Acute Abdomen - Causes and Presentations

No.
Pathology
1
Bowel
obstruction

Presentation
Cramping and belly pain that comes and goes. The pain can occur around or below the belly
button.
Vomiting.
Bloating and a large, hard belly.
Constipation and a lack of gas, if the intestine is completely blocked.
Diarrhoea, if the intestine is partly blocked.

Acute
Appendicitis

Dull pain near the navel or the upper abdomen that becomes sharp as it moves to the lower
right abdomen. This is usually the first sign.
Loss of appetite
Nausea and/or vomiting soon after abdominal pain begins
Abdominal swelling
Fever of 99-102 degrees Fahrenheit
Inability to pass gas

Mesenteric
Adenitis

Abdominal pain - Often right lower quadrant (RLQ) but may be more diffuse
Fever
Diarrhoea
Malaise
Anorexia
Concomitant or antecedent upper respiratory tract infection
Nausea and vomiting (which generally precedes abdominal pain, as compared to the
sequence in appendicitis)
History of ingestion of raw pork may be obtained in areas with endemic Yersinia (eg
Belgium).

Diverticulitis

Left lower quadrant pain (70% of patients)

Change in bowel habits
Nausea and vomiting
Constipation
Diarrhoea
Flatulence
Bloating

Diabetic
Ketoacidosis

Acute
Gastroenteritis

Malaise, generalized weakness, and fatigability

Nausea and vomiting; may be associated with diffuse abdominal pain, decreased appetite,
and anorexia
Rapid weight loss in patients newly diagnosed with type 1 diabetes
History of failure to comply with insulin therapy or missed insulin injections due to vomiting
or psychological reasons or history of mechanical failure of insulin infusion pump
Decreased perspiration
Altered consciousness (eg, mild disorientation, confusion); frank coma is uncommon but
may occur when the condition is neglected or with severe dehydration/acidosis
Diarrhoea and vomiting.
Also stomach pain, cramping, fever, nausea, and a headache.

Biliary Colic

Sharp right upper quadrant pain that radiates to the right shoulder, or less commonly,
retrosternal.
Nausea and vomiting can be associated with biliary colic.
Individuals may also present with pain that is induced following a fatty meal and the
symptom of indigestion.
The pain often lasts longer than 30 minutes, up to a few hours.

Acute
cholecystitis

The symptoms of cholecystitis are similar to biliary colic but the pain becomes more severe
and constant.
Nausea is common and vomiting occurs in 75% of people with cholecystitis.
In addition to abdominal pain, right shoulder pain can be present.
Fever
Mild jaundice

Ascending
cholangitis

A person with cholangitis may complain of abdominal pain (particularly in the right upper
quadrant of the abdomen), fever, rigors (uncontrollable shaking) and a feeling of uneasiness
(malaise).
Some may report jaundice (yellow discoloration of the skin and the whites of the eyes).

10

Renal colic

Renal colic typically begins in the flank and often radiates to the hypochondrium (the part of
the anterior abdominal wall below the costal margins) or the groin.
It is typically colicky (comes in waves) due to ureteric peristalsis, but may be constant.
It is often described as one of the strongest pain sensations known.

11

Acute
pyelonephritis

Fever
Vomiting
Back, side, and groin pain
Chills
Nausea
Frequent, painful urination

12

Testicular
torsion

Sudden, severe pain in the scrotum the loose bag of skin under your penis that contains
the testicles
Swelling of the scrotum
Abdominal pain
Nausea and vomiting
A testicle that's positioned higher than normal or at an unusual angle
Painful urination
Fever

13

Acute
Pancreatitis

14

Perforated
peptic ulcer

Upper abdominal pain that radiates into the back; it may be aggravated by eating, especially
foods high in fat.
Swollen and tender abdomen
Nausea and vomiting
Fever
Increased heart rate
Sudden abdominal pain, which gets steadily worse

15

Ruptured AAA

Pain that radiates to your back or legs

Sweatiness
Clamminess
Dizziness
Nausea
Vomiting
Low blood pressure
Fast pulse

16

Peptic ulcer
disease

A gnawing or burning pain in the middle or upper stomach between meals or at night
Bloating
Heartburn
Nausea or vomiting
Dark or black stool (due to bleeding)
Vomiting blood (that can look like "coffee-grounds")
Weight loss
Severe pain in the mid to upper abdomen

17

Intestinal
ischaemia

Diarrhoea
Fever
Vomiting
Severe abdominal pain, even though the area is not very tender when touched

18

IBD

Abdominal cramps and pain.

Diarrhoea that may be bloody.
Severe urgency to have a bowel movement.
Fever.
Weight loss.
Loss of appetite.
Iron deficiency anaemia due to blood loss.

19

Strangulated
hernia

Nausea, vomiting or both.

Fever.
Rapid heart rate.
Sudden pain that quickly intensifies.
A hernia bulge that turns red, purple or dark.

20

Splenic infarct

The most common presenting symptom is left-upper-quadrant abdominal pain (up to 70%).
Additional symptoms include fever and chills, nausea and vomiting, pleuritic chest pain, and
left shoulder pain (Kehr sign).

21

Ruptured
ectopic
pregnancy

Light vaginal bleeding.

Nausea and vomiting with pain.
Lower abdominal pain.
Sharp abdominal cramps.
Pain on one side of your body.
Dizziness or weakness.
Pain in your shoulder, neck, or rectum.
If the fallopian tube ruptures, the pain and bleeding could be severe enough to cause
fainting.

22

Endometriosis

Abdominal cramps or back pain during menstruation.

Very painful menstrual cramps.
Painful bowel movements.
Painful urination, especially during menstruation.
Abnormal or heavy bleeding during periods.
Painful sex.
Difficulty becoming pregnant.

23

Ruptured
ovarian cyst

Abdominal bloating or swelling.

Painful bowel movements.
Pelvic pain before or during the menstrual cycle.
Painful intercourse.
Pain in the lower back or thighs.
Breast tenderness.
Nausea and vomiting.

24

Mittelschmerz

Lower abdominal pain

Occurs only on one side.
Goes on for minutes to a few hours. It can last up to 24-48 hours.
Feels like a sharp, cramping pain unlike other pain.
Severe (rare)
May switch sides from month to month.
Begins midway through the menstrual cycle.

25

Ovarian torsion

Sudden onset (commonly during exercise or other agitating movement) of severe, unilateral
lower abdominal pain that worsens intermittently over many hours.
Nausea and vomiting
A history of previous episodes may be elicited, possibly attributable to partial, spontaneously
resolving torsion.
Fever may occur as a late finding as the ovary becomes necrotic.

26

PID, tuboovarian abscess

Dull pain or tenderness in the stomach or lower abdominal area, or pain in the right
upper abdomen
Abnormal vaginal discharge that is yellow or green in colour or that has an unusual odour
Painful urination
Chills or high fever
Nausea and vomiting
Pain during sex

27

Salpingitis

Abnormal vaginal discharge, such as unusual colour or smell

Spotting between periods
Dysmenorrhoea (painful periods)
Pain during ovulation
Uncomfortable or painful sexual intercourse
Fever
Abdominal pain on both sides
Lower back pain
Frequent urination
Nausea and vomiting
The symptoms usually appear after the menstrual period.