Acute Abdominal Pain:

Early Recognition and

Management
dokteryasmon
Case 1
• Male
• 50 y
• Abdominal pain
Acute Abdomen
• „any serious acute intra-abdominal
condition attended by pain, tenderness,
and muscular rigidity, and for which
emergency surgery must be considered“
Stedman Medical Dict.
• Acute abdominal pain is defined as severe
pain of more than 6 hours’ duration in a
previously healthy person that requires
timely diagnosis and aggressive
treatment, frequently surgical.

Makrauer FL, Greenberger NJ. Acute Abdominal Pain: Basic Principles & Current Challenges. In: Greenberger NJ, Blumberg RS, Burakoff
R. eds. CURRENT Diagnosis & Treatment: Gastroenterology, Hepatology, & Endoscopy, 3e. McGraw Hill; 2016. Accessed November 01, 2021.
Prevalence
• No exact numbers are available
• 7% and 10% of emergency department visits à abdominal pain
• 12.5% of those à emergent or urgent patients
• About one-third à non-specific abdominal pain
• 30% à acute renal colic

Patterson JW, Kashyap S, Dominique E. Acute Abdomen. [Updated 2021 Jul 14]. In: StatPearls
[Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK459328/
Etiology
1. Infection
2. Inflammation
3. Vascular occlusion
4. Obstruction
Most Frequent Diagnosis
• Appendicitis
• Perforated Peptic Ulcer
• Acute Pancreatitis
• Cholecystitis/Cholangitis/Biliary Colic
• Bowel Obstruction
• Ruptured Sigmoid Diverticulum
• Ovarian Torsion
• Volvulus
• Ruptured Aortic Aneurysm
• Lacerated Spleen or Liver
• Ischemic Bowel
• Renal Colic
Regions
How was the pain? Can you describe it?
• Dull
• Sharp
• Up and go
• Pain gets along with food
• Pain relieves during meal
• Migrate
• Worse in different position
History Taking
• SOCRATES bridge
• Site
• Onset
• Character
• Radiation
• Associated symptoms
• Time course
• Exacerbating or relieving factors
• Severity
Risk Factors
• Pre-existing gastrointestinal disease (e.g. GORD, Crohn’s disease)
• Family history of gastrointestinal disease (e.g. familial adenomatous
polyposis)
• Alcohol
• Smoking
• Recreational drugs
• Diet
Physical Examination
• ABCDE
• Fast, focused, and targeted
• Important issues must be prioritized
• Anatomy approach first
• Then thoroughly
Laboratory
• Blood routine
• BGA
• Blood glucose
• Coagulation studies
• Beta-hCG urine test
• Blood type
• Urinalysis
• Cultures
• Inflammation marker (CRP, Lactate, Troponin)
Imaging
• Upright CXR
• Abdomen X-ray (consider different position)
• Ultrasound
• CT Scan w/wo contrast
Red Flags
• Sudden onset of severe pain
• Pain that interrupts sleep
• Bilious vomiting
• Hematemesis
• Hematoschezia
• Hypotension, tachycardia
• Patient lying very still
• Patient writhing in pain
• Jaundice
• Rigidity (focal or diffused)
• Rebound tenderness
• Absent or tinkling bowel sounds
• Gross abdominal distention
• High-risk patients
Algorithm
Algorithm
Alvarado Score

Alvarado A. A practical score for the early diagnosis of acute appendicitis. Ann Emerg Med. 1986 May;15(5):557-64. doi: 10.1016/s0196-
0644(86)80993-3. PMID: 3963537.
Management
• ABCDE survey
• IV access with two large-bore peripheral Ivs
• IV fluid resuscitation
• Hemodynamic and respiratory support
• NPO status
• Perform a focused history and physical examination
• Perform targeted diagnostics
• Early surgical consult
• Supportive care (analgesics, empiric antibiotic, antiemetic, NGT)
• Treat underlying disease
Case 1
• Male
• 50 y
• Abdominal pain
• Can‘t defecate
and fart
• History of bowel
obstruction and
faecal vomit
• Dx/ Rectal
carcinoma
T4bN1M1
(hepatic)
Case 2. Male, 18 y, traffic injury
Key Concepts

Makrauer FL, Greenberger NJ. Acute Abdominal Pain: Basic Principles & Current Challenges. In: Greenberger NJ, Blumberg RS, Burakoff
R. eds. CURRENT Diagnosis & Treatment: Gastroenterology, Hepatology, & Endoscopy, 3e. McGraw Hill; 2016. Accessed November 01, 2021.
Thank You
Questions?