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Acute Abdominal Pain

Aka: Acute Abdominal Pain, Acute Abdomen, Abdominal Pain
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  1. See Also
    1. Acute Pelvic Pain
    2. Pediatric Abdominal Pain
    3. Abdominal Pain in Older Adults
  2. Definition
    1. Acute Abdominal Pain: Onset under 6 hours
  3. Epidemiology
    1. Abdominal Pain represents 5% of ER visits
    2. Only 10% of these evaluations require surgery
    3. Accounts for 10% of malpractice claims
  4. Pearls
    1. Use low threshold for admiting elderly for observation
    2. Most commonly missed surgical diagnoses
      1. Appendicitis
      2. Small Bowel Obstruction
    3. Specific Warning signs
      1. Low Back Pain in elderly
        1. Abdominal Aortic Aneurysm
      2. Atrial Fibrillation and Abdominal Pain
        1. Mesenteric Ischemia
  5. Signs and symptoms: Findings suggestive of surgical Abdomen
    1. Duration of pain at presentation
      1. Severe, sudden onset pain under 1 hour
        1. High risk for intra-abdominal catastrophe
        2. Causes (especially in elderly)
          1. Ruptured Abdominal Aortic Aneurysm
          2. Mesenteric Ischemia
          3. Myocardial Infarction
          4. Perforated viscus
          5. Nephrolithiasis
      2. Pain duration under 48 hours: 18% need surgery
      3. Pain duration over 48 hours: 11% need surgery
      4. Delayed presentation in young and old
    2. Pain precedes Vomiting
      1. Appendicitis
      2. Cholecystitis
      3. Small Bowel Obstruction
    3. Fever >38 C (only when accompanied by another sign)
      1. Fever lags symptoms in elderly
    4. Tachycardia (Heart Rate exceeds 110 bpm)
    5. Leukocytosis with Neutrophils >75%
    6. Peritoneal signs
    7. Age over 65 years
  6. Signs and symptoms: Findings suggestive of non-surgical Abdomen
    1. Anorexia not present
  7. Differential Diagnosis
    1. See Acute Abdominal Pain Causes
  8. Evaluation
    1. See Acute Abdominal Pain Evaluation
  9. Labs and Diagnostic Studies
    1. See Acute Abdominal Pain Evaluation
  10. Imaging
    1. See Acute Abdominal Pain Evaluation
  11. Management: General
    1. Do not delay adequate analgesia
      1. Does not interfere with exam
      2. References
        1. Pace (1996) Acad Emerg Med 3:1086-92
        2. Thomas (2003) J Am Coll Surg 196:18-31
  12. Management: Surgery Consultation Indications
    1. Severe Abdominal Pain or progressive Abdominal Pain
    2. Vomit feculent or bile-stained
    3. Abdominal guarding or rigidity
    4. Abdominal rebound tenderness
    5. Abdominal distention and hypertympanic to percussion
    6. Significant traumatic injury to Abdomen
    7. Abdominal Pain of unclear etiology
    8. Intra-abdominal fluid accumulation
  13. References
    1. Graff (2001) Emerg Med Clin North Am 19:123-36

Abdominal Pain (C0000737)

Definition (NCI) Painful sensation in the abdominal region.
Definition (NCI) A disorder characterized by a sensation of marked discomfort in the abdominal region.
Definition (MEDLINEPLUS)

Your abdomen extends from below your chest to your groin. Some people call it the stomach, but your abdomen contains many other important organs. Pain in the abdomen can come from any one of them. The pain may start somewhere else, such as your chest. Severe pain doesn't always mean a serious problem. Nor does mild pain mean a problem is not serious.

Call your healthcare provider if mild pain lasts a week or more or if you have pain with other symptoms. Get medical help immediately if

  • You have abdominal pain that is sudden and sharp
  • You also have pain in your chest, neck or shoulder
  • You're vomiting blood or have blood in your stool
  • Your abdomen is stiff, hard and tender to touch
  • You can't move your bowels, especially if you're also vomiting
Definition (MSH) Sensation of discomfort, distress, or agony in the abdominal region; generally associated with functional disorders, tissue injuries, or diseases.
Concepts Sign or Symptom (T184)
MSH D015746
ICD9 789.00, 789.0
ICD10 R10.9
SnomedCT 207205003, 207230000, 158498003, 158512003, 139313005, 21522001
English Abdominal Pains, ABDOMINAL PAIN NOS, ABDOMINAL PAIN, PAIN ABDOMINAL, Pains, Abdominal, Abdominal pain NOS, Abdominal Pain, [D]Abdominal pain (context-dependent category), [D]Abdominal pain NOS (context-dependent category), Abdo pain, Pain abdo, Abd. pain, [D]Abdominal pain, [D]Abdominal pain NOS, Abdomen pain, abdominal pain (symptom), abdominal pain, [D]Abdominal pain (situation), [D]Abdominal pain NOS (situation), Pain, Abdominal, Pain abdominal, Gut pain, ABDOMEN PAIN, Abdmnal pain unspcf site, PAIN, ABDOMINAL, Unspecified abdominal pain, Abdominal Pain [Disease/Finding], Pain;abdominal, gut pain, abdomen pain, abdominal pains, Bellyache, Abdominal pain, AP - Abdominal pain, Abdominal pain (finding), abdominal; pain, abdominalgia, pain; abdominal, Abdominal pain, unspecified site
French DOULEUR ABDOMINALE, Douleur abdominale SAI, Douleur intestinale, Douleur abdo, Douleur abdo., Douleur abd., Douleur abdominale, Douleur de l'abdomen
Portuguese DOR ABDOMINAL, Dor abdominal NE, Dor intestinal, Dor abdominal, Dor Abdominal
Dutch darmpijn, buikpijn NAO, pijn abdominaal, abdominaal; pijn, pijn; abdominaal, abdominale pijn, Buikpijn, Pijn, buik-
German Schmerz abdominal, Bauchschmerz, abd. Schmerz, Abdominalschmerzen NNB, Schmerz abdo, abdo. Schmerz, ABDOMEN SCHMERZHAFT, Abdominalschmerz, Abdominalschmerzen, Bauchschmerzen
Italian Dolore intestinale, Dolore addominale NAS, Dolore addominale
Spanish Dolor de barriga, Dolor abdominal NEOM, [D]dolor abdominal, SAI (categoría dependiente del contexto), [D]dolor abdominal (categoría dependiente del contexto), [D]Abdominal pain NOS, Abdominal pain, [D]Abdominal pain, ABDOMEN, DOLOR, [D]dolor abdominal, SAI, [D]dolor abdominal, SAI (situación), [D]dolor abdominal, [D]dolor abdominal (situación), dolor abdominal (hallazgo), dolor abdominal, Dolor abdominal, Dolor Abdominal
Japanese 腸管痛, 腹痛ＮＯＳ, 腹痛, ﾌｸﾂｳ, ﾁｮｳｶﾝﾂｳ, ﾌｸﾂｳNOS
Swedish Buksmärta
Czech břicho - bolest, Břišní bolest NOS, Střevní bolest, Bolest břicha
Finnish Vatsakipu
Russian BRIUSHNAIA POLOST', BOLI, ABDOMINAL'NAIA BOL', АБДОМИНАЛЬНАЯ БОЛЬ, БРЮШНАЯ ПОЛОСТЬ, БОЛИ
Croatian ABDOMINALNA BOL
Polish Ból brzucha
Hungarian Hasi fájdalom, Abdominalis fájdalom k.m.n., Bél fájdalom, Abdominalis fájdalom, Hasfájdalom
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Acute abdominal pain (C0740577)

Concepts Sign or Symptom (T184)
SnomedCT 116290004, 9991008
English Acute abdominal pain, acute abdominal pain, ABDOMEN PAIN ACUTE, abdominal acute pain, abdominal pain acute, Acute abdominal pain (finding), pain; abdomen, acute abdomen
Dutch pijn; buik, acute buik
Spanish dolor abdominal agudo (hallazgo), dolor abdominal agudo
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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