Acute abdomen

1. Big picture

Acute abdomen is not a single disease. It is a clinical syndrome of sudden abdominal pain that may require urgent surgery. In the surgery exam, the examiner wants to see that you can:

1. Recognize life-threatening surgical patterns.
2. Resuscitate before diagnosis is perfect.
3. Decide who needs immediate operation, who needs urgent imaging, and who can be observed.
4. Avoid dangerous traps: missed perforation, ischemic bowel, ruptured abdominal aortic aneurysm, ectopic pregnancy, strangulated hernia, sepsis.

The practical surgical rule is:

Unstable patient + peritonitis/bleeding/ischemia = resuscitate and operate, do not delay for perfect imaging.

For stable adults with unclear acute abdominal pain, CT abdomen/pelvis with intravenous contrast is usually appropriate, especially for nonlocalized pain and fever; ultrasound is useful for right upper quadrant, pelvic, pregnancy-related, biliary, urinary, and bedside unstable-patient assessment. ([ACR ACSearch][1])

---