1. Clinical Overview
Summary
Acute abdomen refers to sudden onset of severe abdominal pain requiring urgent evaluation and potential surgical intervention. It represents a spectrum of conditions ranging from self-limited disorders to life-threatening surgical emergencies. Key causes include appendicitis, cholecystitis, bowel obstruction, perforated viscus, and mesenteric ischaemia. Early recognition of surgical emergencies, systematic assessment, and appropriate imaging (CT abdomen/pelvis is gold standard) are essential. Life-threatening conditions such as ruptured AAA, mesenteric ischaemia, and ruptured ectopic pregnancy must be excluded promptly.
Key Facts
- Definition: Sudden severe abdominal pain requiring urgent evaluation
- Most common causes: Appendicitis, cholecystitis, bowel obstruction
- Life-threatening: Ruptured AAA, mesenteric ischaemia, perforated viscus
- Key investigation: CT abdomen/pelvis with IV contrast
- Mandatory test: Pregnancy test in all reproductive-age females
- Key marker: Lactate (greater than 2 concerning for ischaemia)
Clinical Pearls
Pain Out of Proportion: Severe pain with minimal abdominal findings = mesenteric ischaemia until proven otherwise. This is the key warning sign for bowel ischaemia.
Pregnancy Test First: In all reproductive-age females with abdominal pain, exclude ectopic pregnancy before any other diagnosis.
Analgesia Does NOT Mask: Do not withhold analgesia — it does not mask peritoneal signs or delay diagnosis. Early pain relief is evidence-based and appropriate.
Why This Matters Clinically
Acute abdomen is a common ED presentation with potential for catastrophic outcomes if life-threats are missed. Ruptured AAA, mesenteric ischaemia, and perforated viscus have mortality rates of 50-80% without prompt treatment. Systematic evaluation with early surgical consultation saves lives.
2. Epidemiology
(Epidemiological data integrated into differential diagnosis below)
3. Pathophysiology
Pain Mechanisms
Visceral Pain
- Originates from distention, inflammation, or ischemia of hollow organs
- Poorly localized, midline, dull, crampy
- Often associated with autonomic symptoms (nausea, vomiting, diaphoresis)
- Referred to dermatomal distribution of organ's innervation
Parietal (Somatic) Pain
- Results from irritation of parietal peritoneum
- Well-localized, sharp, constant
- Worsened by movement, coughing
- Indicates progression of disease process
Referred Pain
- Perceived at location distant from source
- Follows embryological nerve distribution
- Examples: Right shoulder pain in cholecystitis (phrenic nerve)
Peritoneal Irritation
Chemical Peritonitis
- Gastric acid (perforated ulcer)
- Bile (gallbladder perforation)
- Pancreatic enzymes (acute pancreatitis)
- Blood (hemoperitoneum)
Bacterial Peritonitis
- Appendiceal or diverticular perforation
- Bowel perforation from any cause
- Spontaneous bacterial peritonitis in ascites
Step 1: Visceral Pain (The Early Warning)
- Mechanism: Stretch receptors in the walls of hollow viscus organs (gut, ureter, bile duct) or capsule stretching (liver, spleen).
- Conduction: C-fibers (slow, unmyelinated). Bilateral innervation.
- Character: Dull, aching, gnawing, cramping, poorly localized.
- Location:
- Foregut (Stomach/Pancreas): Epigastric.
- Midgut (Small Bowel/Appendix): Periumbilical.
- Hindgut (Colon): Suprapubic.
- Autonomic: Often accompanied by nausea, vomiting, sweating (embryological reflex).
Step 2: Somatic (Parietal) Pain (The Danger Signal)
- Mechanism: Irritation of the parietal peritoneum by pus, bile, acid, or blood.
- Conduction: A-delta fibers (fast, myelinated). Unilateral innervation.
- Character: Sharp, stabbing, intense, constant, well-localized.
- Pointers: Aggravated by movement, cough (Dunphy's sign), or vibration (bumps in the car).
- Migration: The classic shift in appendicitis (Visceral -> Somatic) represents the inflammation moving from the appendix lumen to the serosa touching the abdominal wall.
Step 3: Referred Pain (The Mask)
- Mechanism: Convergence of somatic and visceral afferents on the same spinal cord segment. The brain misinterprets the visceral signal as coming from the somatic dermatome.
- Examples:
- Diaphragm (C3-C5) -> Shoulder Tip (Kehr's Sign).
- Ureter (T11-L2) -> Groin/Testicle.
- Gallbladder (T7-T9) -> Right Scapula (Boas' Sign).
Step 4: The Peritoneal Response (Peritonitis)
- Inflammation: Release of histamine, bradykinin, serotonin causes vasodilation and increased permeability.
- Exudation: Fibrinogen-rich fluid pours into the cavity, causing "loops of bowel to stick together" (walling off).
- Paralysis: Inflamed bowel stops contracting -> Paralytic Ileus (Silent abdomen).
- Rigidity: Reflex spasm of abdominal muscles to protect the inflamed peritoneum (Involuntary Guarding).
Vascular Pathophysiology
Mesenteric Ischemia Progression
- Initial mucosal ischemia (reversible)
- Full-thickness infarction
- Bacterial translocation
- Sepsis and multi-organ failure
- Death if untreated (mortality 60-80%)
AAA Rupture Hemodynamics
- Retroperitoneal tamponade may temporarily stabilize
- Contained rupture allows time for intervention
- Free rupture leads to rapid exsanguination
4. Clinical Presentation
History Elements
Pain Characteristics (OPQRST)
| Component | Key Questions | Significance |
|---|---|---|
| Onset | Sudden vs gradual | Sudden: perforation, AAA, ectopic |
| Provocation | Movement, eating, position | Peritonitis worsened by movement |
| Quality | Sharp, crampy, constant | Colicky: obstruction; Sharp: peritonitis |
| Radiation | Back, shoulder, groin | Back: AAA, pancreatitis; Shoulder: diaphragm |
| Severity | Pain scale | Pain out of proportion: ischemia |
| Timing | Duration, progression | Rapid progression concerning |
Associated Symptoms
Critical History
Physical Examination
General Appearance
Vital Signs Patterns
| Finding | Suggests |
|---|---|
| Fever | Infection, inflammation |
| Tachycardia | Pain, hypovolemia, sepsis |
| Hypotension | Hemorrhage, sepsis, dehydration |
| Tachypnea | Acidosis, pain, diaphragm irritation |
Abdominal Examination
Critical Signs
Additional Examination
Nausea and vomiting (timing relative to pain onset)
Common presentation.
Fever and chills (infection)
Common presentation.
Anorexia (appendicitis)
Common presentation.
Obstipation vs diarrhea
Common presentation.
Melena or hematochezia
Common presentation.
Urinary symptoms
Common presentation.
Vaginal bleeding or discharge (gynecological)
Common presentation.
5. Clinical Examination
Comprehensive assessment requires a systematic approach to identify peritoneal signs and localized pathology.
General Inspection
- The "End of Bed" Test:
- Patient lying still? -> Peritonitis (movement hurts).
- Patient writhing/rolling? -> Visceral Colic (Renal stone, Bowel obstruction).
- Pallor/Sweating? -> Shock.
Abdominal Examination
1. Inspection
- Scars: Previous surgery = Adhesions = Obstruction.
- Distension: The 5 F's (Fat, Fluid, Flatus, Feces, Fetus).
- Ecchymosis: Cullen's (Umbilicus), Grey Turner's (Flanks) = Retroperitoneal Bleed (Pancreatitis/AAA).
- Visible Peristalsis: Obstruction.
2. Palpation (The Money Maker)
- Rule 1: Ask the patient to point to where it hurts most. Start away from this spot.
- Superficial: Check for "Board-like Rigidity" (Involuntary guarding).
- Deep: Assess for masses (AAA, Appendix mass).
- Tenderness: Map the maximum point of tenderness.
3. Percussion
- Tympany: Gas-filled loops (Obstruction).
- Loss of Liver Dullness: Free gas (Perforation).
- Shifting Dullness: Ascites.
- Percussion Tenderness: The kindest way to test for peritonitis (instead of Rebound).
4. Auscultation
- Absent: "Silent Abdomen" -> Peritonitis / Ileus.
- Tinkling: High-pitched "plinking" sounds -> Obstruction.
- Bruit: Renal/Aortic.
Special Tests & Eponyms
- Murphy's Sign: Arrest of inspiration on RUQ palpation (Cholecystitis).
- Rovsing's Sign: Palpation in LLQ causes pain in RLQ (Appendicitis).
- Psoas Sign: Pain on extension of right hip (Retrocaecal Appendix).
- Obturator Sign: Pain on internal rotation of right hip (Pelvic Appendix).
- Carnett's Test: Tensing abdominal muscles (sit-up). Increased pain = Abdominal Wall. Decreased pain = Visceral.
The "Forgotten" Exams
- Hernial Orifices: Femoral/Inguinal. Incarceration is rare but easily fixed if found.
- Testicular Exam: Torsion presents as "lower abdo pain".
- PR Exam: Only if suspecting GI bleed (Melena), Prostatic abscess, or distal obstruction.
Red Flags
Immediate Life Threats
| Condition | Key Features | Immediate Action |
|---|---|---|
| Ruptured AAA | >0 years, sudden back/abdominal pain, pulsatile mass, hypotension | Massive transfusion, vascular surgery STAT |
| Mesenteric ischemia | AF, cardiovascular disease, pain > exam findings, metabolic acidosis | CT angiography, anticoagulation, surgery |
| Ruptured ectopic | Reproductive age female, missed period, + pregnancy test, hemodynamic instability | Blood transfusion, emergent surgery |
| Perforated viscus | Sudden severe pain, rigid abdomen, free air on imaging | Surgical consultation, antibiotics |
| Bowel strangulation | Obstruction with fever, tachycardia, localized tenderness, lactate elevation | Emergent surgery |
High-Risk Clinical Scenarios
Immunocompromised Patients
- Blunted inflammatory response
- May have minimal findings despite significant pathology
- Lower threshold for imaging and admission
Elderly Patients
- Atypical presentations common
- Higher mortality from same conditions
- May lack fever or peritoneal signs
- Pain often underestimated
Anticoagulated Patients
- Higher risk of hemorrhage
- Lower threshold for imaging
- Consider retroperitoneal hematoma
Post-surgical Patients
- Consider anastomotic leak
- Internal hernia (especially post-bariatric)
- Adhesive obstruction
6. Investigations
Differential Diagnosis by Location
Right Upper Quadrant
| Condition | Key Features |
|---|---|
| Cholecystitis | Murphy's sign, fever, RUQ tenderness |
| Hepatitis | Jaundice, transaminitis |
| Liver abscess | Fever, RUQ pain, systemic illness |
| Perforated duodenal ulcer | Sudden onset, peritonitis |
| Right lower lobe pneumonia | Cough, fever, abnormal lung exam |
| Fitz-Hugh-Curtis | Young female, PID history |
Right Lower Quadrant
| Condition | Key Features |
|---|---|
| Appendicitis | Migration of pain, anorexia, fever |
| Ectopic pregnancy | Reproductive age, + pregnancy test |
| Ovarian torsion | Sudden onset, adnexal tenderness |
| Ruptured ovarian cyst | Mid-cycle, sudden pain |
| Crohn's disease flare | Known IBD, diarrhea |
| Mesenteric adenitis | Viral symptoms, younger patient |
| Psoas abscess | Flexed hip, fever |
Left Upper Quadrant
| Condition | Key Features |
|---|---|
| Splenic pathology | Trauma history, Kehr's sign |
| Gastric ulcer | Epigastric pain, melena |
| Pancreatitis | Epigastric radiating to back, elevated lipase |
| Left lower lobe pneumonia | Cough, fever, chest findings |
Left Lower Quadrant
| Condition | Key Features |
|---|---|
| Diverticulitis | Age >0, LLQ tenderness, fever |
| Sigmoid volvulus | Elderly, constipation, massive distention |
| Ectopic pregnancy | As above |
| Ovarian pathology | As above |
| IBD flare | Known history, bloody diarrhea |
Diffuse/Periumbilical
| Condition | Key Features |
|---|---|
| Small bowel obstruction | Vomiting, distention, prior surgery |
| Mesenteric ischemia | AF, pain > exam |
| Ruptured AAA | Elderly, sudden, back pain |
| Pancreatitis | Epigastric, radiating to back |
| Gastroenteritis | Vomiting, diarrhea, contacts |
Suprapubic
| Condition | Key Features |
|---|---|
| Urinary retention | Distended bladder, unable to void |
| UTI/pyelonephritis | Dysuria, CVA tenderness |
| PID | Cervical motion tenderness, discharge |
Extra-Abdominal Causes
Cardiopulmonary
- Inferior myocardial infarction
- Pulmonary embolism
- Lower lobe pneumonia
- Empyema
Metabolic
- Diabetic ketoacidosis
- Addisonian crisis
- Acute porphyria
- Lead poisoning
Other
- Herpes zoster (pre-vesicular)
- Abdominal wall pathology
- Rectus sheath hematoma
Diagnostic Approach
Immediate Assessment
Primary Survey
- Airway patency
- Breathing adequacy
- Circulation (pulses, BP, perfusion)
- Disability (neurologic status)
- Exposure (complete examination)
Rapid Risk Stratification
- Hemodynamically unstable: emergent surgical consultation
- Peritoneal signs: surgical consultation
- High-risk features: expedited workup
Laboratory Studies
Essential Tests
| Test | Purpose | Critical Values |
|---|---|---|
| CBC | Leukocytosis, anemia | WBC >5k or left shift |
| BMP | Electrolytes, renal function | Elevated BUN/Cr, acidosis |
| Lipase | Pancreatitis | >x upper limit |
| LFTs | Hepatobiliary disease | Elevated with cholecystitis |
| Lactate | Tissue perfusion | >2 concerning, > critical |
| Pregnancy test | All reproductive females | Must exclude ectopic |
| Type and screen | Potential transfusion | For all surgical candidates |
| Coagulation studies | If anticoagulated, surgery anticipated | INR elevation |
| Urinalysis | UTI, hematuria | RBCs, WBCs |
Extended Testing
- Blood cultures: If sepsis suspected
- Amylase: Less specific than lipase
- D-dimer: If PE considered
- Troponin: If inferior MI considered
Imaging Studies
Plain Radiography
- Upright chest X-ray: Free air under diaphragm (perforation)
- Abdominal series: Obstruction patterns, calcifications
Ultrasonography
- Point-of-care (POCUS):
- AAA screening
- Free intraperitoneal fluid
- Gallbladder assessment
- IVC for volume status
- Formal ultrasound: RUQ, pelvic, testicular
CT Abdomen/Pelvis
- Gold standard for acute abdominal evaluation
- IV contrast for vascular enhancement
- Oral contrast generally not needed in emergent settings
- Alternative protocols for renal impairment, allergy
CT Angiography
- Suspected mesenteric ischemia
- Suspected AAA rupture (if stable enough)
MRI
- Avoid in acute setting unless CT contraindicated
- May be useful for pregnant patients (after first trimester)
Diagnostic Algorithm
Acute Abdominal Pain
↓
Hemodynamically Unstable?
↓
Yes → Immediate resuscitation
Emergent surgical consultation
Bedside ultrasound (AAA, free fluid)
Consider OR without CT
↓
No → Continue evaluation
↓
Peritoneal Signs Present?
↓
Yes → Surgical consultation
CT abdomen/pelvis (if stable)
Broad-spectrum antibiotics
↓
No → Focused workup based on
location and presentation
↓
CT abdomen/pelvis with IV contrast
(or targeted ultrasound)
↓
Diagnosis made → Condition-specific treatment
Diagnosis unclear → Consider observation, serial exams
7. Management
Initial Resuscitation
Hemodynamically Unstable Patient
Step 1: Vascular access
- Two large-bore IVs (16-18G)
- Consider central venous access if peripheral difficult
- Prepare for massive transfusion if hemorrhage suspected
Step 2: Volume resuscitation
- Crystalloid bolus (1-2L warm normal saline)
- Blood products if hemorrhagic shock
- Goal: MAP >65, urine output >0.5 mL/kg/hr
Step 3: NPO status
- Insert NG tube for decompression if obstruction/vomiting
- Prepare for emergent surgery
Management Algorithm
Acute Abdominal Pain
↓
┌───────────────────────────────────────────────┐
│ IMMEDIATE RESUSCITATION │
│ - ABCDE Assessment │
│ - IV Access, Fluid Resuscitation │
│ - Analgesia (Opioids do NOT mask signs!) │
│ - PREGNANCY TEST (Females under 55y) │
└───────────────────────────────────────────────┘
↓
┌───────────────────────────────────────────────┐
│ HEMODYNAMIC STATUS? │
├──────────────────────┬────────────────────────┤
│ UNSTABLE │ STABLE │
│ (Shock / Peritonitis)│ │
├──────────────────────┼────────────────────────┤
│ ↓ │ ↓ │
│ Straight to Theatre │ Detailed History │
│ (Laparotomy) │ & Examination │
│ OR │ ↓ │
│ Bedside Ultrasound │ Blood Tests (Lactate)│
│ (Ruptured AAA?) │ ↓ │
└──────────────────────┤ CT Abdomen/Pelvis │
│ (Gold Standard) │
└───────────┬────────────┘
↓
┌────────────────────────┐
│ DISPOSITION │
│ - Surgical Admission │
│ - Medical Admission │
│ - Discharge (Review) │
└────────────────────────┘
Acute/Emergency Management
1. The "Resuscitate Before Diagnosis" Phase
- Access: 2x Large bore cannulae.
- Fluids: Hartmann's solution (avoid saline due to acidosis risk).
- Analgesia: Morphine 10mg IV / Fentanyl 100mcg. Myth Buster: Analgesia makes the patient cooperative and exam reliable. It does NOT mask peritonitis.
- Antiemetics: Ondansetron 4-8mg.
2. The "Sepsis Six" (If Septic)
- Oxygen.
- Blood Cultures.
- IV Antibiotics (Broad spectrum, e.g., Amoxicillin + Gentamicin + Metronidazole).
- Fluid Challenge.
- Lactate measurement.
- Urine Output monitoring.
Analgesia
Pain Management Principles
- Analgesia does NOT mask peritoneal signs or delay diagnosis
- Early pain control is appropriate and evidence-based
- IV route preferred for rapid onset
Medications
| Medication | Dose | Notes |
|---|---|---|
| Morphine | 0.1 mg/kg IV | Titrate to effect |
| Fentanyl | 1-2 mcg/kg IV | Shorter acting, less histamine release |
| Hydromorphone | 0.5-1 mg IV | Alternative to morphine |
| Ketorolac | 15-30 mg IV | Avoid if surgical, renal disease, GI bleed risk |
Antimicrobial Therapy
Indications
- Suspected perforation
- Peritonitis
- Cholecystitis, cholangitis
- Appendicitis
- Diverticulitis
- Sepsis
Empiric Regimens
| Severity | Regimen |
|---|---|
| Mild-moderate community acquired | Ceftriaxone 2g IV + Metronidazole 500mg IV |
| Severe/sepsis | Piperacillin-tazobactam 4.5g IV OR Meropenem 1g IV |
| Healthcare-associated | Meropenem 1g IV + Vancomycin (if MRSA risk) |
| Penicillin allergy | Ciprofloxacin 400mg IV + Metronidazole 500mg IV |
Surgical Consultation
Emergent (Immediate) Consultation
- Ruptured AAA
- Peritonitis
- Hemorrhagic shock
- Bowel ischemia/necrosis
Urgent Consultation
- Appendicitis
- Cholecystitis
- Small bowel obstruction
- Strangulated hernia
- Perforated viscus
Condition-Specific Management
Appendicitis
- NPO, IV fluids
- Antibiotics (ceftriaxone + metronidazole)
- Surgical consultation for appendectomy
Cholecystitis
- NPO, IV fluids
- Antibiotics
- Surgical consultation for cholecystectomy
- Percutaneous cholecystostomy if high surgical risk
Small Bowel Obstruction
- NPO, NG decompression
- IV fluids
- Surgical consultation
- Surgery if signs of strangulation or no improvement in 24-48 hours
Diverticulitis
- Uncomplicated: May be outpatient with oral antibiotics
- Complicated (abscess, perforation): Admission, IV antibiotics, drainage, possible surgery
8. Complications
Disposition
ICU Admission
- Hemodynamic instability
- Septic shock
- Massive transfusion requirement
- Post-operative monitoring for complex cases
- Multiorgan failure
Surgical Ward Admission
- Confirmed surgical pathology
- Peritonitis
- Bowel obstruction
- Acute pancreatitis (moderate-severe)
- Cholecystitis/cholangitis
Medical Ward Admission
- Diagnostic uncertainty requiring observation
- Mild-moderate pancreatitis
- Uncomplicated diverticulitis in high-risk patient
- Elderly with concerning exam
Discharge Criteria
Safe for Outpatient Management
- Stable vital signs
- Benign abdominal examination
- Tolerate oral intake
- Reliable follow-up available
- Clear diagnosis with outpatient treatment plan
- No concerning laboratory abnormalities
Appropriate for Discharge
- Uncomplicated diverticulitis (low-risk patient)
- Mild gastroenteritis
- Constipation
- Musculoskeletal pain
- Viral syndromes
Follow-up Recommendations
| Condition | Follow-up Timeline |
|---|---|
| Observation discharge | 12-24 hours with PCP |
| Uncomplicated diverticulitis | 2-3 days with PCP, colonoscopy later |
| Kidney stone | Urology within 1-2 weeks |
| Ovarian cyst | Ob/Gyn within 1 week |
| Abdominal wall pain | PCP within 1 week |
Return Precautions
Strict Return Instructions
- Worsening or severe pain
- Fever >101°F (38.3°C)
- Vomiting and unable to keep fluids down
- Blood in stool or vomit
- Fainting or severe dizziness
- Abdominal distention
- No bowel movements with worsening symptoms
9. Prognosis & Outcomes
9. Special Populations
Pediatric Considerations
- Appendicitis remains common
- Intussusception in young children
- Malrotation with volvulus (neonate through infant)
- Limited history from young children
- Consider child abuse with unexplained injury
Geriatric Patients
High-Risk Features
- Presentations often atypical
- May lack fever, leukocytosis, peritoneal signs
- Higher mortality from equivalent conditions
- Consider bowel ischemia early
- AAA more common
Management Modifications
- Lower threshold for imaging
- Earlier surgical consultation
- Consider limited life expectancy in decision-making
- Involve family/caregivers in disposition planning
Pregnancy
Special Considerations
- Ectopic pregnancy until proven otherwise
- Appendicitis most common surgical emergency
- Appendix displaced superiorly by gravid uterus
- Avoid CT if possible (use MRI or US)
- Consider obstetric consultation early
Modified Imaging Approach
- Ultrasound first-line
- MRI without gadolinium if ultrasound inconclusive
- CT if life-threatening condition suspected
Immunocompromised Patients
- Opportunistic infections possible
- Neutropenic enterocolitis (typhlitis)
- Muted inflammatory response
- Lower threshold for broad-spectrum antibiotics
- Consider CMV, fungal infections
Quality Metrics
Performance Indicators
| Metric | Target |
|---|---|
| Time to initial assessment | within 15 minutes |
| Pregnancy test in reproductive-age females | 100% |
| Time to surgical consultation (acute abdomen) | within 60 minutes |
| Appropriate imaging obtained | >5% |
| Pain assessment documented | 100% |
| Analgesia provided when appropriate | >0% |
Documentation Requirements
- Complete vital signs including temperature
- Pregnancy test result (reproductive-age females)
- Detailed abdominal examination
- Risk stratification and reasoning
- Treatment provided (fluids, analgesia, antibiotics)
- Disposition rationale
- Clear follow-up instructions
10. Evidence & Guidelines
Key Clinical Pearls
Critical Decision Points
- Never delay surgical consultation for hemodynamically unstable patients with suspected surgical abdomen
- Pregnancy test first in all reproductive-age females with abdominal pain
- Pain out of proportion to exam = mesenteric ischemia until proven otherwise
- Elderly and immunocompromised may have minimal findings with severe pathology
- Free air on upright CXR = surgical emergency
Diagnostic Pearls
- Always check hernia orifices - incarcerated hernia is easy to miss
- Right shoulder pain with RUQ tenderness suggests diaphragmatic irritation (cholecystitis, perforated ulcer)
- Lactate >4 in abdominal pain suggests tissue ischemia or necrosis
- Oral contrast is rarely needed emergently for CT
- Serial abdominal exams remain valuable when diagnosis unclear
Management Pearls
- Analgesia does not mask surgical findings - provide early pain relief
- NG decompression helps with nausea/vomiting but doesn't change obstruction management timeline
- Broad-spectrum antibiotics before surgery in suspected perforation/peritonitis
- When in doubt, consult surgery early rather than late
- Observation admission is appropriate if diagnosis uncertain and patient appears unwell
11. Patient/Layperson Explanation
Understanding Acute Abdominal Pain
- Many causes of abdominal pain are not serious
- Some conditions require close monitoring or surgery
- Follow-up is important even if discharged
Post-Discharge Care
General Instructions
- Take prescribed medications as directed
- Maintain hydration
- Follow dietary recommendations (if given)
- Activity as tolerated unless otherwise instructed
When to Return
- Worsening pain despite medications
- New symptoms (fever, vomiting, blood)
- Unable to keep food/fluids down
- No improvement in 24-48 hours
Condition-Specific Education
After Bowel Rest
- Clear liquids first
- Advance diet slowly
- Avoid heavy, fatty foods initially
Post-Surgical Instructions
- Wound care
- Activity restrictions
- Signs of complications
12. References
- Cartwright SL, Knudson MP. Evaluation of acute abdominal pain in adults. Am Fam Physician. 2008;77(7):971-978.
- Macaluso CR, McNamara RM. Evaluation and management of acute abdominal pain in the emergency department. Int J Gen Med. 2012;5:789-797.
- Caporale N, et al. Acute abdomen: diagnosis and management. Clin Med (Lond). 2020;20(6):573-577.
- Gans SL, et al. Guideline for the diagnostic pathway in patients with acute abdominal pain. Dig Surg. 2015;32(1):23-31.
- Bhangu A, et al. Systematic review and meta-analysis of randomized trials comparing laparoscopic appendicectomy with open appendicectomy. Br J Surg. 2010.
- Solomkin JS, et al. Diagnosis and management of complicated intra-abdominal infection in adults and children: SIS guidelines. Surg Infect (Larchmt). 2010. |---------|------|---------| | 1.0 | 2025-01-15 | Initial comprehensive version with 14-section template |