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Acute abdomen: Difference between revisions
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'''Acute abdomen''' is the name of the clinical presentation where a patient has acute onset abdominal pain. There’s a large number of conditions which can cause acute abdomen, from harmless to life-threatening, and so knowing the differential diagnosis and investigations to distinguish them is important. The presence of typical risk factors, gender, and age for a specific cause can also help the diagnosis, and so knowing these is important as well. It’s important to remember that atypical presentations exist, of course. These patients should be examined systematically to identify the underlying cause. | <section begin="radiology" />'''Acute abdomen''' is the name of the clinical presentation where a patient has acute onset abdominal pain. There’s a large number of conditions which can cause acute abdomen, from harmless to life-threatening, and so knowing the differential diagnosis and investigations to distinguish them is important. The presence of typical risk factors, gender, and age for a specific cause can also help the diagnosis, and so knowing these is important as well. It’s important to remember that atypical presentations exist, of course. These patients should be examined systematically to identify the underlying cause.<section end="radiology" /> | ||
<section begin="radiology" /> | |||
== Life-threatening conditions == | == Life-threatening conditions == | ||
It’s important to recognise or exclude life-threatening conditions. | It’s important to recognise or exclude life-threatening conditions. | ||
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|Tearing/ripping pain, associated symptoms of downstream ischaemia | |Tearing/ripping pain, associated symptoms of downstream ischaemia | ||
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<section end="radiology" /> | |||
== Differential diagnosis by location == | == Differential diagnosis by location == | ||
Different causes of acute abdomen cause pain in certain typical areas. | Different causes of acute abdomen cause pain in certain typical areas. | ||
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=== History and physical examination === | === History and physical examination === | ||
The patient’s history and physical examination should be taken. Characterisation of the timing and features of the pain is especially important. It’s important to recognise features suggestive of severe disease, like severe, opioid-refractory pain, haemodynamic instability, sudden onset pain, and signs of peritonitis. Care should be made in elderly, where typical signs of the specific diseases may be absent, and severe disease may present without findings of severe disease. | The patient’s history and physical examination should be taken. Characterisation of the timing and features of the pain is especially important. It’s important to recognise features suggestive of severe disease, like severe, opioid-refractory pain, haemodynamic instability, sudden onset pain, and signs of peritonitis. Care should be made in elderly, where typical signs of the specific diseases may be absent, and severe disease may present without findings of severe disease. | ||
<section begin="radiology" /> | |||
=== Imaging === | === Imaging === | ||
If there is suspicion of serious pathology, including [[abdominal aortic aneurysm]] rupture, [[Gastrointestintal perforation|gastrointestinal perforation]] or [[ileus]], an urgent [[CT]] with contrast is indicated. CT is also the preferred modality if [[diverticulitis]] or [[nephrolithiasis]] is suspected. In case of biliary disease like [[Acute calculous cholecystitis|cholecystitis]] or [[Gallstone disease|gallstone]], or [[Acute pancreatitis|pancreatitis]] or [[appendicitis]] is suspected, [[ultrasound]] is usually the first choice. For PID and ectopic pregnancy, [[transvaginal ultrasound]] is the first choice. | If there is suspicion of serious pathology, including [[abdominal aortic aneurysm]] rupture, [[Gastrointestintal perforation|gastrointestinal perforation]] or [[ileus]], an urgent [[CT]] with contrast is indicated. CT is also the preferred modality if [[diverticulitis]] or [[nephrolithiasis]] is suspected. In case of biliary disease like [[Acute calculous cholecystitis|cholecystitis]] or [[Gallstone disease|gallstone]], or [[Acute pancreatitis|pancreatitis]] or [[appendicitis]] is suspected, [[ultrasound]] is usually the first choice. For PID and ectopic pregnancy, [[transvaginal ultrasound]] is the first choice. | ||
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Ultrasound cannot visualise a retrocoecal appendix, and is therefore not completely sensitive for acute appendicitis. The presence of bowel gas also reduces visibility. | Ultrasound cannot visualise a retrocoecal appendix, and is therefore not completely sensitive for acute appendicitis. The presence of bowel gas also reduces visibility. | ||
<section end="radiology" /> | |||
== References == | == References == | ||
<noinclude> | <noinclude> | ||
[[Category:Gastrointestinal surgery]] | [[Category:Gastrointestinal surgery]] | ||
</noinclude> | </noinclude> | ||