Acute Abdominal pain
Dr. L Veloz.
Objectives.
To learn to recognize the alarm signs of
abdominal pain.
 To know the causes of abdominal pain in
co relation with the abdominal
topography.
 To know the classification of pain.

Definition.
Abdominal pain is common and often
inconsequential.
 Acute and severe abdominal pain,
however, is almost always a symptom of
intra-abdominal disease. It may be the
sole indicator of the need for surgery and
must be attended to swiftly.
 It’s the unpleasant subjective feeling
coming from the patients abdomen.

Pathophysiology of the Abdominal
pain.
Classification:
 Visceral pain. Dull, vague, nauseating,
poorly localized. Responds to distention
and muscle contraction. Ex, stomach, liver,
duodenum.
 Somatic pain. Sharp and well localized.
Responds to inflammation, irritation.
 Referred pain. Is pain perceived distant
from its source and results from
convergence of nerve fibers at the spinal
cord. Ex, billiary colic.
Peritonitis
Peritonitis is the inflammation of the
peritoneal cavity.
Causes of peritonitis:
 Intrabdominal bleeding, ej., trauma,
ruptured ectopic pregnancy, ruptured
aneurism.
 Abdominal inflammation, eg appendicitis,
diverticulitis, strangulating intestinal
obstruction, pancreatitis, PID, mesenteric
ischemia.
Clinical presentation of peritonitis.
Patients have symptoms and signs of
ascites.
 Discomfort is usually present.
 Fever, malaise, worsening hepatic failure,
and unexplained clinical deterioration.
 Peritoneal signs (eg, abdominal tenderness
and rebound) are present but may be
somewhat diminished by the presence of
ascitic fluid.

Peritonitis treatment.
Antibiotic.
 Surgery.

Appendicitis.
Appendicitis is thought to result from
obstruction of the appendiceal lumen,
typically by lymphoid hyperplasia, but
occasionally by a fecalith, foreign body, or
even worm.
 Appendicitis is the inflammation of the
vermiform appendix.

Signs and symptoms.
The classic acute appendicitis symptoms
are:
 Epigastric or periumbilical pain followed
by brief nausea, vomiting, and anorexia.
 After a few hours, the pain shifts to the
right lower quadrant. Pain increases with
cough and motion.
Signs appendicitis.
Right lower quadrant direct and rebound
tenderness located at the McBurney
point.
 Rovsign sign.
 Low grade fever.
 Rebound tenderness.
 Psoas sign.
 Obturator sign.

Diagnosis.
Clinical.
 Workup, cbc, chemistries, urine test,
pregnancy test.
 Ultrasound.

Treatment.
Surgical.

Extra abdominal causes of
abdominal pain.
Thoracic
Costochondritis
Myocardial infarction
Pneumonia
Pulmonary embolism
Radiculitis
 Toxic
Black widow spider bite
Heavy metal poisoning
Methanol poisoning
Opioid withdrawal
Scorpion sting

Abdominal wall
Rectus muscle hematoma
 Genitourinary
Testicular torsion
 Infectious
Herpes zoster
 Metabolic
Alcoholic ketoacidosis
Corticosteroid insufficiency
Diabetic ketoacidosis
Hypercalcemia
Porphyries
Sickle cell disease

Assessment or evaluation of the
patient with abdominal pain.
History taking, foccus in gastrointestinal
disorders and metabolic diseases.
 Detailed physical examination.
 Alarm signs.
 Workup.
 Management.

History taking
Questions
Where is the pain?
What is the pain like?
Have you had it before?
Was the onset sudden?
How severe is the pain?
Does the pain travel to any other part of the
body?
 What relieves the pain?
 What other symptoms occur with the pain?







Physical examination
General aperance.
 vital signs.
 Inspection.
 Auscultation.
 Palpation.
 Rectal examination.
 Vaginal examination.

Alarm signs.
Severe pain
 Signs of shock (eg, tachycardia,
hypotension, diaphoresis, confusion)
 Signs of peritonitis
 Abdominal distention.

Workup.
Urine test.
 Pregnancy test.
 Cbc.
 Chemistries.
 Xray.
 The management will atend the cause of the
pain, keep in mind always interconsult with
the specialist, due the high risk of mortality
in a cause of acute abdomen.
 I.V fluids are always indicated to avoid shock.

Bibliography.
Bates.
 Other:
 Mercks manual.
 Mosbys medical dictionary.


Thank you…