Acute abdomen first aid

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Acute abdomenfirst aid

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• The critical distinction, then, is not between
  acute and nonacute pain, but between surgical and
  nonsurgical conditions.

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• serious condition arises suddenly and is
  continuous, progressively worse, and long
  lasting, begins during inactivity and is not
  near the umbilicus

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Gastrointestinal Tract

• Appendicitis, acuteMeckel's diverticulitisPerf
  orated bowelPerforated peptic ulcerSmall and
  large bowel obstructionStrangulated
  herniaDiverticulitisGastritisGastroenteritisI
  nflammatory bowel diseaseMesenteric
  lymphadenitis

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Liver, Spleen, and Biliary Tract

• Cholangitis, acuteCholecystitis, acuteHepatic
  abscessRuptured hepatic tumorRuptured
  spleenBiliary colicHepatitis, acuteSplenic
  infarct

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Peritoneum

• Intra-abdominal abscessPrimary
  peritonitisTuberculous peritonitis

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Pancreas

• Pancreatitis, acute

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Urinary Tract

• Cystitis, acutePyelonephritis, acuteRenal
  infarctUreteral or renal colic

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Female Reproductive System

• Ruptured ectopic pregnancyRuptured ovarian
  follicular cystTwisted ovarian
  tumorDysmenorrheaEndometriosisSalpingitis,
  acute

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Vascular System

• Ischemic colitis, acuteMesenteric
  thrombosisRuptured arterial aneurysm

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Retroperitoneum

• Retroperitoneal hemorrhage

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Miscellaneous

• Precompetition anxiety Trauma

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Appendicitis, acute

• Constant pain, progressively more severe begins
  in periumbilical region, moves to right lower
  quadrant nausea, vomiting, and anorexia follow
  pain low-grade fever patient appears ill

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Cholecystitis, acute

• Constant pain in right upper quadrant, onset
  often postprandial nausea and vomiting
  tenderness in right upper quadrant and right
  shoulder splinting on right side

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Perforated peptic ulcer

• Sudden onset of pain in midepigastrium that
  spreads and is aggravated by movement patient
  appears acutely ill and is reluctant to move
  rigid abdomen grunting respiration bowel sounds
  absent

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Ectopic pregnancy

• Pain sudden, severe, and persistent, generally
  following a missed or abnormal period, typically
  epigastric often associated with hypotension and
  tachycardia

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Ovarian cyst

• Pain constant with sharp, sudden onset usually
  in ipsilateral hypogastrium may have nausea and
  vomiting following the pain

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Pelvic inflammatory disease

• Pain at end of or shortly after normal menstrual
  period bilateral lower quadrant pain aggravated
  by cervical manipulation anorexia, nausea, and
  vomiting rare possible cervical discharge fever

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Urinary calculus

• Pain location changes with movement of stone, may
  radiate to testicle, groin of involved side pain
  very severe patient cannot get comfortable

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History and PE
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Mode of onset, progression, character, and
severity of pain

• surgical etiology sudden in onset, severe or
  explosive, progressive, continuous, and lasts
  more than 6 hours generally.
• nonsurgical diagnosis gradual in onset, mild to
  moderate in intensity, intermittent, recurrent,
  or resolves partially or completely in less than
  6 hours.

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Colic pain

• Pain arising in a hollow, tubular structure, such
  as the ureter, intestine, biliary radicles, or
  fallopian tubes, may be continuous or
  intermittent

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Activity during which pain was first noted

• Surgical etiology awakens the patient or begins
  during relative inactivity
• Nonsurgical diagnosis during or closely
  following strenuous activity--or after eating

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Initial location of pain

• the farther from the umbilicus the pain
  localizes, the greater the chance that a surgical
  condition exists.
• Epigastrium foregut derivatives (stomach,
  duodenum, biliary tract, and pancreas) or the
  spleen presents.
• periumbilical area midgut derivatives (jejunum,
  ileum, proximal third of the colon, and
  appendix).
• Hypogastrium embryonic hindgut (distal
  two-thirds of the colon), internal reproductive
  organs (ovaries, fallopian tubes, uterus, seminal
  vesicles, and prostate), and the urinary bladder.

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Shifting pain

• When the original inflammation extends to the
  parietal peritoneum.
• Appendicitis initially causes pain in the
  periumbilical area. Then, after 4 to 6 hours, the
  inflammation extends to the regional peritoneal
  surface and is perceived in the right lower
  quadrant.

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Associated symptoms

• In surgical conditions, pain may be followed by
  nausea, vomiting, and anorexia.
• In nonsurgical conditions nausea, vomiting, and
  anorexia typically precede pain.
• Clinical experience vomiting in the obese
  patient is an ominous symptom and suggests
  serious abnormalities.

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• Fever is a common finding in patients who have
  abdominal pain.
• However, fever and chills is rarely seen in
  surgical processes. This combination suggests
  infection in the urinary tract, respiratory
  system, etc.

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• Obstipation--nonpassage of both stool and
  gas--however, always suggests a surgical problem.
  
• Diarrhea, especially with cramps, indicates
  gastroenteritis and other nonsurgical conditions
  like inflammatory bowel disease.

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What aggravates the pain

• Always ask first about which activities aggravate
  the pain. (One can generally assume that the
  opposite will ease the pain.)
• If the patient hears questions about what eases
  the pain, he or she may perceive it as minimizing
  the problem and become defensive.
• Coughing, sneezing, rapid movements, and walking,
  especially down stairs, can cause peritoneal
  irritation. Musculoskeletal pain is often
  relieved by changing position. A bowel movement
  often eases the pain of gastroenteritis, but the
  pain may promptly recur.

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• Men who do experience abdominal pain have a
  higher incidence of surgical disease.

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Medications and supplements

• Aspirin and other nonsteroidal anti-inflammatory
  drugs, erythromycin, potassium, and salt tablets
  commonly cause gastric irritation and abdominal
  pain.

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nonsurgical diagnosis

• Previous episodes, family history of similar
  problems, peers with the same symptoms, food
  intolerance, allergies, sudden changes in
  training or diet, and travel to regions with
  endemic disease.

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Physical Exam Pointers

• vital signs, inspection, auscultation, light
  touch, palpation, percussion, and rectovaginal
  exam

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keys to the physical exam

• tell the patient
• Auscultation should precede other modalities
• farthest from the site of maximal pain
• ask the patient questions and have him or her
  answer during palpation
• rebound tenderness
• Any pain elicited in the obese patient is
  significant