What is Acute Abdomen?
When someone has a severe, sudden stomach problem, it’s classified as an ‘acute abdomen.’ This can be triggered by issues like infections, inflammation, a blocked blood vessel, or an obstruction. Usual symptoms for this condition include sudden stomach pain, along with nausea or vomiting. Patients with an acute abdomen typically appear unwell.
When a patient comes in with an acute abdomen, doctors need to get a detailed history of the patient and conduct a physical exam. The particular location of the pain is important because it can indicate a specific problem. In some cases, though, like when there’s free air in the abdomen, the pain can be spread out. When a doctor listens to the abdomen, they might not hear the usual sounds of the intestines moving. On touching, the abdomen might be tender and rigid, signs of a condition called peritonitis.
There are many causes for acute abdomen. Some possibilities include appendicitis, a ruptured ulcer in the stomach or small intestine, acute pancreatitis (sudden inflammation of the pancreas), a ruptured diverticulum in the sigmoid colon (a pouch in the lower part of the colon), ovarian torsion (a twisted ovary), volvulus (twisted intestine), a ruptured aortic aneurysm, injuries to the spleen or liver, and a portion of the intestine losing its blood supply.
What Causes Acute Abdomen?
An acute abdomen refers to severe abdominal pain that comes on suddenly and requires immediate attention. This situation can arise from several causes, including appendicitis, cholecystitis, pancreatitis, and diverticulitis. Acute peritonitis, which is inflammation of the abdominal lining, can cause an acute abdomen due to a rupture in an organ, inflammatory bowel disease, or cancer.
Heart and blood vessels problems like interrupted blood flow to the intestines (mesenteric ischemia) or a ruptured abdominal aortic aneurysm can also cause severe belly pain. Conditions related to pregnancy and female reproductive health, such as a ruptured ectopic pregnancy and twisted ovary, are other potential causes. Some issues related to the urinary system, like kidney stones and kidney infections, can also cause acute abdominal pain.
There are also some conditions that can lead to blocked intestines, known as small bowel obstruction, triggering acute belly pain. For instance, newborns can potentially suffer from a serious gastrointestinal disease called necrotizing enterocolitis, which also presents as acute abdominal pain.
Midgut volvulus, a condition wherein the intestines twist upon themselves, often affects newborns during the first week, month, or year of life. Intussusception, a condition where a part of the intestine slides into another, usually occurs in children between nine to 24 months. Appendicitis, an inflammation of the appendix, however, is the most common cause of severe abdominal pain in children.
Risk Factors and Frequency for Acute Abdomen
Abdominal pain is a common reason why many people visit the emergency department. While exact figures aren’t available, estimates suggest that around 7% to 10% of all emergency department visits are due to this issue. Based on data taken from a study by the Centers for Disease Control and Prevention (CDC), it was found that 11% of all emergency department visits in 2008 were for abdominal pain. Furthermore, 12.5% of these were categorized as urgent or emergency cases.
- About one-third of the people coming in with abdominal pain were diagnosed with non-specific abdominal pain.
- Around 30% were diagnosed with acute renal colic, a type of severe abdominal pain.
Signs and Symptoms of Acute Abdomen
A medical history and physical examination can help rule out certain causes and suggest others when dealing with abdominal pain. Based on the symptoms described, doctors can make deductions about possible issues. For example, sudden onset pain may indicate a circulatory issue, while fainting suggests possible blood loss. Certain conditions also have their unique symptoms: appendicitis often starts with a vague belly button pain that later moves to the lower right abdomen, and ovarian torsion (twisting of the ovaries) can cause sudden pain on one side of the lower abdomen with episodes of vomiting. However, these symptoms are not always present or clear; a serious condition like a leaking abdominal aortic aneurysm (a bulge in the aorta) can have symptoms as innocuous as low back pain.
The type of abdominal pain can also hint at potential causes: for instance, lower left pain is often associated with acute diverticulitis (inflammation of pouches in the colon), while gallbladder inflammation, or cholecystitis, generally causes pain in the upper central or upper right abdomen. Identifying a clear case of serious abdominal illness is straightforward, but diagnosing developing issues in early stages with vague symptoms can be challenging.
A patient’s medical and social history is similarly important—high blood pressure, which increases the risk of an abdominal aortic aneurysm. Frequently consuming alcohol, which may suggest pancreatitis (inflammation of the pancreas), is also a critical factor.
The physical exam should be prompt and thorough. Changes in the patient’s appearance, such as facial color and expression, or body temperature could signal severe distress. An in-depth examination of the abdomen, including listening to the functioning bowel and feeling for tender areas, lumps, or tension, is necessary. Traditional teachings in medicine recommend rectal exams for all abdominal pains, though recent studies show it might not be useful for diagnosing appendicitis. Rectal exams, however, are still considered important in cases with suspected gastrointestinal bleeding or prostate concerns. If a gynecological problem is suspected, a pelvic exam should be performed. In young males, a testicular exam is needed to rule out testicular torsion (twisting of the testicles). Moreover, checking for hernias should be a routine part of the examination.
Testing for Acute Abdomen
It’s absolutely vital to quickly diagnose and treat severe abdominal pain, often referred to as “acute abdomen”. This process involves evaluating symptoms and treating the patient simultaneously – so both diagnosis and treatment happen at the same time. The steps to diagnose patients often include blood tests and medical imaging.
In adults who are over 40, a specific type of heart test, known as a 12-lead ECG, can be used to rule out a heart attack as the cause of severe stomach pain. Additionally, it can be helpful to know if a patient with a condition called mesenteric ischemia (reduced blood flow to the intestines) has an irregular heartbeat or ‘atrial fibrillation’.
Usually, doctors will order a complete blood count (CBC), a comprehensive metabolic profile, and a lipase test (which checks the function of the pancreas). If the doctor suspects conditions like septicemia (infection in the blood) or again, mesenteric ischemia, they might ask for a blood lactate test. If there are suspicions of a pregnancy-related condition like an ectopic pregnancy (where the embryo implants outside the womb), a urine or blood pregnancy test will be needed.
Modern technological advances have greatly improved our ability to diagnose conditions associated with the acute abdomen. A quick ultrasound in the emergency room can help diagnose conditions like gallbladder inflammation, kidney swelling, internal bleeding, and abdominal aortic aneurysm – this usually takes less than 5 minutes.
Ultrasound is the go-to method for diagnosing gallbladder inflammation, appendicitis in children, a ruptured ectopic pregnancy, and ovarian torsion (a serious condition where the ovary twists, cutting off its blood supply). But, keep in mind, the use of CT scans has drastically simplified the diagnosis of acute abdomen. In most instances, these scans only require an intravenous (given through the veins) contrast – oral contrast takes more time and typically isn’t necessary.
While magnetic resonance imaging (MRI) can also provide valuable data, it is not commonly used in emergency situations because it takes longer to perform and can be challenging for patients who are not stable.
Treatment Options for Acute Abdomen
If a patient has low blood pressure and a fast heart rate, it could mean they have lost blood, are dehydrated, or have a severe infection called sepsis. All of these conditions require quick action, starting with giving them a lot of fluids through a large needle connected to an IV drip. If an infection is suspected, they should be given broad-spectrum antibiotics that can fight off various types of bacteria found in the gut.
It’s essential to keep a close eye on patients who are very ill by frequently checking their vital signs. They should also be given strong painkillers, like opioids, to manage their discomfort. Using anti-nausea medication may also be important. If signs or symptoms point to an emergency that requires surgery, a surgeon needs to be called urgently. The surgeon should be consulted before any time-consuming tests are done.
In conclusion, any condition that causes severe stomach pain (also known as an ‘acute abdomen’) can involve several problems inside the belly that need immediate attention for both diagnosis and treatment. Even if the symptoms are unclear or not immediately obvious, these conditions should never be overlooked. Rapid testing combined with immediate therapeutic actions are necessary. If there’s a chance that surgery might be required, consult a surgeon as soon as possible.
What else can Acute Abdomen be?
If a person is suffering from severe stomach pain, the cause could be any one of a broad range of conditions. These might include:
- An abdominal aortic aneurysm (a bulge or swelling in the main blood vessel that runs from your heart down through your tummy)
- Appendicitis (inflammation of the appendix)
- Gallbladder inflammation (acute cholecystitis)
- Diverticulitis (inflammation or infection of small pouches in your intestines)
- Intestinal ischemia (a condition characterized by poor blood flow to your intestines)
- Peptic ulcer (a sore in the lining of your stomach or duodenum)
- Pancreatitis (inflammation of the pancreas)
- Peritonitis (inflammation of the lining of the abdomen)
- Pyelonephritis (a kidney infection)
- Ureteric colic (a sharp, severe pain due to a stone in the kidney or ureter)
- Adrenal crisis (a potentially life-threatening condition that occurs if your adrenal gland is damaged)
- Biliary colic (gallstones causing pain in your abdomen)
- Bowel obstruction (a blocked intestine)
- Bowel twisting (volvulus)
- Carcinoid syndrome (a type of cancer that affects hormone-producing cells)
- Ectopic pregnancy with tubal rupture (a life-threatening condition in which a fertilized egg grows outside the uterus, typically in a fallopian tube)
- Familial Mediterranean fever (a disorder that causes recurrent fevers and painful inflammation of your abdomen)
- Blood in the abdomen (hemoperitoneum)
- Kidney stones
- Ovarian torsion (when an ovary twists around the ligaments that hold it in place)
- Ruptured spleen
- Sickle cell anemia (a genetic disease that causes abnormally shaped red blood cells).
Each of the conditions listed above needs different treatments, so it’s important that the correct diagnosis is made as quickly as possible.
What to expect with Acute Abdomen
In simpler terms, finding a sudden, severe abdominal pain often suggests a surgical issue, and traditionally, such patients were taken directly to the operating room. However, certain medical issues can also cause harsh abdominal pain and they require medical treatment instead of surgery. These conditions could be severe pancreatic inflammation, genetic blood disorders such as sickle cell anemia, diabetic ketoacidosis which is a serious diabetes complication, adrenal crisis, or kidney infection.
These days, medical techniques like ultrasound or CT scans are commonly used to identify the reason behind sudden severe abdominal pain. This helps the surgeons prepare for the surgery in advance and it also helps in avoiding unnecessary surgeries in cases where medical treatment is needed instead of surgery.
All patients experiencing sudden severe abdominal pain should see a surgeon. If the patient’s condition is stable, imaging studies such as an ultrasound scan or CT scan can be done. However, if the patient’s condition is not stable, immediate surgical intervention might be required. How the patient will do in the long run, largely depends on the cause of the pain.
Possible Complications When Diagnosed with Acute Abdomen
If an acute abdomen isn’t treated, it can lead to a number of serious outcomes:
- Sepsis, a severe infection that can spread through the body
- Necrosis or gangrene, which is death of bowel tissues
- Fistula, an abnormal connection between two body parts
- Death
Recovery from Acute Abdomen
Most patients experiencing severe abdominal pain, typically older individuals, are ideally cared for in an ICU (Intensive Care Unit). They often need supportive treatments like intravenous fluids to prevent dehydration, nasogastric decompression to relieve digestive complaints, and pain relief. The use of antibiotics depends on the root cause of their symptoms. On-going close observation is crucial, because these patients can develop complications such as lung collapse (atelectasis), bowel obstruction (ileus), wound infections, blood clots in the legs (DVT), and pneumonia.
