21/12/2025
Acute abdominal pain is sudden-onset abdominal pain (hours to days) that may indicate a medical or surgical emergency (“acute abdomen”).
👉Common Symptoms
• Severe or worsening abdominal pain
• Nausea, vomiting
• Fever
• Abdominal distension
• Constipation or diarrhea
• Anorexia
• Guarding or rebound tenderness
• Hemodynamic instability (tachycardia, hypotension) ⚠️
👉Diagnosis (Stepwise Approach)
1. History
• Onset, location, radiation, character, severity
• Associated symptoms (fever, vomiting, bleeding)
• Past surgery, pregnancy, medications
2. Physical Examination
• Inspection → distension, scars
• Palpation → tenderness, guarding, rigidity
• Percussion → tympany, dullness
• Auscultation → bowel sounds
3. Investigations
• Labs: CBC, CRP, electrolytes, LFTs, amylase/lipase, urinalysis, β-hCG (women)
• Imaging:
• Ultrasound (gallbladder, pelvis)
• CT abdomen (most causes)
• X-ray (obstruction, perforation)
👉Differential Diagnosis (by Location)
↗️Right Upper Quadrant
• Acute cholecystitis
• Hepatitis
• Liver abscess
↗️Right Lower Quadrant
• Acute appendicitis
• Ectopic pregnancy
• Ovarian torsion
↗️Left Lower Quadrant
• Diverticulitis
• Ovarian pathology
↗️Epigastric
• Acute pancreatitis
• Peptic ulcer disease
↗️Generalized
• Peritonitis
• Intestinal obstruction
• Mesenteric ischemia
👉Treatment
• Initial (ABC first):
• IV fluids
• Analgesia (don’t delay pain control)
• Antiemetics
• NPO
• Cause-specific:
• Antibiotics (if infection suspected)
• Urgent surgery for appendicitis, perforation, ischemia
• Avoid delay in surgical referral if red flags present
👉Red Flags 🚨
• Rigid abdomen
• Rebound tenderness
• Persistent vomiting
• Fever + severe pain
• Hypotension or shock
• Pain out of proportion to exam
👉Follow-Up
• Admit if diagnosis uncertain or red flags present
• Serial abdominal examinations
• Repeat labs/imaging if symptoms evolve
• Clear discharge instructions if managed conservatively