Acute abdomen jason axt oscar guillamondegui, md, mph, facs. The acute series is used for a variety of indications including. Assessment of the patient with acute abdominal pain essay. Feb 14, 2018 acute abdomen refers to signs and symptoms of abdominal pain and tenderness, that often requires emergency surgical therapy. The varying presentations of acute surgical conditions make diagnoses often challenging. An acute abdomen is diagnosed by a combination of history, physical examination, radiography, and laboratory results.
Jul 30, 2017 the initial examination of the emergency patient is covered in chapter 1, but points to consider in the acute abdomen patient are as follows. Following laparoscopic adjustable gastric banding, abdominal pain may be caused by esophagitis. The history and physical examination remain the critical first step in effective management and must be based on a thorough understanding of the anatomy and physiology of abdominal pain. The crucial role of timely surgical intervention in treating acute abdomen has been reported by others 3, 4. Evaluation of the acute abdomen in infants and children can be challenging. Evaluating abdominal pain requires an approach that relies on the. A patient with acute surgical pathology may deteriorate rapidly. Acute abdomen definition of acute abdomen by medical dictionary. Abdominal pain is the most common cause for hospital admission in the united states. Nonsurgical causes of acute abdominal pain stimulating an acute abdomen account for up to 30% of patients requiring hospital admission. Full text full text is available as a scanned copy of the original print version. Metabolic and clinical aspects third edition, 2014.
The initial examination of the emergency patient is covered in chapter 1, but points to consider in the acute abdomen patient are as follows. Nonsurgical causes of acute abdominal pain intechopen. Acute abdomen vanderbilt university medical center. Dec 18, 2015 since acute abdomen requires accurate diagnosis and treatment within a particular time limit to prevent mortality, the japanese society for abdominal emergency medicine in collaboration with four other medical societies launched the practice guidelines for primary care of acute abdomen that were the first english guidelines in the world for the management of acute abdomen. An accurate and comprehensive history of the events surrounding the onset of pain and knowledge of the nature of pain, its location and accompanying symptoms are crucial in developing a differential. Patients with acute surgical abdomens will often have a rapid symptom. Clearly, the case of a pregnant patient with acute abdomen is a clinical scenario that overlaps specialties. In tables i and ii are summarized characteristic features for differential diagnosis of common conditions which may either cause or mimic an acute abdomen. Sep 26, 2012 syncope may indicate disease originating in the chest pulmonary embolism, dissection or abdomen acute aortic aneurysm, ectopic pregnancy. The acute abdomen is managed by many kinds of physicians and requires accurate diagnosis and treatment within a particular time limit to prevent mortality. Acute and severe abdominal pain, however, is almost always a symptom of intraabdominal disease. Acute abdomen an acute intraabdominal condition of abrupt onset, usually associated with pain due to inflammation, perforation, obstruction, infarction or rupture of abdominal organs, and usually requiring emergency intervention. Review assessment strategy for the acute abdomen discuss management strategy for common sources of abdominal painthe surgical abdomen in both the out patient and in patient environment. The best dx in this patient presenting as an acute abdomen is.
Page 76 guidelines on how to write a practice profile assessment of the patient with acute abdominal pain ns344 cole e et ai 2006 assessment of the patient with. The differential diagnosis of abdominal pain is extensive and requires a logical evaluation. However, not all cases of acute abdomen are best treated with surgery. Dept of general, emergency and miniinvasive surgery, universitary hospital of. The acute abdomen commonly missed and misdiagnosed. Non surgical causes of acute abdominal pain stimulating an acute abdomen account for up to 30% of patients requiring hospital admission. Appendicitis common in younger, whereas biliary disease, bowel obstruction, intestinal ischemia and infarction, and diverticulitis are more. The initial approach to acute abdomen should be to assess for immediately lifethreatening causes e. Acute abdominal pain is one of the most commonly encountered leading symptoms in the emergency department. Acute abdominal pain is a clinical stgn assoctated with several underlying disease processes, many of which can be life threatening. Assessment of acute abdomen in the emergency department mario luka csenar summary. Since acute abdomen requires accurate diagnosis and treatment within a particular time limit to prevent mortality, the japanese society for abdominal emergency medicine in collaboration with four other medical societies launched the practice guidelines for primary care of acute abdomen that were the first english guidelines in the world for the management of acute abdomen.
Surgical abdomen definition of surgical abdomen by. The cavity, which is lined with a membrane known as the peritoneum, contains the stomach, large and small intestines, liver, spleen. As opposed to common abdominal pain, which can be caused by minor issues such as constipation or gas, acute abdominal pain can signal a variety of more serious conditions, some of which. Acute abdominal series radiology reference article. Gangrene and perforation of the gut can occur acute abdominal pain ranges between 510% of all visits at emergency department. Acute abdominal pain in the bariatric surgery patient. The acute abdomen commonly missed and misdiagnosed conditions. Acute abdomen in pregnancy requiring surgical management. Acute abdomen is the medical term used for pain in the abdomen that usually comes on suddenly and is so severe that one may have to go to the hospital.
Definition signs and symptoms of abdominal pain a clinical picture that often requires emergency surgery therapy. What are the two general categories of acute abdomen. Evaluation of acute abdomen differential diagnosis of. Lower bmi cutoffs to define overweight and obesity in china. When evaluating a patient with acute abdominal pain, the most important elements in making an accurate early diagnosis are the history and physical examination. Pdf the acute surgical abdomen epidemiology, diagnosis. Practice guidelines for primary care of acute abdomen 2015. The practice guidelines for primary care of acute abdomen 2015. Perioperative management of acute abdomen authorstream. Get a printable copy pdf file of the complete article 765k, or click on a page image below to browse page by page. The acute abdomen is test of clinical acumen of the clinician. Pdf diagnostic approach and management of acute abdominal. The only exception to this is the presence of a metabolic alkalosis, which is highly suggestive of an upper gi obstruction although note that this may also occur in some severe acute pancreatitis cases. Although it is oftentimes held for a purely surgical problem, two thirds of patients do not require operative management.
The acute surgical abdomen epidemiology, diagnosis and general principles of management. It may be the sole indicator of the need for surgery and must be attended to swiftly. Ischemic acute abdomen ischemia due to a reduction in blood flow due to acute arterial occlusion, venous thrombosis, or hypoperfusion risk factors. Evaluation and management of acute abdominal pain in the. The term acute abdomen is used to indicate the rapid onset of severe symptoms that may indicate potentially lifethreatening intraabdominal pathology requiring urgent surgical intervention. It was found that mortality was higher among older age group. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Gangrene and perforation of the gut can occur pdf file of the complete article 765k, or click on a page image below to browse page by page. As defined in the 27th edition of stedmans medical dictionary, acute abdomen is any serious acute intraabdominal condition attended by pain, tenderness, and muscular rigidity, and for which emergency surgery must be considered. Apr 07, 2020 acute abdomen, as it presents with pregnancy, has many possible causes. Acute abdomen knowledge for medical students and physicians. Table iv divides these diseases into surgical and nonsurgical groups. Assessment of acute abdomen in the emergency department. Evaluation of acute abdomen differential diagnosis of symptoms.
Triage and disposition acute abdominal pain frequently requires. Past medical and surgical history, current medications a history of prior abdominal surgery can rule out a condition or raise the suspicion for a complication such as obstruction from adhesions. Acute abdomen article about acute abdomen by the free. Abdominal pain requires efficient diagnostic evaluation to determine the approprtate course of treatment. Coagulation testing and platelet counts should be considered in many acute abdomen cases. Abdominal emergencies of hospital visits may include surgical and non surgical emergencies. Abdominal pain is the most common reason for a visit to the emergency department ed, accounting for 8 million 7% of the 119 million ed visits in 2006. The upper end of the bowel is bought out as a descending colostomy. Among geriatrics, it was found that acute cholecystitisis the most common cause of acute abdomen and abdominal malignancies is the second most common cause.
Acute abdomen definition of acute abdomen by medical. Diagnose or at least and most importantly determine if the acute abdomen is a lifethreatening surgical emergency or indolent medical condition. While this is not entirely incorrect, peritonitis is the more specific term, referring to inflammation of the peritoneum. It manifests on physical examination as rebound tenderness, or pain upon removal of pressure more than on application of pressure to the abdomen. If only one book about surgery could be made available to physicians from all specialties, it should probably be silens recent revision of copes early diagnosis of the acute abdomen. The acute abdomen samuel hamner gay ummc school of medicine surgical clerkship 2. If a surgical emergency is suspected based on presentation or physical findings, a surgeon should be consulted in an emergent fashion. Also called surgical abdomen in contrast to peritonitis inflammation of the peritoneum.
May require a hartmanns the lower end of the rectum is closed with sutures or staples and left in situ. Evaluation of acute abdominal pain in adults sarah l. The commonly missed or misdiagnosed surgical conditions include acute appendicitis, testicular torsion, midcycle ovarian. Acute abdominal pain the goal of the evaluation of the patient with acute abdominal pain is an early, efficient, and accurate diagnosis. The underlying pathology may be intraabdominal, thoracic, or systemic and may require urgent surgical intervention. The acute abdomen requires rapid and specific diagnosis as several etiologies demand urgent operative intervention. Diagnose or at least and most importantly determine if the acute abdomen is a lifethreatening surgical emergency or indolent. Evaluation of the acute abdomen paediatrics and child health. Definitions acute abdomen intraabdominal process causing severe, usually sudden onset pain and often requiring surgical intervention. Aa may also be defined as an acute intraabdominal inflammatory.
Any cause for acute abdomen can occur coincident with pregnancy. Evaluation of acute abdominal pain in adults american. Acute abdomen is characterized by sudden, sharp pains in the abdomen, tension of the muscles of the anterior abdominal wall, and irritation of the peritoneum. Animals may have tachypnoea due to pain, or in some acute abdomen cases, distended organs or large abdominal effusions may press on the diaphragm causing respiratory compromise. Mortality from non surgical acute abdominal pain was low, it represented 1. Aa may also be defined as an acute intraabdominal inflammatory process that may require surgical intervention. Mortality from nonsurgical acute abdominal pain was low, it represented 1. Practice guidelines for primary care of acute abdomen 2015 that were the. The practice guidelines for primary care of acute abdomen. The acute abdomen remains a challenge to surgeons and other physicians. Acute abdomen refers to signs and symptoms of abdominal pain and tenderness, that often requires emergency surgical therapy. Evaluation of the acute abdomen melissa whitmill, m.
Acute abdominal pain gastrointestinal disorders msd. Although a common presentation, abdominal pain must be approached in a serious manner, as it is often a. When symptoms do not necessitate immediate surgery and when imaging has not led to a definitive diagnosis, further abdominal examination by an experienced physician may help to determine the underlying cause. Most patients have a benign andor selflimited etiology, and the initial goal of evaluation is to identify those patients with a serious etiology that may require urgent intervention. In literature as well as in clinical practice the borders between the acute abdominal pain and acute abdomen overlap and are used interchangeably. A striking feature in our study is the association between mortality rate and the delay in surgical evaluation and intervention table 2, fig. Abdominal emergencies of hospital visits may include surgical and nonsurgical emergencies. Assistant professor of clinical surgery the ohio state university the acute abdomen any abrupt onset of significant abdominal pain requires urgent decision, diagnoses, and treatment treatment is often surgical diagnoses often unclear, but treatment must be appropriate acute. Acute abdomen refers to severe abdominal pain lasting for. An acute abdomen denotes any sudden, spontaneous, nontraumatic, severe abdominal pain, typically of less than 24 hours duration. The acute abdomen sudden nontraumatic disorder of the abdomen for which urgent operation may be necessary goal of acute abdomen hp. Although it is not always possible to make an exact diagnosis preoperatively. Colonic ischemia most common form of intestinal ischemia.
912 114 1628 1051 109 685 606 1631 1664 439 1650 1662 528 901 1150 905 754 268 1579 842 393 777 569 118 802 1411 1157 676 384 406