What is Acute Abdominal Pain?
Pain is defined as a distressing feeling or uncomfortable sensation. Acute abdominal pain refers to the sudden onset of severe abdominal discomfort occurring over a short period of time that does not go away. The pain may be described as sharp, stabbing, or shooting in nature, and may affect part or all of the abdominal area. Most causes of acute abdominal pain are very serious and considered life-threatening medical emergencies that require immediate medical attention.
Causes of Acute Abdominal Pain
Acute abdominal pain is commonly caused by medical conditions pertaining to the abdominal organs. These conditions include:
- Abdominal aortic aneurysm
- Mesenteric ischemia (damage to the small intestine due to inadequate blood supply)
- Gastroesophageal reflux disease
- Appendicitis (inflammation of the appendix)
- Cholecystitis (inflammation of the gall bladder)
- Cholangitis (inflammation of the bile ducts)
- Cystitis (inflammation of the bladder)
- Duodenitis (inflammation of the upper part of the small intestine)
- Diverticulitis (inflammation of small pouches that form in the intestines)
- Kidney stones
- Cholelithiasis or gallstones
- Intestinal obstruction
- Pancreatitis (pancreas inflammation)
- Intestinal infections
Signs and Symptoms of Acute Abdominal Pain
Some of the signs and symptoms of acute abdominal pain include:
- Excruciating or radiating pain
- Tenderness to touch
- Fatigue
- Fever
- Diarrhea
- Bloating
- Nausea
- Vomiting
- Dizziness
- Confusion or altered mental status
- Inability to pass gas
- Shortness of breath
- Tachycardia
- Hypotension
Diagnosis of Acute Abdominal Pain
Your physician diagnoses acute abdominal pain by observing your symptoms and medical history, and by performing a thorough physical examination of your abdomen. For additional information, your physician may request blood tests, urine and culture tests, and imaging studies. Imaging studies such as X-ray, ultrasound, endoscopy, barium enema, and CT scans are helpful in isolating the source of the abdominal pain and confirming the diagnosis.
Treatment for Acute Abdominal Pain
Treatment for acute abdominal pain depends on the cause, intensity, and frequency of the pain. Conservative treatment is usually the first approach. This may include:
- Pain management techniques to control and manage pain
- Aggressive fluid resuscitation with large-bore IV access to treat conditions such as hypoventilation and tachycardia
- Broad-spectrum antibiotics for sepsis, abscesses, or other infection-related pain
- Muscle relaxants for muscle spasm and contraction-related pain
- Opioids/pain medicines for pain relief
Surgical Treatment
Surgical intervention is employed when conservative treatment is unsuccessful, or if the acute pain is a medical emergency such as mesenteric ischemia or abdominal aortic aneurysm. If surgery is needed, there are two methods:
Diagnostic laparoscopy:
- This is a minimally invasive approach that utilizes small surgical incisions and a laparoscope to assess the condition of the abdomen.
- It is highly assistive in triaging the abdomen and determining whether an open surgical technique is needed.
- In some cases, a definitive surgery can be carried out laparoscopically.
- It can be technically restrictive in difficult-to-access regions and cases requiring complex operative repairs.
- It should not be used in cases of a considerably dilated bowel due to potential risk of perforation from laparoscopic instruments and port insertion.
- It should not be used in cases where the diagnosis is obvious and open surgery will definitely be needed.
Exploratory laparotomy:
- This is an open surgical technique, usually through a midline incision of several centimeters.
- It allows for tactile and visual inspection of all four abdominal quadrants and their contents.
- It is the method of choice in cases of gross abdominal contamination with enteric or bile contents.
- It allows for thorough irrigation of the abdominal cavity and optimal repair of the contamination source.