Sudden onset of pain suggest a peroration ,rupture ,torsion and acute pancreatitis
Pain is stimulated mainly by the stretching of smooth muscle or organ capsules .Severe acute abdominal pain can be due to a large number of gastrointestinal conditions ,and normally presents as an emergency.An acute abdomen can occasionally be due to referred pain from the chest ,as in pneumonia ,or to metabolic causes ,such as diabetic ketoacidosis .
In patients with abdominal pain the following should be ascertained :
- The site ,intensity ,character ,duration and frquency of the pain .
- The aggravating and relieving factors.
- Associated symptoms ,including non gastrointestinal symptoms.
The onset ,site ,type and subsequent course of the pain should be determined as accurately as possible .In general ,the pain of an acute abdomen can either be constant ( usually owing to inflammation ) or colicky because of a blocked tube .The inflammatory nature of a constant pain wil be supported by a raised temperature ,tachycardia and /or a raised white cell count .If these are normal, then other causes ( e.g musculoskeletal ,aortic aneurysm ) or rare causes ( e.g porphyria ) should be considered .Colicky pain can be due to an obstruction of the gut ,biliary system ,urogenital system or the uterus .These will probably initially require conservative management along with analgesics .If a colicky pain becomes a constant pain,then inflammation of the organ may have supervened ( e.g strangulated hernia ,ascending cholangitis or salpingitis ).
A sudden onset of pain suggests:
- A perforated ( e.g of a duodenal ulcer ) .
- A rupture ( e.g of an aneurysm ) .
- Torsion ( e.g of an ovarian cyst ).
- Acute pancreatitis.
Back pain suggests :
- Pancreatitis.
- Rupture of an aortic aneurysm.
- Renal tract disease.
Inflammatory conditions (e.g appendicitis ) produce a more gradual onset of pain .With peritonitis the pain is continuous and may be made worse by movement.
COMMON CAUSES OF ACUTE ABDOMINAL PAIN
Non-specific abdominal pain.
Acute appendicitis.
Renal colic.
Gynaecological disorders.
Intestinal obstruction.
Urinary tract infection.
Gall bladder disease.
Peritoneal ulcer/ dyspepsia.
Diverticular disease.
MEDICAL CAUSES OF ACUTE ABDOMEN.
REFERRED PAIN
Pneumonia.
Myocardial infarction.
FUNCTIONAL GASTROINTESTINAL DISORDERS
RENAL CAUSES
Pelviureteric colic.
Acute pyelonephritis.
METABOLIC CAUSES.
Diabetic mellitus.
Acute intermittent porphyria.
Lead poisoning.
HAEMATOLOGICAL CAUSES
Haemophilia and other bleeding disorders.
Henoch-Schonlein purpura.
Sickle cell crisis.
Polycythemia vera.
VASCULITIS
Embolic
