Refers to diseases with acute onset, primarily presenting as abdominal pain.

• Timely surgical intervention is crucial for conditions with life-threatening complications, though not all cases require surgery.
• Up to 50% of abdominal pain cases may have unclear causes and resolve spontaneously or with simple analgesics, termed nonspecific abdominal pain (NSKA).

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What to first Ask ?

1. Determine Cause: Is it acute abdominal disease?
2. Assess Need: Does it require surgery?
3. Evaluate Urgency: How urgent is surgical intervention?

Avoid Before Full Diagnosis

• No analgesics, antispasmodics, antibiotics, hot pads, or interventions like enemas or laxatives.
• Causes of Complications

Aetiology

• Inflammatory:
  • Appendicitis, diverticulitis, peritonitis, pancreatitis.
• Obstructive:
  • Intestinal: Hernia, tumour, volvulus, adhesions.
  • Biliary: Tumour, cholelithiasis, haemobilia, parasites.
  • Renal: Stones, tumors.
  • Gynecological: Ovarian cyst torsion, ectopic pregnancy.
• Vascular:
  • Mesenteric artery/vein occlusion, aortic aneurysm rupture, liver/spleen rupture.

Clinical Presentation

• Pain Onset & Course
  • Sudden, Severe, Continuous Pain: Organ rupture, vascular events.
  • Gradual Onset, Increasing Intensity: Inflammatory processes.
  • Intermittent Pain with Painless Periods: Colic, subacute pancreatitis.
• Somatic Pain
• Visceral Pain

In pancreatitis, the visceral peritoneum is involved, leading to visceral pain as the dominant feature, often radiating to the back.

• Nausea and Vomiting
• Diarrhoea

Acute Abdomen pain with Jaundice, Chills, Shivering, Fever, and Right Hypochondrium Pain: Suppurative Cholangitis.

• History

Peritonitis

• Primary Peritonitis
• Secondary Peritonitis

Diagnosis

• Early Diagnosis: Prevents ARF, shock, perforation.
• Accurate Diagnosis: Avoids unnecessary laparotomies.
• Differential Diagnosis: Excludes other causes (e.g., MI, hepatitis, pneumonia, renal disease)
• Physical Examination
• Labs
• Imaging

Management

• Colicky Pain: Responds to analgesics and antispasmodics.
• Vascular Events/Organ Ruptures: Pain typically does not respond to medication.
• Aim of Surgical Therapy
• Urgent Operation (within 24 hours)
• Preoperative Preparation:
• Postoperative Course:

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Differential Diagnosis

Severe central abd pain + shock -peritoneal signs

• Intra-abdominal Causes:

  • Acute Pancreatitis: Pain radiates to the back.
  • Ruptured AAA: Pulsatile mass.
  • Hemoperitoneum:
    • Spontaneous rupture of spleen.
    • Splenic artery aneurysm: Pain radiates to the left shoulder.
    • Ruptured Ectopic Pregnancy.

• Extra-abdominal Causes:

  • Acute MI with Cardiogenic Shock.

  

Severe central Abd pain + Vomiting, Distension, No Peritoneal Signs

• Small Bowel Obstruction:

  • Bilious Vomiting: In proximal obstruction.
  • Feculent Vomiting: In distal small bowel obstruction.

• Gastric Outlet Obstruction:

  • Non-bilious Vomiting.
  • Vomiting of undigested food particles.

  

Severe central abd pain without associated signs

• Intra-abdominal Causes:
  • Intestinal Colic.
  • Early Appendicitis.
  • Early/Mild Pancreatitis.
  • Early Mesenteric Thrombosis.
• Extra-abdominal Causes:

Severe Abd Pain + Localised Peritoneal Signs [ RUQ ]

• Intra-abdominal Causes:
• Extra-abdominal Cause:

Severe Abdominal Pain + Localised Peritoneal Signs in the Hypogastric/Suprapubic Area

• Gastrointestinal Causes:
• Urinary Tract Causes:
• Gynecologic/Obstetric Causes