Acute Abdomen Pain – A Pandora’s Box

Abdominal pain is one of the most common reasons for visiting the emergency dept. It poses to be a diagnostic challenge for an emergency physician as the causes for abdomen pain are numerous ranging from benign to serious life-threatening conditions.

The presentation varies from person to person, right from younger to elderly population – causes are various. The abdominal pain may be of different characters: continuous, colicky, crampy, radiating and is usually associated with varying other symptoms such as vomiting, loose stools, constipation, decreased urine output or blood in urine or motion.

Usually in younger population, the most commonly presenting conditions include acute appendicitis, gall bladder stones, kidney or urinary tube stones, torsion testis or ovary. But in the elderly, causes can vary from acute intestinal obstruction to vascular problems.

In pregnant women, a very common diagnosis would be ectopic pregnancy, (i.e. tubal pregnancy – fertilized egg attaches itself somewhere outside the uterus) and this is one of the most life threatening conditions in which the person presents with worst ever abdominal pain all over along with vaginal bleeding associated with bleeding from vagina and giddiness and low BP, commonly patient coming to the hospital in an unconscious state due to profound blood loss in the pelvic cavity.

If the pain occurs in upper abdomen, radiating to the right side associated with vomiting & fever, then there are chances of gall bladder infection -acute cholecystitis.

If the pain is initially at the navel region and then localizes to right side of the lower abdomen associated with vomiting and fever (especially in younger population), then one must have suspicion about infection of the appendix – acute appendicitis.

If the pain is in the centre of the upper abdomen, radiating to the back along with vomiting especially in young individuals with background history of habitual alcohol intake, it can be infection & inflammation of the pancreas – acute pancreatitis.

In case of sudden onset of severe lower abdominal pain on either side, radiating from the back to the groin region(patient will be rolling in pain) associated with vomiting, decreased urine output, blood in urine or burning sensation while passing urine – it is more in favour of kidney or urinary tube stones – acute ureteric colic.

In middle aged or elderly, who have undergone various abdominal surgeries in the past, when they present with severe abdominal pain with bloating, not able to pass motion or gas associated with vomiting, we would suspect any acute blockage in the intestinal tracts. This will require urgent surgical evaluation to prevent bursting of the intestines and full-blown infection with multi-organ involvement. The condition is diagnosed as acute intestinal obstruction.

Most common presentation to the emergency in young adults is acute gastritis. Patients present with burning type of pain (heartburn), alot of burping sensation, feeling of ingestion, at times associated with severe difficulty in breathing secondary to severe gas accumulation. The common causes for this – the sedentary lifestyle, untimely meals, oily, spicy outside food consumption frequently, lack of sleep and other personal habits.

When there is a crampy type of diffuse abdominal pain associated vomiting and loose motions probably due to outside, junk or spicy foods, it can be food poisoning. In that scenario, maintaining good hydration is essential. Adequate hydration can be ensured by having electral (ORS), tender coconut water, plenty of oral fluids at home. But if the person becomes extremely dehydrated, unable to tolerate anything orally, has persistent vomiting, develops extreme tiredness and fatigue, altered sensorium or decreased urine output, their warning signs need a consultation with the doctor to prevent further dehydration and kidney damage and other complications.

So,When Do We Rush to the Hospital?

• Severe pain – not settling with regular painkillers
• Persistent vomiting: > 6-8 episodes of vomiting per day, not settling with regular medications
• Not able to pass gas (flatus) or motion
• Severe tiredness and fatigue
• Chest pain associated with abdominal pain
• Urinary symptoms like reduced urine out or blood in urine
• Severe sweating with abdomen pain
• Altered sensorium
• High grade fever – not settling with regular paracetamol