Acute abdomen, AAb

Notes

## Basic introduction

  • This is a clinical term that describes a syndrome that involves symptoms and signs in the abdomen (with the main symptom being acute abdominal pain).

## The common causes AAb 

  • Acute cholecystitis
  • Acute intestinal obstruction
  • Acute pancreatitis
  • Acute diverticulitis
  • Adrenal crisis
  • Abdominal aortic aneurysm
  • Appendicitis
  • Bowel volvulus
  • Drugs such as NSAIDs
  • Ectopic pregnancy
  • Gastroenteritis
  • Mittelschmerz disease
  • Acute pyelonephritis
  • Ovarian torsion
  • Pelvic inflammatory disease (PID)
  • Peptic ulcer disease (PUD)
  • Peritonitis
  • Renal colic
  • Renal stone
  • Ruptured or twisted ovarian cyst
  • Ruptured spleen
  • Urinary tract infections (UTIs)
  • Sickle cell anemia

## Statistics

  • Globally, acute appendicitis constitutes 15.9 to 28.1 % of cases of AAb
  • Globally, acute biliary disease constitutes 9 - 9.7 % of cases of AAb
  • Globally, undifferentiated abdominal pain remains the diagnosis for about 25 % of patients discharged from the emergency department
  • Globally, undifferentiated abdominal pain remains the diagnosis for about 35 - 41 % for those admitted to hospitals
  • Globally, about 80% of patients with AAb discharged with undifferentiated abdominal pain improve or become pain-free within 2wks of presentation
  • Globally, AAb comprises 5-10% of emergency department visits.
  • In Kenya, a study on AAb in childhood by Nyaga and Ndungu (2010) at Kenyatta National Hospital found that: AAb was more common in boys at 62.4%; 33.6% of children with AAb were admitted (of which 56.5% underwent surgery); surgical causes constituted 14% of all AAb cases seen in the filter clinic; most common causes of surgical abdominal pain were intussusceptions at 25.7% and appendicitis at 30% in infants and children above 6yrs of age respectively; of non-surgical causes, URTIs (21%), gastroenteritis (15.6%) and non-specific abdominal pain (9.2%) were the most common.
Symptoms
  • Acute abdominal pain
  • Symptoms and signs that are more specific to the underlying disease.
Diagnosis
  • Investigations to be directed toward the suspected disease and the need to carry out the differential diagnosis.
  • Ultrasound
  • X-ray
  • Urinalysis
  • Urea & electrolytes
  • Complete blood count (CBC)
  • Pregnancy test for all women of child bearing age
Differential
  • Not applicable
Prevention
  • Not applicable
Reference

a. The acute (surgical) abdomen - epidemiology, diagnosis and general principles of management. Z Gastroenterol. 2010 Jun;48(6):696-706.

b. Kenyan Ministry of Health. Clinical guidelines for management and referral of common conditions at levels 4-6. Hospitals. 2009; 3:259-261.http://apps.who.int/medicinedocs/documents/s21000en/s21000en.pdf

c. Lukens TW, Emerman C, Effron D. The natural history and clinical findings in undifferentiated abdominal pain. Ann Emerg Med. 1993 Apr; 22(4):690-6.

d. Ministry of Health, Kenya. Kenya Essential Medicine List (2016). http://publications.universalhealth2030.org/uploads/KEML-2016Final-1.pdf

e. Nyaga, EM and Ndungu. JM. Acute Non-Traumatic Abdominal Pain in Childhood at Kenyatta National Hospital,  Kenya . Annals of African Surgery, Vol 6 (2010)

Management
  • Look for the life-threatening causes first and manage them accordingly
  • Avoid feeding by mouth
  • Prepare wide bore IV line
  • Initiate investigation and treat as per finding
  • For analgesia avoid NSAIDS but consider EITHER Fentanyl 50 -100 mcg OR morphine 4 - 6 mg
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