Serious disorders not to be missed

Most of the causes of the acute abdomen are serious and early diagnosis is mandatory to reduce mortality and morbidity. It is vital not to misdiagnose a ruptured ectopic pregnancy, which causes lower abdominal or suprapubic pain of sudden onset, or the life-threatening vascular causes such as a ruptured or dissecting aortic aneurysm, mesenteric artery occlusion and myocardial infarction (which can present as epigastric pain).

Perforated ulcers and strangulated bowel, such as volvulus of the sigmoid and entrapment of the the small bowel in a hernial orifice or around adhesions, also demand an early diagnosis. There are some important 'red flag' symptoms and signs 1 of abdominal emergencies demanding urgent attention:

• collapsing at toilet (points to intra-abdominal bleeding)

• light-headedness

• progressive intractable vomiting

• progressive abdominal distension

• progressive intensity of pain

• prostration

Signs

• pallor and sweating

• hypotension

• atrial fibrillation or tachycardia

• rebound tenderness and guarding

• decreased urine output

Dangers of misdiagnosis

• ectopic pregnancy ^ rapid hypovolaemic shock

• ruptured aortic aneurysm ^ rapid hypovolaemic shock

• gangrenous appendix ^ peritonitis/pelvic abscess

• perforated ulcer ^ peritonitis

• obstructed bowel ^ gangrene

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