Key facts and checkpoints

• The commonest causes of the acute abdomen in two general practice series were: Series 1 acute appendicitis (31%) and the colics (29%); Series 2 acute appendicitis (21%), the colics (16%), mesenteric adenitis (16%). 3 The latter study included children.

• As a general rule upper abdominal pain is caused by lesions of the upper GI tract and lower abdominal pain by lesions of the lower GI tract.

• Colicky midline umbilical abdominal pain (severe) ^ vomiting ^ distension = small bowel obstruction.

• Midline lower abdominal pain ^ distension ^ vomiting = large bowel obstruction.

• If the acute abdomen has a surgical cause, the pain nearly always precedes the vomiting.

• Mesenteric artery occlusion must be considered in an elderly person with arteriosclerotic disease or in patients with atrial fibrillation presenting with severe abdominal pain or following myocardial infarction.

• Up to one-third of presentations of abdominal pain are considered to be non-specific, whereby no specific cause is found.

A summary of the separate diagnostic models for acute abdominal pain and chronic abdominal pain are presented in Tables 30.2 and 30.3 .

Table 30.2 Acute abdominal pain (adults): diagnostic strategy model

Q. Probability diagnosis

Acute gastroenteritis A Acute appendicitis ' Mittelschmerz/dysmenorrhoea Irritable bowel syndrome

Q. Serious disorders not to be missed

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