• 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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Deal With Your Pain, Lead A Wonderful Life An Live Like A 'Normal' Person. Before I really start telling you anything about me or finding out anything about you, I want you to know that I sympathize with you. Not only is it one of the most painful experiences to have backpain. Not only is it the number one excuse for employees not coming into work. But perhaps just as significantly, it is something that I suffered from for years.