Acute Abdomen

Clinical evaluation of abdominal pain

Onset and duration of the pain

The duration, acuity, and progression of pain should be assessed, and the exact location of maximal pain at onset and at present should be determined. The pain should be characterized as diffuse or localized. Time course of pain should be characterized as either constant, intermittent, decreasing, or increasing.

Acute exacerbation of longstanding pain suggests a complication of chronic disease such as peptic ulcer disease, inflammatory bowel disease, or cancer. Sudden, intense pain often represents an intraabdominal catastrophe (eg, ruptured aneurysm, mesenteric infarction, or intestinal perforation). Colicky abdominal pain of intestinal or ureteral obstruction tends to have a gradual onset.

Pain character

  • Intermittent pain is associated with spasmodic increases in pressure within hollow organs.

Bowel ischemia initially causes diffuse crampy pain due to spasmodic contractions of the bowel. The pain becomes constant and more intense with bowel necrosis, causing pain out of proportion to physical findings. A history of intestinal angina can be elicited in half of patients.

  • Constant pain. Biliary colic from cystic or common bile duct obstruction usually is constant. Chronic pancreatitis causes constant pain. Constant pain also suggests parietal peritoneal inflammation, mucosal inflammatory conditions, or neoplasms.
  • Appendicitis initially causes intermittent periumbilical pain. Gradually the pain becomes constant in the right lower quadrant as peritoneal inflammation develops.

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