Acute Abdominal Pain: All You Need to Know

Almost everyone experiences abdominal pain at some time or the other in their lives. It can occur suddenly or over a period of several hours, and requires immediate attention. A detailed history and thorough clinical examination should be done in every case of acute abdomen. In this article, we discuss all you need to know about acute abdominal pain, including its causes, symptoms, diagnosis and treatment. Let’s start with some basics.

What is Acute Abdominal Pain/Acute Abdomen?

Acute abdominal pain, also known as acute abdomen, refers to sudden and severe pain in the abdomen that typically indicates a medical emergency. This type of pain can arise from a wide range of underlying causes, and may be accompanied by other symptoms such as nausea, vomiting, fever, bloating, diarrhea, constipation, or changes in bowel habits. It is essential to promptly seek medical attention if you experience acute abdominal pain, as it may be a sign of a serious condition that requires urgent evaluation and treatment.

Who Does It Affect?

Acute abdominal pain can affect individuals of all ages, genders, and backgrounds. However, certain factors may increase the risk of someone developing acute abdominal pain.

What are the Causes and Symptoms of an Acute Abdomen?

• Acute appendicitis: Occurs in all age groups. It can present with pain mainly on the right lower side of abdomen with fever and vomiting.
• Acute gall bladder stone pain: Pain in upper abdomen along with vomiting, fever and elevated pulse rate
• Acute pancreatitis: Commonly seen after 30 yrs of age. Severe pain in the upper part of the abdomen, mainly central & may be associated with profuse vomiting and elevated pulse rate.
• Amoebic liver abscess: Occur after amoebic dysentery. Pain is in the region of the upper and right side of the abdomen.
• Gastritis: Inflammation of stomach and can present as pain in upper abdomen and vomiting
• Urinary tract infection: Abdominal pain with burning sensation while passing urine.
• Acute gastroenteritis: It is due to infection in the gastrointestinal tract and may present with cramping abdominal pain, loose stools, fever, nausea and vomiting.
• Acute intestinal obstruction: Abdominal pain, vomiting, abdominal distension, inability to pass flatus and stools. It might be due to abdominal tuberculosis, acute strangulation of small and large intestines, Intestinal worms etc.
• Ruptured ectopic gestation: Rupture of gestational sac may present with pain in the abdomen. It may be associated with fainting. It is found in females of child bearing age.
• Cholecystitis: Inflammation of the gallbladder, usually due to gallstones blocking the bile duct. Cholecystitis causes severe pain in the upper right abdomen, often after eating fatty foods, along with nausea, vomiting, and fever.
• Pancreatitis: Inflammation of the pancreas, often caused by gallstones or excessive alcohol consumption. Pancreatitis presents with severe, persistent abdominal pain that radiates to the back, along with nausea, vomiting, and fever.
• Perforated peptic ulcer: A hole or perforation in the lining of the stomach or small intestine, usually caused by untreated peptic ulcers. Perforated peptic ulcers cause sudden, severe abdominal pain that may be localized or diffuse, along with signs of peritonitis, such as rigidity and rebound tenderness.
• Mesenteric ischemia: Reduced blood flow to the intestines, leading to tissue damage and ischemia. Mesenteric ischemia causes severe, crampy abdominal pain that worsens after eating, along with diarrhea, nausea, and vomiting.
• Ovarian torsion: Twisting of the ovary, cutting off its blood supply. Ovarian torsion presents with sudden, severe lower abdominal pain, usually on one side, accompanied by nausea, vomiting, and sometimes fever.
• Diverticulitis: Inflammation or infection of small pouches (diverticula) that form in the wall of the colon. Diverticulitis causes localized abdominal pain, usually in the lower left abdomen, along with fever, nausea, and changes in bowel habits.
• Ectopic pregnancy: Implantation of a fertilized egg outside the uterus, usually in the fallopian tube. Ectopic pregnancy causes sudden, severe lower abdominal pain, often on one side, along with vaginal bleeding and signs of shock in severe cases.

• Other causes: Ruptured cyst of ovary, twisted ovarian cyst, Ruptured Aortic aneurysms, Aortic dissection , Acute regional ileitis, Acute salpingitis, Sub diaphragmatic abscess, etc.

What to do in Case of Acute Abdominal Pain?

When someone feels acute pain in abdomen, they should:

• Seek advice of a qualified medical practitioner immediately
• Visit emergency services of a nearby hospital
• Avoid self-medication or diagnose
• Avoid over the counter medicines, which suppress the pain for the time being and may reoccur later in more severe forms.

How is Acute Abdomen Diagnosed?

Diagnosing acute abdominal pain typically involves a combination of medical history review, physical examination, laboratory tests, and imaging studies. Here's an overview of the diagnostic process:

Medical history review

The doctor will inquire about your symptoms, including the onset, location, severity, and duration of abdominal pain. They will also ask about any associated symptoms such as nausea, vomiting, fever, changes in bowel habits, or urinary symptoms. 

Physical examination

During the physical examination, the doctor will assess the patient’s vital signs, abdominal tenderness, rigidity, rebound tenderness, and other signs of peritonitis (inflammation of the abdominal lining). They may also palpate the abdomen to identify areas of tenderness, masses, or organ enlargement.

Laboratory tests

Doctors may prescribe various lab tests to diagnose the cause of acute abdomen. These include:

• Complete blood count (CBC)
• Comprehensive metabolic panel (CMP)
• Renal function test
• Liver function tests (LFTs)
• Pancreatic enzymes (amylase and lipase)
• Inflammatory markers (such as C-reactive protein and erythrocyte sedimentation rate)

Imaging studies

Imaging studies are often used to visualize the abdominal organs and identify any abnormalities. Common imaging modalities used in the diagnosis of acute abdomen include:

• Ultrasonography of abdomen: Used to evaluate the liver, gallbladder, pancreas, kidneys, and abdominal blood vessels. It is often the initial imaging test of choice, especially in cases of suspected gallbladder or biliary tract disease.In some cases, contrast enhanced CT of the abdomen might be used.
• Computed Tomography (CT) scan: Provides detailed cross-sectional images of the abdomen and pelvis, allowing visualization of the abdominal organs, blood vessels, and other structures. CT scan is particularly useful for diagnosing conditions such as appendicitis, diverticulitis, bowel obstruction, and abdominal trauma.
• X-ray: May be used to detect signs of bowel obstruction, perforation, or abdominal gas patterns suggestive of certain conditions.
• Magnetic Resonance Imaging (MRI): Less commonly used than CT scan or ultrasound but may be indicated in certain cases, such as suspected pancreatic or liver pathology.

Specialized tests

Depending on the suspected underlying cause of acute abdomen, additional specialized tests or procedures may be performed. For example, upper and lower gastrointestinal endoscopy may be used to directly visualize the abdominal organs and diagnose conditions such as appendicitis or pelvic inflammatory disease. 

All that said, the diagnostic approach to acute abdomen is multifaceted and tailored to the individual patient's presentation and suspected underlying cause. 

How is Acute Abdomen Treated?

Treatment for acute abdomen depends on the underlying cause of the condition. Since acute abdomen is a medical emergency, prompt evaluation and intervention are essential to prevent complications and improve outcomes. Treatment may include the following:

Supportive care

Initially, supportive measures may be implemented to stabilize the patient and alleviate symptoms. This may include intravenous fluids to prevent dehydration, pain management to relieve discomfort, and monitoring of vital signs.

Medications

Depending on the suspected cause of acute abdomen, medications may be prescribed to address specific symptoms or underlying conditions. For example:

• Antibiotics may be given if there is evidence of infection, such as in cases of appendicitis or diverticulitis.
• Analgesics (pain relievers) may be administered to alleviate abdominal pain.
• Antiemetics may be prescribed to control nausea and vomiting.

Surgical intervention

While the treatment for conditions such as inflammation and ulcers can be medical, many underlying causes, such as appendicitis, cholecystitis,hernia, bowel resection, etc. require surgical intervention which can be done laparoscopically with less discomfort and faster postoperative recovery of the patient.

Non-Surgical interventions

In some cases, non-surgical interventions such as endoscopic procedures or interventional radiology techniques may be used to address certain causes of acute abdomen, such as bleeding ulcers or gallstone-related complications.

Treatment of underlying condition

Once the underlying cause of acute abdomen has been identified, additional treatment may be necessary to address the underlying condition and prevent recurrence. This may include lifestyle modifications, dietary changes, medication management, or ongoing medical monitoring.

It's important to note that the specific treatment approach for acute abdomen will vary depending on the individual patient's presentation, underlying cause, and clinical status. Prompt evaluation by a healthcare professional is essential to determine the appropriate treatment plan and optimize outcomes for patients with acute abdomen. Acute abdominal conditions can be treated successfully in most cases when treated timely thorough detailedclinical examination, investigation and correct diagnosis by expert clinician. 

How to Prevent Acute Abdominal Pain?

Preventing acute abdominal pain involves addressing underlying risk factors and adopting healthy lifestyle habits. While not all causes of acute abdomen are preventable, there are steps you can take to reduce your risk of certain conditions that may lead to abdominal pain. These include:

• Maintain a healthy diet
• Exercise regularly
• Practice good hygiene
• Manage stress
• Avoid smoking and alcohol consumption
• Take prescribed medications as directed
• Manage chronic health conditions
• Maintain an active lifestyle

While these measures can help reduce the risk of certain causes of acute abdominal pain, it's important to remember that not all cases of acute abdomen are preventable. If you experience sudden or severe abdominal pain, seek prompt medical attention for evaluation and treatment.

What are possible complications of acute abdomen?

Acute abdomen is a medical emergency that can lead to serious complications if not promptly evaluated and treated. Potential complications of acute abdomen include:

• Peritonitis: Inflammation or infection of the peritoneum, the lining of the abdominal cavity, which can occur due to perforation of the gastrointestinal tract (e.g., perforated peptic ulcer, bowel perforation). Peritonitis can lead to sepsis and life-threatening systemic infection if left untreated.
• Sepsis: A severe and potentially life-threatening response to infection, characterized by widespread inflammation and organ dysfunction. Sepsis can develop as a complication of untreated peritonitis or other intra-abdominal infections.
• Septic shock: A life-threatening condition that occurs when sepsis leads to a significant drop in blood pressure and inadequate blood flow to vital organs, resulting in organ failure and potentially death.
• Organ dysfunction: Acute abdomen can cause dysfunction or injury to abdominal organs such as the liver, pancreas, kidneys, or intestines, leading to complications such as acute kidney injury, acute liver failure, or pancreatic necrosis.
• Bowel obstruction: Complete or partial blockage of the intestines, which can occur due to conditions such as bowel adhesions, hernias, or tumors. Bowel obstruction can lead to abdominal distension, vomiting, dehydration, and ischemia of the intestines if not promptly relieved.
• Hemorrhage: Severe abdominal pain may be associated with internal bleeding, such as in cases of ruptured abdominal aortic aneurysm, trauma, or gastrointestinal bleeding. Untreated hemorrhage can lead to hypovolemic shock and organ damage.
• Organ perforation: Rupture or perforation of abdominal organs, such as the appendix, gallbladder, or intestines, can lead to leakage of contents into the abdominal cavity, causing peritonitis, sepsis, or abscess formation.
• Chronic abdominal pain: In some cases, acute abdomen may be followed by chronic abdominal pain or functional gastrointestinal disorders, which can significantly impact quality of life and require long-term management.

When to Consult a Doctor for Acute Abdominal Pain?

It's crucial to seek prompt medical attention if you experience acute abdominal pain, as it can be a sign of a serious medical condition requiring urgent evaluation and treatment. Here are some situations in which you should consult a doctor for acute abdominal pain:

• Severe pain: If you experience severe abdominal pain that is unrelenting or progressively worsening, it could indicate a medical emergency.
• Abrupt onset: If the abdominal pain develops suddenly, especially if it is accompanied by other concerning symptoms, such as nausea, vomiting, fever, or changes in bowel habits.
• Persistent pain: If the abdominal pain persists for more than a few hours or does not improve with over-the-counter pain medications or home remedies.
• Associated symptoms: If the abdominal pain is accompanied by other symptoms such as:
• Nausea and vomiting
• Fever or chills
• Difficulty breathing
• Dizziness or fainting
• Blood in vomit or stool
• Inability to pass gas or have a bowel movement
• Abdominal swelling or distension
• Jaundice (yellowing of the skin or eyes)
• Difficulty swallowing or severe chest pain
• Recent trauma: If the abdominal pain follows a traumatic injury to the abdomen or pelvis, such as a fall, blunt trauma, or motor vehicle accident.
• History of medical conditions: If someone has a history of medical conditions such as appendicitis, gallbladder disease, diverticulitis, or inflammatory bowel disease, and they experience symptoms consistent with those conditions.
• Pregnancy: If someone is pregnant and experiences abdominal pain, it is important to seek medical attention promptly, as abdominal pain during pregnancy can be a sign of complications such as ectopic pregnancy or miscarriage.
• Age and medical history: If someone is elderly, has a weakened immune system, or has underlying medical conditions such as diabetes or kidney disease, they may be at higher risk of complications from acute abdominal pain and should seek medical evaluation promptly.

Wrap up

When it comes to your health, timely and expert medical care is paramount. If you or someone you know has been experiencing acute abdominal pain or any related symptoms that raise concern, don't hesitate to reach out to a specialist at Max Hospitals. Our experienced team of healthcare professionals is dedicated to providing comprehensive evaluation, personalized treatment, and compassionate care to address your needs effectively. Contact us today to schedule a consultation and take proactive steps towards better health and recovery.