ACUTE ABDOMEN

Acute abdomen is a clinical term used to describe a syndrome that usually incorporates symptoms and signs in the abdomen. Central to the syndrome is  severe, acute abdominal pain. The term acute abdomen is a symptomatic
diagnosis and not a definitive one. It is critical in these patients that a variety of conditions be suspected and diagnosed or clearly excluded before definitive treatment is initiated.

CAUSES

  • Medications (NSAIDs)
  • Gastroenteritis
  • Peptic ulcer disease
  • Acute erosive gastritis
  • Appendicitis
  • Acute cholecystitis
  • Acute pancreatitis
  • Acute intestinal obstruction
  • Renal colic
  • Diverticulitis
  • Ectopic pregnancy
  • Ruptured or twisted ovarian cyst
  • Mittelschmerz
  • Urinary tract infection
  • Pelvic inflammatory disease.

Clinical Features

Meticulous history and physical examination are very important in establishing the diagnosis. The clinical features include;

  • Abdominal pain
  • Abdominal distension
  • Abdominal guarding and rigidity
  • Altered bowel sounds
  • Alteration of bowel
    habits.

Examination

  • A search should be made for signs and symptoms of GIT disease genitourinary
  • Hepatobiliary and respiratory diseases as well as metabolic disorders (diabetes mellitus, porphyrias)
  • CNS diseases (neuropathies)
  • Haematologic diseases (for example, thrombotic crisis in sickle cell disease)
  • Cardiovascular disease.
    • Caution: As a result of organ displacement associated with pregnancy, clinical examination of the abdomen for abdominal pain in a pregnant
      female can be confusing.

Investigations

    • Haemoglobin, white blood cell count, packed cell volume
    • Urea and electrolytes
  • Urinalysis
  • Plain abdominal radiograph (erect and dorsal decubitus), chest radiograph
  • Other investigations as the condition dictate, e.g., ultrasound in suspected cholecystitis, liver abscess or pancreatitis.

Management

Details of the patient’s history and condition, as well as an accurate documentation of events are important. Ensure the following:

  • Order nil orally.
  • Conduct nasogastric suction.
  • Prepare wide bore intravenous line or other form of secure intravenous access.
  • Catheterize and initiate an input-output chart.
  • Perform radiological and other investigations as able in the particular facility.
  • Use analgesia cautiously and make sure if used it is documented.
  • Arrange transfer to a suitable surgical facility as soon as possible if not able to handle case
  • Maintain resuscitation during transfer, nasogastric suction, fluids, and input output chart.
  • Manage conservatively if found appropriate: Nil by mouth, nasogastric suction, correct fluid and electrolyte imbalance by intravenous fluids
  • Re-evaluate with the appropriate investigations.
  • Initiate specific treatment of the underlying cause, e.g., surgery for perforation, peritonitis, ruptured ectopic pregnancy, etc.
  • Group and cross-match blood for all laparoscopies.
  • Organize post discharge follow up as indicated.