Abdominal Pain

Definition: (Acute Abdomen)

This is a term used to define a group of abdominal conditions in which early surgical treatment must be considered.

Few medical conditions mimic surgical conditions and sometime un-necessary surgery is performed e.g;
Some patient with myocardial infarction just present with epigastric pain and vomiting.
Patient of diabetes ketoacidosis or porphyria may present with abdominal pain.



Cases in Surgical Emergency present with abdominal pain:

Pain due to Inflammation:
Appendicitis.
Cholecystitis.
Pancreatitis.
Intra-abdominal abscess.
Pelvic inflammation disease.

Pain due to Perforation:
Peptic Ulcer.
Ovarian Cyst.

Pain due to Vascular Ischemia:
Ruptured aortic aneurysm.
Mesenteric infarction.

Pain due to Obstruction:
Intestinal Obstruction.
Ureteric Colic.



Cases in Medical Emergency present with Abdominal pain:

Referred pain:
Myocardial Infarction.
Pneumonia.

Metabolic Causes:
DKA.
Lead poisoning.

Functional Gastrointestinal Disorders:
Irritable Bowel Syndrome.

Renal Causes:
Acute pyelonephritis

Hematological Causes:
Sickle cell crisis.
Hemophilia.
Purpura.

Vasculitis:
Embolic.

Mechanism of Abdominal pain:

1. Visceral pain.
2. Referred pain.
3. Miscellaneous.

1. Visceral pain:

Irritation or Inflammation of peritoneum.

Vascular Insufficiency.

Spasm of hallow viscus.

Stretching of capsule of solid organs.

Ulceration of tissues.

2. Referred pain:

From the chest.

From the vertebral column.

From the Gonads.

3. Miscellaneous:

Metabolic disorders.

Psychogenic disturbances.

Diagnosis of Abdominal Pain:

• History.
• Examination.
• Investigation.

History:

Take pain history from the patient like, onset, nature and other features.

Ask about other symptoms history like, Nausea & Vomiting.

Examination:

Check the sign of Peritonitis and Obstruction;

Tenderness.

Rebound tenderness.

Guarding.

Distension of abdomen due to gas.

Increased gut sounds.

Absent gut sounds suggest peritonitis.

Pelvic and Rectal Examination:

Pelvic examination for gynaecological disorder e.g; Ruptured ectopic pregnancy.

Rectal examination to detect localized tenderness.

Other Observation:

Tongue.

Temperature.

DM (DKA).

Pneumonia.

MI.

IBS.

Investigations:

FBC.

Serum Electrolytes.

Serum amylase.

Urine Analysis.

Porphyrins.

X-Ray Abdomen.

Management:

Management perform according to underlying cause of abdominal pain.