Abdominal pain

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A great fit of the stone in my left kidney: all day I could do but three or four drops of water, but I drunk a draught of white wine and salet oyle, and after that, crabs' eyes in powder with the bone in the carp's head and then drunk two great draughts of ale with buttered cake; and I voyded with an hour much water and a stone as big as an Alexander seed. God by thanked!

John Dee 1594

Abdominal pain represents one of the top 15 presenting symptoms in primary care 1 and varies from a self-limiting problem to a life-threatening illness requiring immediate surgical intervention. Abdominal pain can be considered to be acute, subacute, chronic or recurrent. It can embrace all specialties including surgery, medicine, gynaecology, geriatrics and psychiatry. For acute abdominal conditions it is important to make a rapid diagnosis in order to reduce morbidity and mortality. Most cases require surgical referral (Table 30.1). Lower abdominal pain in women adds another dimension to the problem and will be presented in a separate chapter.

Table 30.1 Surgical causes of the acute abdomen

Process Organ involved Disorder


Bowel Appendix Gall bladder Pancreas Fallopian tube Colonic diverticulae






Inflammatory bowel disease

Duodenum Stomach

Perforated duodenal ulcer Perforated gastric ulcer Faecal peritonitis Biliary peritonitis Appendicitis


Colon (diverticula or carcinoma) Gall bladder Appendix


Gall bladder Small intestine Large bowel Ureter Urethra

Mesenteric artery occlusion

Biliary colic

Acute small bowel obstruction Acute large bowel obstruction Ureteric colic Acute urinary retention Intestinal infarction


Fallopian tube Spleen or liver Ovary

Abdominal aorta

Ruptured ectopic pregnancy Ruptured spleen or liver (haemoperitoneum) Ruptured ovarian cyst Ruptured AAA

Sigmoid colon Torsion (ischaemia) Ovary


Sigmoid volvulus Torsion ovarian cyst Torsion of testes

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