II. Definition
- Acute Abdominal Pain
- Abdiominal pain onset under 6 hours
III. Epidemiology
- Abdominal Pain represents 5% of ER visits
- Only 10% of these evaluations require surgery
- Accounts for 10% of Malpractice claims
IV. Pearls
- Cohorts with atypical presentations of serious Abdominal Pain causes
- Elderly and Immunocompromised
- Use low threshold for admiting elderly (and Immunocompromised) for observation
- See Abdominal Pain in Older Adults
- Pregancy
- Appendix migrates upward into peri-renal and even RUQ in third trimester
- Elderly and Immunocompromised
- Most commonly missed surgical diagnoses
- Specific Warning signs
- Low Back Pain in elderly
- Atrial Fibrillation and Abdominal Pain
- Common serious causes mimicking more benign causes
- Retrocecal appendix
- May present with back pain or upper quadrant Abdominal Pain
- Abdominal aoortic aneurysm
- May present with Renal Colic symptoms (Flank Pain, LLQ Pain and even Hematuria)
- Retrocecal appendix
V. Signs and symptoms: Findings suggestive of surgical Abdomen
- See Acute Abdominal Pain Evaluation
- 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
- Severe, sudden onset pain under 1 hour
- Pain precedes Vomiting
-
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
VI. Signs and symptoms: Findings suggestive of non-surgical Abdomen
- Anorexia not present
VII. Differential Diagnosis
- See Acute Abdominal Pain Causes
- See Generalized Abdominal Pain
- See Left Upper Quadrant Abdominal Pain
- See Right Upper Quadrant Abdominal Pain
- See Left Lower Quadrant Abdominal Pain
- See Right Lower Quadrant Abdominal Pain
- See Extraperitoneal Abdominal Pain Causes
- See Abdominal Wall Pain Causes
- See Epigastric Pain
- See Suprapubic Pain
VIII. Evaluation
- See Acute Abdominal Pain Evaluation
IX. Labs and Diagnostic Studies
- See Acute Abdominal Pain Evaluation
X. Imaging
- See Acute Abdominal Pain Evaluation
XI. Management: Surgery Consultation Indications
- Severe Abdominal Pain or progressive Abdominal Pain (regardless of non-diagnostic imaging)
- Vomit feculent or bile-stained
- Abdominal guarding or rigidity
- Abdominal Rebound Tenderness
- Abdominal Distention and hypertympanic to percussion
- Significant Traumatic Injury to Abdomen
- Abdominal Pain of unclear etiology
- Intra-abdominal fluid accumulation
XII. Management: General
-
Antiemetics
- Ondansetron (Zofran)
- Prochlorperazine (Compazine)
- More effective Antiemetic in Abdominal Pain than Phenergan, Reglan
- Ernst (2000) Ann Emerg Med 36(2): 89-94 +PMID:10918098 [PubMed]
- Parenteral Analgesics
- Opioid Dosing
- Dilaudid 0.3 to 0.5 mg every 15 minutes prn
- Morphine Sulfate 2-4 mg every 15 minutes prn
- Parenteral NSAIDs
- Toradol 15-30 mg IV (or 30-60 mg IM) every 6 hours as needed
- Do not delay adequate analgesia
- Does not interfere with exam
- Pace (1996) Acad Emerg Med 3:1086-92 [PubMed]
- Thomas (2003) J Am Coll Surg 196:18-31 [PubMed]
- Opioid Dosing
XIII. Management: Disposition
- Re-evaluate in 6-12 hours persistent Abdominal Pain with non-diagnostic evaluation and unclear cause
- Appendicitis rupture is unlikely in first 36 hours (<2%)
XIV. References
- Natesan (2015) Crit Dec Emerg Med 29(12): 2-11
- Graff (2001) Emerg Med Clin North Am 19:123-36 [PubMed]
Images: Related links to external sites (from Bing)
Related Studies
Definition (MSHCZE) | Klinickým syndromem náhlé příhody břišní je kritický stav a rychlý nástup. Příčinou jsou různé poruchy, zranění nebo nemoci. |
Definition (MSH) | A clinical syndrome with acute abdominal pain that is severe, localized, and rapid onset. Acute abdomen may be caused by a variety of disorders, injuries, or diseases. |
Concepts | Sign or Symptom (T184) |
MSH | D000006 |
ICD10 | R10.0 |
SnomedCT | 207221008, 207255006, 140460009, 269021002, 158499006, 9209005 |
English | Abdomen, Acute, Abdomens, Acute, Acute Abdomen, Acute Abdomens, [D]Acute abdomen, [D]Acute abdomen (context-dependent category), ACUTE ABDOMEN, acute abdomen (diagnosis), acute abdomen, Abdominal syndrome acute, Syndrome abdominal acute, Abdomen, Acute [Disease/Finding], abdomen acute, acute abdominal syndrome, surgical abdomen, [D]Acute abdomen (situation), Abdomen - acute, Acute abdomen, Acute abdomen (disorder), Acute abdominal pain syndrome, Surgical abdomen, abdomen; acute abdomen, abdomen; acute, abdomen; pain, general, acute abdomen, abdominal; syndrome, acute, acute; abdomen, acute; abdominal syndrome, pain; abdomen, general, acute abdomen, syndrome; abdominal, acute, syndrome; acute abdominal, Acute abdomen, NOS, Acute abdominal pain syndrome, NOS |
French | ABDOMEN AIGU, Syndrome abdominal aigu, Abdomen aigu, Urgence abdominale, Syndrome douloureux abdominal, Ventre aigu |
Dutch | abdominaal syndroom, acuut, syndroom abdominaal acuut, abdomen; acute buik, abdominaal; syndroom, acuut, acuut; abdominaal syndroom, acuut; buik, buik; acuut, buik; pijn, algemeen, acute buik, pijn; buik, algemeen, acute buik, syndroom; abdominaal, acuut, syndroom; acuut abdominaal, acuut abdomen, Acute buik, Buik, acute |
German | Abdominalsyndrom akut, akutes Abdominalsyndrom, akutes Abdomen, Abdomen, akutes, Akutes Abdomen |
Italian | Sindrome addominale acuta, Addome acuto |
Portuguese | Síndrome abdominal agudo, Síndrome abdominal aguda, ABDOMEN AGUDO, Abdómen agudo, Abdome Agudo |
Spanish | Síndrome de abdomen agudo, Síndrome abdominal agudo, [D]abdomen agudo (categoría dependiente del contexto), [D]abdomen agudo, [D]abdomen agudo (situación), Abdomen en Tabla, abdomen agudo (trastorno), abdomen agudo, síndrome de dolor abdominal agudo, Abdomen agudo, Abdomen Agudo |
Japanese | 急性腹症, 急性腹部症候群, キュウセイフクショウ, キュウセイフクブショウコウグン |
Swedish | Akut buk |
Finnish | Akuutti vatsa |
Russian | OSTRYI ZHIVOT, ОСТРЫЙ ЖИВОТ |
Czech | Syndrom akutního břicha, Akutní břicho, náhlá příhoda břišní, náhlé příhody břišní, břicho - náhlé příhody, akutní břišní bolest, akutní bolest břicha |
Korean | 급성 복통 |
Croatian | ABDOMEN, AKUTNI |
Polish | Zespół ostrego brzucha, Ostry brzuch, Brzuch ostry |
Hungarian | Acut has syndroma, Acut has, Acut abdominalis syndroma |
Norwegian | Akutt abdomen |
Ontology: Abdominal Pain (C0000737)
Definition (MSHCZE) | Pocit nevolnosti, obtíží nebo bolesti v břišní oblasti; obvykle při funkčních poruchách, tkáňových poraněních nebo nemocech. |
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
|
Definition (NCI_CTCAE) | A disorder characterized by a sensation of marked discomfort in the abdominal region. |
Definition (NCI) | Painful sensation in the abdominal region. |
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 , D003085 |
ICD9 | 789.00, 789.0 |
ICD10 | R10.9 |
SnomedCT | 207205003, 207230000, 158498003, 158512003, 139313005, 21522001 |
LNC | MTHU013636, LA15468-4 |
English | Abdominal Pains, 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, abdominal pain (symptom), abdominal pain, Pain abdominal, Gut pain, Abdmnal pain unspcf site, Unspecified abdominal pain, Abdominal Pain [Disease/Finding], Pain;abdominal, gut pain, abdomen pain, abdominal pains, Bellyache, Pain, Abdominal, Abdomen pain, [D]Abdominal pain (situation), [D]Abdominal pain NOS (situation), ABDOMINAL PAIN, PAIN, ABDOMINAL, 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., Colique, Douleur abdominale, Douleur de l'abdomen |
Portuguese | DOR ABDOMINAL, Dor abdominal NE, Dor intestinal, Câimbras Abdominais, Cólicas, Câimbra Abdominal, Cãibra Abdominal, Dor abdominal, Cólica, 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, Kolik |
Italian | Dolore intestinale, Dolore addominale NAS, Dolore colico, Colica, Dolore addominale |
Spanish | Dolor de barriga, Dolor abdominal NEOM, [D]dolor abdominal, SAI (categoría dependiente del contexto), [D]dolor abdominal (categoría dependiente del contexto), ABDOMEN, DOLOR, [D]dolor abdominal (situación), [D]dolor abdominal, SAI (situación), [D]dolor abdominal, [D]dolor abdominal, SAI, 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, 疝痛, 腹部痙攣, 仙痛, 腹部けいれん |
Swedish | Buksmärta |
Czech | kolika, Břišní bolest NOS, Střevní bolest, Bolest břicha, bolesti břicha, břicho - bolest |
Finnish | Koliikki, Vatsakipu |
Russian | BRIUSHNAIA POLOST', BOLI, ABDOMINAL'NAIA BOL', KOLIKA, ABDOMINAL'NYI SPAZM, АБДОМИНАЛЬНАЯ БОЛЬ, АБДОМИНАЛЬНЫЙ СПАЗМ, БРЮШНАЯ ПОЛОСТЬ, БОЛИ |
Croatian | ABDOMINALNA BOL |
Polish | Ból brzucha |
Hungarian | Hasi fájdalom, Abdominalis fájdalom k.m.n., Bél fájdalom, Abdominalis fájdalom, Hasfájdalom |
Norwegian | Kolikksmerter, Magesmerter, Kolikk, Abdominalsmerter, Magesmerte |
Ontology: Acute abdominal pain (C0740577)
Concepts | Sign or Symptom (T184) |
SnomedCT | 116290004, 9991008 |
English | Acute abdominal pain, acute abdominal pain, 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 |