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'''Acute abdomen''' is the name of the clinical presentation involving acute onset abdominal pain. There’s a large number of conditions which can cause acute abdomen, 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.
'''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, 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.


== Life-threatening conditions ==
== Life-threatening conditions ==
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|Tender costovertebral angle on percussion, fever, chills, UVI symptoms
|Tender costovertebral angle on percussion, fever, chills, UVI symptoms
|}
|}
== Physical examination of acute abdomen ==
=== Inspection ===
{| class="wikitable"
!Finding
!Suspicious for
|-
|Inspect for any hernias
|–
|-
|Patient lies completely still (any small movement causes pain) with knees bent
|[[Peritonitis]]
|-
|Patients is curled up, writhes in agony, wants to keep moving
|[[Biliary colic|Biliary]] or [[renal colic]]
|}
=== Auscultation ===
{| class="wikitable"
!Finding
!Suspicious for
|-
|Abnormally active, high-pitched bowel sounds
|Early [[Ileus|bowel obstruction]]
|-
|Absent bowel sounds
|Late bowel obstruction
|-
|Bruit on auscultation
|[[Abdominal aortic aneurysm]]
|}
=== Percussion ===
{| class="wikitable"
!Finding
!Suspicious for
|-
|Even gentle percussion causes pain
|[[Peritonitis]]
|-
|Shifting dullness on percussion
|[[Ascites]]
|}
=== Palpation ===
{| class="wikitable"
!Finding
!Suspicious for
|-
|Palpate the whole abdomen to locate the area of maximal pain, first superficially then deeper
|–
|-
|Palpate for hepatomegaly or splenomegaly
|–
|-
|Palpate for any masses
|–
|-
|Muscular rigidity or “guarding” on palpation
|[[Peritonitis]]
|-
|Rebound tenderness
|Peritonitis
|-
|Markle sign/Heel-drop test
|Peritonitis
|-
|Maximal pain at the McBurney’s point
|[[Acute appendicitis|Appendicitis]]
|-
|Palpation of contralateral McBurney’s point elicits pain at the McBurney’s point ([[Acute appendicitis#Physical signs of acute appendicits|Rovsing sign]])
|Appendicitis
|-
|[[Acute appendicitis#Physical signs of acute appendicits|Psoas sign]]
|Appendicitis, especially retrocaecal appendicitis
|-
|[[Acute appendicitis#Physical signs of acute appendicits|Obturator sign]]
|Appendicitis, especially pelvic appendicitis
|-
|Carnett sign
|Abdominal wall pathology (rather than visceral pathology)
|-
|[[Acute calculous cholecystitis#Clinical features|Murphy sign]]
|[[Acute calculous cholecystitis|Cholecystitis]]
|-
|Pain out of proportion to physical findings (severe pain but nontender, soft abdomen)
|[[Intestinal ischaemia|Mesenteric ischaemia]]
|}
Peritonitis may be local or generalised, and the physical findings will follow this. It’s important to know that, because the visceral organs aren’t innervated with somatic pain fibres, appendicitis isn’t painful in itself but causes pain because it causes localised peritonitis in the overlying peritoneum.
Markle sign is tested by asking the patient to stand on their toes and suddenly drop down on the heels with an audible thump, which causes localised pain. An alternative way to elicit this sign is to lift the patient’s legs slightly off the bed and striking the patient’s heels.
Carnett sign refers to increased tenderness when the abdominal wall muscles are voluntarily contracted.


== Initial management ==
== Initial management ==