Don't Ignore the Acute Abdominal Pain

Everyone can suffer from pain in the stomach, at one time or the other and we usually ignore it. But when the pain is sudden and severe abdominal pain then it is termed as acute pain and this should not be ignored.

Often the following can be expected with acute pain:

1. Acute abdomen pain is usually synonymous with rapid onset of the symptoms which might indicate life threatening intra-abdominal pathology.
2. Pain is just a feature and not necessary that it is present at all times. An acute abdomen which is pain free usually occurs in children and women who are in their third trimester of pregnancy.
3. The differential diagnosis is difficult and wide especially in primary care. This is because the different organs within their peritoneal cavity might have different areas of referred pains.
4. Abdominal pain usually happens to be in the top three symptoms when patients present their state in the emergency and accident departments. But only few of these have acute abdominal pain.
5. Management of the abdominal pain should be the primary focus and an assessment should be done to reach the differential diagnosis so that care can be given accordingly.
6. The clinical evaluation regarding abdomen pain can change quickly. Any diagnosis which had been made can change and both doctor and patient should not be hesitant and seek other treatment.

Conditions which might cause acute abdomen pain are:

1. Meckel's diverticulitis or Acute appendicitis
2. Acute cholecystitis
3. Ectopic pregnancy
4. Acute pancreatitis.
5. Peptic ulcer disease
6. Diverticulitis.
7. Intestinal obstruction, including paralytic ileus (adynamic obstruction)
8. Pelvic inflammatory disease.
9. Gastrointestinal (GI) haemorrhage
10. Gastroenteritis.
11. Acute intestinal ischaemia/infarction or vasculitis.
12. Acute urinary retention
13. Renal colic or renal tract pain
14. Testicular torsion
15. Abdominal aortic aneurysm
16. Non surgical diseases like pericarditis, sickle cell crisis, acute intermittent porphyria, HIV-associated lymphadenopathy, bowel disease, typhoid, opiate withdrawal, enteritis, pneumonia, myocardial infarction and hepatitis.
17. Rare causes might include thromboemboli, phytobezoar, and phytobezoar

Diagnosis of abdominal pains:

1. Patients can be ordered to get their blood tests done. Also if need be then imaging can also be referred to them.
2. Following tests can be done to rule out the condition causing the abdominal pain:
3. Blood Tests: these include FBC, LFTs, glucose, amylase, clotting, calcium and arterial blood gas for pancreatitis
4. Crossmatch or group and save
5. Pregnancy test in women of childbearing age
6. Blood cultures
7. Peritoneal lavage in case of an abdominal trauma
8. Urine analysis
9. X ray of the abdomen, ultrasound, CT scan
10. ECG and cardiac enzymes
11. Laparoscopy should be a routine procedure