ABDOMINAL PAIN

PRESENTATION
CP1

AND

MANAGEMENT

Chris Neophytou

Research Fellow

What is acute abdomen?

Introduction
Acute abdominal pain:
Previously undiagnosed pain that arises
suddenly and is of less than 7 days (usually
less than 48 hours) duration
de Dombal FT: Diagnosis of Acute Abdominal Pain, 2nd ed. Churchill
Livingstone, London, 1991

Abdominal pain that persists for 6 hours or

longer is usually caused by disorders of
surgical significance
Purcell TB: Nonsurgical and extraperitoneal causes of abdominal pain.
Emerg Med Clin North Am 7:721, 1989

Introduction
Frequency of Diagnoses in Patients with Acute
Abdominal Pain

Types of pain

Visceral

Involves hollow or solid organs

Midline pain due to bilateral innvervation
Stimulation of visceral afferent nerve plexus
result from contraction or distension against
resistance & chemical irritation
Steady ache or vague discomfort to
excruciating or colicky pain
Poorly localized

Epigastric region: stomach, duodenum, biliary tract

Periumbilical: small bowel, appendix, cecum
Suprapubic: colon, sigmoid, GU tract

Types of pain

Parietal

Involves parietal peritoneum as peritonitis

develops
Irritation perceived through segmental somatic
fibers reflex
Involuntary muscle wall rigidity (guarding) may
result from irritation of segmental sensory
nerves
Localized pain
Causes tenderness and guarding which
progress to rigidity and rebound
Hyperesthesia of the skin may be result from
ipsilateral peritoneal irritation

Referred pain

Pain perceived at a site distant from the

affected organ due to overlapping
transmission pathways

Location of pain