The document discusses the acute abdomen, which refers to intra-abdominal disease that is often best treated surgically. It outlines characteristics of patients who need surgery versus those who do not, and provides potential non-surgical and metabolic causes of acute abdominal pain. The physiology of abdominal pain and patterns of referred pain are described. A history and physical exam are important for diagnosis, with differential diagnoses provided for various locations of abdominal pain. Immediate treatment of the acute abdomen includes IV fluids, pain medication, tubes, antibiotics, and definitive therapy based on diagnosis.

1. Acute abdomen Dr. Alaa Osman, MD Surgeon

2. The term ‘ acute abdomen’ designates symptoms and signs of intra-abdominal disease usually treated best by surgical operation.

13. Pattern of referred pain Gastric pain Liver and biliary pain Colonic pain Ureteral or kidney pain Diaphragmatic irritation Biliary colic Pancreatic and renal pain , Uterine and rectal pain

24. Physical Examination: The Quadrants

30. Differential Diagnosis: RUQ Pain Fever, tachypnea, bronchial breathing Right lower lobe pneumonia Shift of pain, tenderness Retrocecal appendicitis Edema, dyspnea, elevated JVP Congestive heart failure Dysuria, fever, costovertebral angle tenderness Right pyelonephritis Alcohol history, jaundice, medications Acute hepatitis Recurrent attacks, tender over gall bladder area Biliary colic, acute cholecystitis clues Condition

32. Differential Diagnosis: LUQ and Epigastric Pain Fever, XR findings, bronchial breathing Pneumonia Recurrent, relationship to meals, relationship to posture Gastritis / Peptic ulcer disease History of alcohol consumption, history of similar event, elevated labs Pancreatitis History of trauma, gross deformity, extreme tenderness on palpation Fractured ribs History of trauma or splenic disease Splenic rupture clues Condition

34. Differential Diagnosis: RLQ Pain … see next Gynecologic causes Recurrent, several days history Crohn’s disease Tender swollen testis, usually young age Torsed right testis Colicky pain, hematuria Right renal colic Fever, inconstant signs Mesenteric adenitis Shift of pain, anorexia, localized tenderness Acute appendicitis clues Condition

35. Gynecologic Causes of RLQ Pain Sudden onset, amenorrhea, shock Pelvic inflammatory disease Severe pain, vomiting Ruptured ectopic pregnancy Midcycle, sudden onset Torsion of ovary Fever, cervical excitation, discharge Ruptured follicle CLUES CONDITION

37. Differential Diagnosis: LLQ Pain Gynecologic causes as for RLQ pain Tender, swollen testis, young age Torsion of testis Colicky pain, hematuria Left renal colic Colicky pain, constipation Large bowel obstruction Recurrent attacks, diarrhea (+/- mucus, blood) Inflammatory bowel disease Dysuria, frequency Urinary tract infection Palpable bladder, difficulty passing urine Acute urinary retention Elderly patient, recurrent Diverticular disease CLUES CONDITION