digestive disorders
Acute Abdominal Pain
Evaluation of Acute Abdominal Pain
The following information can help people decide when a doctor's evaluation is needed and help them know what to expect during the evaluation. In people with acute abdominal pain, certain symptoms and characteristics are cause for concern. They include Severe pain Signs of shock (for example, a rapid heart rate, low blood pressure, sweating, and confusion) Signs of peritonitis (for example, constant pain that doubles the person over and/or pain that worsens with gentle touching or with bumping the bed) Swelling of the abdomen People who have warning signs should go to the hospital right away. People who have no warning signs should see a doctor within a day. Doctors ask questions about the person's symptoms and medical history and do a physical examination. What doctors find during the history and physical examination helps them decide what, if any, tests need to be done. Doctors follow the same process whether they are evaluating mild or severe pain, although a surgeon may be involved early on in the evaluation of severe abdominal pain. When taking the medical history ( see Table: History in People With Acute Abdominal Pain ), doctors ask questions about the pain's location ( see Figure: Doctors ask questions about known medical conditions and previous abdominal surgeries. Women are asked whether they are or could be pregnant. When conducting a physical examination, doctors first note the person's general appearance. A comfortable-appearing person rarely has a serious problem, unlike one who is anxious, pale, sweating, or in obvious pain. The focus of the examination is the abdomen, and doctors inspect, tap, and touch (a process called palpation) the abdominal area. They usually examine the rectum and pelvis (for women) to locate tenderness, masses, and blood. Doctors touch the whole abdomen gently to detect areas of particular tenderness, as well as the presence of guarding, rigidity, rebound, and any masses. Guarding is when a person involuntarily contracts the abdominal muscles when the doctor touches the abdomen. Rigidity is when the abdominal muscles stay firmly contracted even when the doctor is not touching them. Rebound is when a person flinches in pain as the doctor's hand is briskly withdrawn. Guarding, rigidity, and rebound are signs of peritonitis. Sometimes, people have findings so significant that doctors realize right away that they need surgery. Doctors try not to delay surgery on such people by doing tests. However, more often, doctors must do tests to help choose among several different causes suggested by the person's symptoms and physical examination results. Doctors select tests based on what they suspect: Urine pregnancy test for all girls and women of childbearing age Imaging tests based on suspected diagnosis An abdominal Computed Tomography (CT) helps identify many, but not all, causes of abdominal pain. Urine tests (for example, 