Associated symptoms. Acute Abdomen
Constitutional symptoms (eg, fatigue, weight loss) suggests underlying chronic disease.
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Gastrointestinal symptoms
Anorexia, nausea and vomiting are commonly associated with acute abdominal disorders. The frequency, character, and timing of these symptoms in relation to pain and time of the last flatus or stool should be determined.
Constipation, obstipation, crampy pain and distention usually predominate in distal small-bowel and colonic obstruction. Paralytic ileus causes constipation and distention.
Diarrhea is suggestive of gastroenteritis or colitis but may also be seen in partial small-bowel obstruction or fecal impaction.
Small amounts of bleeding may accompany esophagitis, diverticulitis, inflammatory bowel disease, and left colon cancer. Right colon cancers usually present with occult blood loss. Severe abdominal pain accompanied by melena or hematochezia suggests ischemic bowel. Pain is often absent in massive GI bleeding.
Jaundice with abdominal pain usually is caused by biliary stones. Obstruction of the common bile duct by cancer may also cause pain and jaundice.
Urinary symptoms. Urinary tract infections may cause pain in the lower abdomen (cystitis) or flanks (pyelonephritis). Urinary tract infections are characterized by dysuria, frequency, and cloudy urine.
Recent menstrual and sexual history should be determined in women with acute abdominal pain.
Menstrual cycle. Lower abdominal pain and recent amenorrhea in a young woman suggests ectopic pregnancy. Pelvic inflammatory disease tends to occur early in the menstrual cycle. Ovarian torsion may cause intense, acute pain and vomiting. A ruptured corpus luteum cyst may cause acute lower abdominal pain at the onset of menses. Chronic pain at the onset of menses suggests endometriosis.
Pregnancy. Ectopic pregnancy occurs in the first trimester. Threatened abortion, ovarian torsion, or degeneration of a uterine fibroid also may cause acute pain in pregnant women.
