Emergency Medicine

ACUTE ABDOMEN

Surgical Emergencies 259

(b) with i.v. plus or minus oral contrast for difficult diagnoses
particularly in the older patient, such as suspected bowel
cancer or other complex masses, diverticulitis
(c) without contrast to confirm ureteric colic.
11 Give all patients i.v. analgesia as required, such as morphine 2.5–5 mg i.v.
with metoclopramide 10 mg i.v. This does not interfere with the surgical
diagnosis, which may even be facilitated.

12 Refer all cases to the surgical team if an acute surgical condition is suspected
or cannot be excluded.

Causes of acute abdominal pain

Disorders causing acute abdominal pain may be categorized as intestinal, biliary,
vascular, pancreatic, urinary, peritoneal and retroperitoneal, gynaecological and
medical. See Table 8.8 for a complete list.

Table 8.8 Causes of acute abdominal pain

Intestinal disorders Acute appendicitis

Intestinal obstruction

Intussusception

Perforation of a viscus

Diverticulitis

Inflammatory bowel disease

Biliary disorders Biliary colic

Acute cholecystitis

Vascular disorders Ruptured aortic aneurysm

Ischaemic colitis

Mesenteric infarction

Ruptured spleen

Pancreatic disorder Acute pancreatitis

Urinary disorders Renal and ureteric colic

Pyelonephritis

Acute urinary retention

Acute epididymo-orchitis

Acute testicular torsion

Peritoneal/retroperitoneal disorders Primary peritonitis

Retroperitoneal haemorrhage

Gynaecological disorders

Medical disorders