Acute abdomen is sudden onset of severe abdominal pain which may require surgical operation. Some medical conditions may present as acute abdominal pain.

CAUSES

Possible causes are:

• Inflammatory conditions e.g Appendicitis, salpingitis, cholecystitis
• Perforations e.g typhoid perforation, traumatic perforation
• Intestinal obstruction e.g. strangulated hernia, adhesions, volvulus
• Haemorrhage e.g ruptured ectopic pregnancy, ruptured spleen
• Acute pancreatitis
• Colics e.g ureteric colic, biliary or intestinal colic
• Medical conditions e.g. diabetes mellitus, gastro-enteritis, gastritis, malaria, pneumonia, UTI, sickle cell crises, adrenocortical crises, porphyria, nephrotic syndrome

SYMPTOMS

• Pain

• Gradually increasing abdominal pain suggests inflammation

• It is sudden in perforations and colics

• Colicky abdominal pain and absolute constipation suggest intestinal obstruction

• Anorexia, nausea and vomiting may occur

• A history of dyspepsia may point to perforated peptic ulcer

• Fever, headaches, joint pains and sudden onset of abdominal pain may suggest typhoid perforation

• Dizziness or faintness or collapse may be due to bleeding from ruptured ectopic, ruptured spleen or liver

• Vaginal discharge may suggest pelvic infection

• Frequency and dysuria may suggest urinary tract infection

• A past history of alcohol ingestion may suggest gastritis or acute pancreatitis

• Watery mucoid blood-stained stools with abdominal colic points to dysentery

SIGNS

• Signs of dehydration e.g. dry tongue, sunken eyes, loss of skin turgor

• High temperature in acute inflammations

• Hypotension with low blood pressure and rapid pulse if shock is present or adrenocortical crises

• Abdominal distension with fluid or gas may suggest peritonitis, haemorrhage, acute pancreatitis or intestinal obstruction

• Abdominal surgical scars may suggest intestinal obstruction due to adhesions

• Examine the hernia orifices for a strangulated hernia, especially for femoral hernia

• Tenderness, rebound tenderness and guarding suggest peritonitis due to inflammatory conditions or perforations

• Absence of bowel sounds points to peritonitis and increased bowel sounds intestinal obstruction

• Rectal and vaginal examinations will reveal tenderness in the rectovesical or recto-uterine pouch

• Examine the chest for basal pneumonia or myocardial infarction.

• Pallor, gnathopathy, frontal bossing in sickle cell disease

INVESTIGATIONS

• Full blood count, blood film for malaria parasites, sickling test

• Chest X-ray to look for gas under the diaphragm in perforations and for signs of pneumonia

• Plain abdominal x-ray (erect & supine) for fluid level and distended bowel due to intestinal obstruction. Gallstones or kidney stones may be seen

• 4-quadrant abdominal tap may yield pus, bile stained fluids from perforations or blood from bleeding ectopic or ruptured spleen or liver

• Random blood glucose

• Urine examination for RBCs, WBCs

• Blood urea, electrolytes and creatinine

TREATMENT

Therapeutic objectives

• To resuscitate patient
• To relieve pain
• To control infection if present
• To treat the underlying causes.

Non-Pharmacological Treatment

• Pass nasogastric tube and aspirate the stomach
• Monitor pulse, blood pressure and urine output. Aim at urine output of 30-50 ml per hour
• Re-examine patient frequently if the diagnosis is uncertain

Pharmacological Treatment

(Evidence rating: C)

• Resuscitation with IV fluids or blood transfusion
• Relieve pain as soon as diagnosis is made Pethidine, IM

• Antibiotics may be indicated for infectious conditions. The following regime may be used for gut related infections

Gentamicin, IV or IM

Adults and Children:

2-5 mg/kg BW daily in 3 divided doses.Do not give if urine output is less than 30ml/hour.

Metronidazole, IV

Ciprofloxacin, IV,

Further treatment will depend on the diagnosis.

REFER

• If diagnosis cannot be made
• If surgical expertise is not available at the facility