ACUTE ABDOMEN

Surgical Emergencies 273

Gynaecological causes

The following causes are discussed in Section XII, Obstetric and Gynaecological
Emergencies.

● Ruptured ectopic pregnancy (see p. 377).
● Pelvic inflammatory disease (acute salpingitis) (see p. 379).
● Ruptured ovarian cyst (see p. 380).
● Torsion of an ovarian tumour (see p. 380).
● Endometriosis (see p. 381).

Medical disorders presenting with acute abdominal pain

It is rare for non-surgical disorders causing acute abdominal pain to present
without other symptoms or signs suggesting their true medical origin.

Always remember diabetic ketoacidosis (DKA), and perform a urinalysis in every
patient with abdominal pain. DKA is suggested by finding glycosuria and
ketonuria (see p. 78).

DIAGNOSIS

Medical disorders presenting with acute abdominal pain include:

1 Thoracic origin
(i) Myocardial infarction, pericarditis.
(ii) Pulmonary embolus, pleurisy, pneumonia.
(iii) Aortic dissection.

2 Abdominal origin
(i) Hepatic congestion from hepatitis or right heart failure.
(ii) Infection, including gastroenteritis, pyelonephritis and primary
peritonitis.
(iii) Intestinal ischaemia from atheroma or sickle cell disease,
vasculitis and Henoch–Schönlein purpura.
(iv) Irritable bowel syndrome.

3 Endocrine and metabolic origin
(i) Diabetic ketoacidosis.
(ii) Hypercalcaemia – ‘stones, bones and abdominal groans’.
(iii) Addison’s disease.
(iv) Lead poisoning, paracetamol or iron poisoning.
(v) Porphyria (acute intermittent).

Warning: constipation, particularly in the elderly, should be regarded as a

symptom and not a diagnosis. Other significant underlying conditions such

as a bowel obstruction, diverticulitis, urinary or other sepsis, colon cancer,

hypercalcaemia or neurological disease must be actively excluded.

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