An acute abdomen is a condition that demands urgent attention and treatment. The acute abdomen may be caused by an infection, inflammation, vascular occlusion, or obstruction. The patient will usually present with sudden onset of abdominal pain with associated nausea or vomiting. This activity reviews the evaluation and treatment of patients presenting with an acute abdomen, and highlights the role of the interprofessional team in caring for these patients.
- Explain how a patient with an acute abdomen might present.
- Describe the evaluation of a patient with an acute abdomen.
- Generate a differential diagnosis for a patient presenting with an acute abdomen.
- Explain how a well-coordinated, interprofessional team approach can improve outcomes for patients presenting with an acute abdomen.
Introduction
The approach to a patient with an acute abdomen should include a thorough history and physical exam. The causes of an acute abdomen include appendicitis, perforated peptic ulcer, acute pancreatitis, ruptured sigmoid diverticulum, ovarian torsion, volvulus, ruptured aortic aneurysm, lacerated spleen or liver, and ischemic bowel.
Etiology
Common causes of an acute abdomen include acute appendicitis, cholecystitis, pancreatitis, and diverticulitis. rupture of a hollow viscus or as a complication of inflammatory bowel disease or malignancy. Vascular events causing an acute abdomen include mesenteric ischemia and ruptured abdominal aortic aneurysm. Obstetric and gynecologic causes include ruptured ectopic pregnancy and ovarian torsion. Urologic conditions including ureteral colic and pyelonephritis can also present as acute abdominal pain. Many authors include small bowel obstruction as a cause of acute abdomen. Newborns can present with necrotizing enterocolitis
History and Physical
Various causes of an acute abdomen have classic presentations. Appendicitis is supposed to start with dull periumbilical pain that migrates with time to the right lower quadrant. Pain in various quadrants suggests varying diagnoses. Acute diverticulitis usually lives in the left lower quadrant while cholecystitis is usually felt in the epigastrium or right upper quadrant.
Evaluation
rapid initial diagnosis and treatment of the acute abdomen are crucial. Diagnostic interventions include blood work and imaging. In adults older than 40, a 12 lead ECG can help exclude myocardial infarction as the cause of apparent severe abdominal pain. complete blood count (CBC), metabolic profile and lipase, A urine or serum pregnancy test is needed in the workup of ectopic pregnancy.
A bedside ultrasound in the Emergency Department can diagnose cholecystitis, hydronephrosis, hemoperitoneum, and the presence of an abdominal aortic aneurysm in a less than 5 minutes. Diagnostic ultrasound is the preferred modality for cholecystitis, pediatric appendicitis, ruptured ectopic, and ovarian torsion. Multislice helical CT scanning has made the diagnosis of an acute abdomen much more straightforward. In the majority of cases, intravenous (IV) contrast is sufficient.
Treatment / Management
prompt aggressive fluid resuscitation with adequate large bore IV access. Broad-spectrum antibiotics covering gram-negative enteric organisms should be administered. Adequate pain relief with opioids is a standard of care. The use of anti-emetics is likewise important.
Pearls and Other Issues
Acute abdomen is a condition that demands urgent attention and treatment. The acute abdomen may be caused by an infection, inflammation, vascular occlusion, or obstruction. The patient will usually present with sudden onset of abdominal pain with associated nausea or vomiting. Most patients with an acute abdomen appear ill.
An Interprofessional Approach and Outcomes:
While the general surgeon is almost always involved in the care of patients with an acute abdomen, it is important to consult with an interprofessional team of specialists that include an obstetrician, gynecologist, and a vascular surgeon. The nurses are also a vital member of the interprofessional group as they will monitor the patient’s vital signs. In the postoperative period for pain, wound infection and ileus.
