopy or Exploratory Laparotomy: May be performed based on findings from other diagnostic methods.

Treatment, Prevention and Prognosis of Acute Abdominal Pain

Surgical Treatment: Surgery may involve removing damaged organs, addressing blockages, stopping internal bleeding, or repairing injuries.

Nonsurgical Treatment: Stabilization, monitoring vital signs, administration of fluids, antibiotics, pain relievers, and antiemetics.

Prevention: There is no specific prevention for acute abdomen as it can stem from various causes, many of which are not preventable. However, adopting a healthy lifestyle, incorporating a balanced diet, and engaging in regular exercise are recommended practices.

These habits contribute to overall well-being and may indirectly mitigate some risk factors associated with certain causes of acute abdominal pain. While preventive measures may not eliminate all potential triggers, maintaining a healthy lifestyle can positively impact one's general health and potentially reduce the risk of specific conditions contributing to acute abdomen.

Prognosis: The prognosis for acute abdomen is intricately tied to its underlying cause. Swift and immediate treatment significantly enhances overall outcomes, often preventing the progression of complications. However, if left untreated, acute abdomen may lead to severe complications such as fistula formation, tissue necrosis, sepsis, or even death.

Conclusion

Timely diagnosis, coupled with appropriate medical interventions, plays a pivotal role in shaping the prognosis and minimizing the potential risks associated with acute abdominal conditions. Regular medical monitoring and adherence to recommended treatments are crucial factors in ensuring a positive and improved prognosis for individuals experiencing acute abdomen.

References:

The Acute Abdomen - (https://www.ncbi.nlm.nih.gov/books/NBK412/)
The Role of Noncontrast CT in the Evaluation of Surgical Abdomen Patients - (https://pubmed.ncbi.nlm.nih.gov/29981641/)
Epidemiology and outcomes of acute abdominal pain in a large urban Emergency Department: retrospective analysis of 5,340 cases - (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5075866/)

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Dr. Krishanga. (2023, December 27). Understanding Acute/Emergency Abdominal Pain. Medindia. Retrieved on Dec 24, 2024 from https://www.medindia.net/health/symptoms/understanding-acute-emergency-abdominal-pain.htm.
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