Approach to a patient with Acute Abdomen
Previously undiagnosed pain that arises suddenly having duration of 7 days (mostly less than 48 hours) and usually needs immediate surgical intervention. Causes according to age Neonates : Intestinal atresia and stenosis, meconium ileus, meconium peritonitis, imperforate anus, annular pancreas Infants : Volvulus, Intussusception, Meckel’s diverticulitis Children: Round worm infestation, Appendicitis, Mesenteric lymphadenitis Adults: Appendicitis, Meckel's Diverticulitis, Perforation of peptic ulcer, Acute Cholecystitis, Acute pancreatitis Elderly: Sigmoid volvulus, Intestinal obstruction from malignant growth, diverticulitis History Time of onset Pain starts early in the morning → Acute appendicitis Mode of onset Sudden: Perforation, colic, volvulus and torsion Gradual: Obstruction Referred pain: T5 to T8 → foregut → Epigastric pain T9 to T10 → midgut → umbilical pain T11, 12 L1, 2 → Hindgut → Suprapubic pain shoulder pain
