Etiology, Diagnosis, and Treatment of Acute Abdomen in Adults
Blake Bergeron, M3
Acute Abdomen
Diagnosis
PAIN: stabbing, usually localized and SEVERE Extremely rigid with severe voluntary and involuntary guarding in R lateral decubitus position Exquisitely tender to light, deep and rebound palpation Positive “bed-bump” test, psoas, obturator, and Rovsing’s sign Depending on etiology, usually see elevated Temp and pulse rate Absent bowel sounds (sometimes)
Causes of Acute Abdomen (DDx)
Appendicitis Peritonitis Bowel Perforation Pancreatitis Diverticular disease Cholecystitis Perforating Gastric/Duodenal ulcer Ruptured Ectopic Pregnancy Ruptured or hemorrhagic ovarian cyst Pelvic Inflammatory Disease Abdominal Aortic Aneurysm Tubo-ovarian abscess
Work-up of Patient
Serum pregnancy test: elevated ß–HCG hints at ectopic pregnancy (<50K mIU/mL) CBC: leukocytosis with left shift is present in 90% of patients with appendicitis Abdominal CT scan – gold standard for finding acute appendicits Abdominal ultrasound – can identify ovarian cysts, bleeding into abdomen, abscesses, etc. Culture if suspect PID or other infection
Treatment
KEY: A patient with an acute abdomen is an EMERGENCY, and it is IMPERATIVE to get a correct diagnosis Treatment depends entirely on the cause For example:
Surgery indicated for: ectopic pregnancies, acute appendicitis, duodenal and gastric perforating ulcers Antibiotics for PID or peritonitis Observation for mild ovarian cyst ruptures or pancreatitis