Special Operations Forces Medical Handbook

3-3

DescriptorBurning, KnifelikeAgonizingTearingExcruciatingOrthostaticConstrictingBoring/DrillingAche Ache CrampySpasticAche

Onset/IntensitySudden/severeSudden/severeSudden/severeSudden/severeSudden/severeRapid/moderateRapid/severeSlow/moderateSlow/mild to mod-erateSlow/moderateSlow/mild to mod-erateSlow/moderate

Location/RadiationEpigastric/backPeriumbilical/noneAbdomen/back & flankPeriumbilicalEither adnexal (pelvic) area/noneRUQ*/scapulaEpigastric/backPeriumbilical- early RLQ* - late/noneLLQ*/nonePeriumbilical/nonePeriumbilicalEither adnexal (pelvic) area/none

CharacterLocalized early, diffuse lateDiffuseDiffuseDiffuseLocalizedLocalizedLocalizedDiffuse early, localized lateLocalizedDiffuseDiffuse Localized

Key HistoryAspirin or NSAID* ingestionASHD*, DM*, high cholesterol, smokerPulsatile abdomenAfrican or Mediterranean heritageMissed menses, nipple discharge, & AM nauseaFamily history of gallstones, rapid weight reductionHistory of gallstones, high triglycerides, abdominal trauma.Unless prior appendectomy, it is always a potential cause.Often onset after straining at defecationPrevious abdominal surgery & vomitingNausea, vomiting and diarrheaSexual promiscuity; vaginal discharge

EtiologyPerforated ulcerIntestinal ischemia/infarctionRuptured aneurysmSickle cell crisisRuptured ectopic pregnancyCholecystitisPancreatitisAppendicitisDiverticulitisSmall bowel obstructionGastroenteritisPelvic inflammatory disease

*nonsteroidal anti-inammatory drugs (NSAIDs), arteriosclerotic heart disease (ASHD), diabetes mellitus (DM), right upper quadrant (RUQ), right lower quadrant (RLQ), left lower quadrant (LLQ)
Table 3-1 Common causes of acute abdominal pain and their associated symptoms.