causes of Acute Abdominal Pain:

Acute Abdominal Pain:


definition



Acute Abdominal Pain: Onset under 6 hours
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Epidemiology



Abdominal Pain represents 5% of ER visits

Only 10% of these evaluations require surgery
Accounts for 10% of malpractice claims


Pearls



Use low threshold for admiting elderly for observation

Most commonly missed surgical diagnoses

Appendicitis

Small Bowel Obstruction

Specific Warning signs

Low Back Pain in elderly

Abdominal Aortic Aneurysm

Atrial Fibrillation and Abdominal Pain
Mesenteric Ischemia


Signs and symptoms: Findings suggestive of surgical abdomen



Duration of pain at presentation

Severe, sudden onset pain under 1 hour

High risk for intra-abdominal catastrophe

Causes (especially in elderly)

Ruptured Abdominal Aortic Aneurysm

Mesenteric Ischemia

Myocardial Infarction

Perforated viscus

Nephrolithiasis

Pain duration under 48 hours: 18% need surgery

Pain duration over 48 hours: 11% need surgery

Delayed presentation in young and old

Pain precedes Vomiting

Appendicitis

Cholecystitis

Small Bowel Obstruction

Fever >38 C (only when accompanied by another sign)

Fever lags symptoms in elderly

Tachycardia (Heart Rate exceeds 110 bpm)

Leukocytosis with Neutrophils >75%

Peritoneal signs
Age over 65 years


Signs and symptoms: Findings suggestive of non-surgical abdomen


Anorexia not present