This presentation is very common. The diagnosis of acute abdominal pain is infamous in medicine due to the large size of the differential diagnosis and the number of medical and surgical emergencies which present this way.
Causes
Gastrointestinal
- Appendicitis
- Colitis
- Diverticulitis
- Gastroenteritis
- Gastrointestinal perforation
- Inflammatory bowel disease
- Intestinal obstruction
- Mesenteric lymphadenitis
- Peptic ulcer disease
- Perforated viscus
- Strangulated hernia
- Volvulus
- Paediatric
Hepatobiliary
- Acute cholangitis
- Acute cholecystitis
- Acute hepatitis
- Acute pancreatitis
- Cholelithiasis (gallstones)
- Haematobilia
Vascular
Nephro/Urological
Andrological
Gynaecological
- Endometriosis
- Mittelschmerz
- Ovarian torsion
- Ruptured ectopic pregnancy
- Ruptured ovarian cyst
- Salpingitis
- Tubo-ovarian abscess
Musculoskeletal
- Muscle strain
- Psoas abscess
- Rib fracture
Medical
- Hypercalcaemia
- Malaria
- Cardiac pain
- Pleuritic pain
- Porphyria
- Sickle cell crisis
Endocrinological
Neurological
Other infectious diseases
- Bornholm disease
- Cholera
- Tuberculosis
- Typhoid fever
- Yersinia
Must not be missed
- Perforated viscus
- Acute pancreatitis
- Ruptured aortic aneurysm
- Ruptured ectopic pregnancy
- Ovarian torsion
- Testicular torsion
- Myocardial infarction
Investigations
- For women of reproductive age, always pregnancy test, even if they deny any chance of pregnancy.
- Glucose meter for diabetes mellitus
- Urine test strip to check for UTI
- Full blood count
- Urine microscopy
- Ultrasound scan
- Liver
- Abdomen
- Plain x-ray imaging
- Abdomen
- CT scan
- Abdomen
- Diagnostic endoscopy
Management
If indicated:- ABCD assessment
- Cannulation
- Analgesia for pain relief
- Oxygen therapy
- Fluid resuscitation
- Urinary catheterisation
- NG tube feeding
- Airway management
- Urgent surgery
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