ACUTE ABDOMINAL PAIN IN ADULTS
The GP overview
The sudden onset of severe abdominal pain represents a genuine emergency in general practice and is a common out-of-hours call. In the true acute abdomen, the patient is obviously ill, and as the clinical condition may deteriorate rapidly, ensure that you examine the patient as soon as possible.
NOTE: Upper and mid-abdominal pain are dealt with here. Lower abdominal pain is dealt with under ‘acute pelvic pain’ and specifically epigastric-type pain is covered in more detail in the epigastric pain section.
Differential diagnosis
COMMON
Z peptic ulcer
Z biliary colic
- appendicitis
Z gastroenteritis
Z renal colic
OCCASIONAL
Z cholecystitis (may follow biliary colic, but pain is constant and fever present)
- diverticulitis
B acute or subacute bowel obstruction (adhesions, carcinoma, strangulated hernia, volvulus)
B pyelonephritis
B muscular wall pain
B pancreatitis
B Meckel’s diverticulum
RARE
B perforation (e.g. duodenal ulcer [DU], carcinoma) resulting in peritonitis
B hepatitis
B Crohn’s and ulcerative colitis
B ischaemic bowel