What is an Acute Abdomen? Sudden Severe Abdominal Pain

An acute abdomen is the sudden onset of severe abdominal symptoms, including pain, usually due to a major problem with one of the organs in the abdomen such as the appendix, gall bladder, intestine, and so on. It may be caused by inflammation of the organs, rupture, perforation or any other pathology. An acute abdomen can proceed to become a medical emergency with potentially life-threatening consequences unless correctly diagnosed and treated immediately. Surgical intervention often becomes necessary.

The abdomen is the area that lies between the chest (thorax) and pelvis commonly referred to as the tummy or belly. It is continuous with the pelvic cavity. The abdominal cavity is the largest such space in the body and houses the most amount of organs. These organs, blood vessels, muscles and other structures are part of several systems of the body, although it is the organs of the digestive system that are the most abundant in the abdominal cavity. Due to its size, the number of structures and the lack of a protective skeleton, the abdomen is prone to various diseases and forms of injury.

What causes sudden severe abdominal pain?

Causes of Acute Abdomen

An acute abdomen may occur due to a vast number of causes, the most common of which are :

Gastrointestinal (Gut)

• Acute appendicitis – inflammation of the appendix, the small elongated outpouching from the cecum of the small intestine.
• Acute cholecystitis – inflammation of the gallbladder, the small pouch under the liver that stores gallbladder.
• Acute pancreatitis – inflammation of the pancreas, the versatile gland in the upper abdomen that secretes digestive enzymes (exocrine) and metabolic hormones that regulate glucose utilization (endocrine).
• Peptic ulcer – an open sore in the lining of the stomach and/or duodenum (first part of the small intestine) which may also present with complications such as perforation and bleeding.
• Acute peritonitis – inflammation of the lining around most of the abdominal organs (peritoneum) and peritoneal cavity. It is more commonly due to inflammation of an abdominal organ, microorganisms within the otherwise sterile cavity, fluid, pus or blood in the peritoneum due to rupture or perforation of an organ.
• Bowel perforation – a tear in the small or large intestine.
• Intestinal obstruction – partial or complete blockage within the small or large intestine.
• Meckel’s diverticulitis – inflammation of the pouch that abnormally forms from the wall of the intestine from birth.
• Acute intestinal ischemia – injury of part of the wall of the intestine due to the blood supply being cut off and tissue death arising as a result.
• Acute diverticulitis – inflammation of numerous pouches that arise from the wall of the colon.
• Gastroenteritis – inflammation of the stomach and small intestine most commonly due to an infection. It leads to severe nausea, vomiting and diarrhea and tends to occur in outbreaks known as a tummy bug or stomach flu.
• Hepatitis – inflammation of the liver more commonly caused by viral infections or seen repeatedly with alcohol abuse.

Kidneys, Urinary Tract and Reproductive Organs

• Acute ureteric colic – pain caused by solid material, like kidney stones, passing through the ureter.
• Acute pyelonephritis – inflammation of the part of the kidney that leads to the ureters most commonly due to a bacterial infection.
• Acute cystitis – inflammation of the urinary bladder often associated with a urinary tract infection.
• Renal colic – pain in the loin and lower back caused by a kidney stone passing through the narrower ureter towards the bladder.
• Ruptured ovarian cyst – rupture of the fluid-filled vesicle in the ovaries seen with conditions like polycystic ovarian syndrome (PCOS).
• Adnexal torsion – twisting and strangulation of the fallopian tube.
• Testicular torsion – twisting and strangulation of the spermatic cord that houses the blood vessel which carries blood to the the testis (testicle).

Respiratory Causes

• Pneumonia – inflammation of the lung often associated with bacterial or viral infections. Pneumonia of the lower lobe of the lung is more likely to cause abdominal pain.
• Pulmonary embolism – damage of the lung tissue due to loss of blood supply as a blood clot hampers the circulation. It is more commonly a complication of deep venous thrombosis.

Blood Vessels

• Ruptured or leaking abdominal aortic aneurysm – break in the abnormal bulge or ballooning of the abdominal aorta.
• Splenic artery aneurysm – ballooning of the artery that carries blood to the the spleen.
• Superior mesenteric artery syndrome – a rare condition where part of the duodenum (first part of the small intestine) is compressed between the abdominal aorta and superior mesenteric artery.

Pregnancy

• Ruptured ectopic pregnancy -bursting of the fallopian tube where the fertilized egg is abnormally lodged.
• Septic abortion with peritonitis – miscarriage associated with an infection and surrounding inflammation of the peritoneal lining.
• Abruptio placentae – premature separation of the placenta from the uterine wall.
• Uterine rupture – tearing of the uterus.
• Acute retention of urine due to retroverted gravid (pregnant) uterus where the uterus is tipped backward and blocks the urinary tract.
• Red degeneration of fibroid during pregnancy – breakdown of a uterine fibroid that occurs during pregnancy.
• Torsion of pedunculated fibroid during pregnancy – twisting of a uterine fibroid that has a stalk.
• Chorioamnionitis – infection of the aminiotic sac and/or placenta.

Other Causes of Acute Abdomen

• Diabetic ketoacidosis – high levels of acidic compounds (ketones) in the blood associated with diabetes mellitus.
• Adrenal crisis – sudden need for cortisol in a patient with low cortisol levels (adrenal insufficiency).
• Rupture of spleen
• Abdominal trauma – injury to the abdomen (blunt or sharp) due to car accidents, blows (assault) and falls.
• Pelvic inflammatory disease
• Myocardial infarction (heart attack) where part of the heart muscle dies due to blockage of one or more of the coronary arteries.

What are the symptoms with severe abdominal pain?

Signs and Symptoms of Acute Abdomen

The symptoms will depend upon the cause but the most common features include :

• Abdominal pain – the site of the pain will vary in different conditions and may indicate the cause of acute abdomen, such as right lower quadrant pain in acute appendicitis, or right upper quadrant pain in acute cholecystitis. The type of pain is also important in narrowing down the cause, such as colicky pain (in acute ureteric colic) or pain intensifying on movement (in peritonitis). In some cases, the pain may be referred from some other site (shoulder pain due to irritation of the diaphragm by blood or infection).
• Signs of peritonitis, such as severe pain and silent abdomen.
• Accompanying symptoms such as nausea, vomiting, constipation, diarrhea, vaginal bleeding.
• Hematemesis (blood in vomit) or melena (blood in stool).
• Abdominal distension
• Shock

How is severe abdominal pain diagnosed?

Diagnosis of Acute Abdomen

It is often difficult to determine the cause of an acute abdomen because many of the signs and symptoms may overlap. A thorough evaluation of the patient’s history may be crucial to identifying the possible cause. In addition to the clinical presentation, the diagnosis is based upon :

• History
• Physical examination
• Routine blood and urine tests
• X-ray – flat and upright abdominal and chest x-ray if perforation or obstruction is suspected.
• Ultrasound
• CT scan of abdomen
• ECG and cardiac enzymes
• Pregnancy test

How is severe abdominal pain treated?

Treatment of Acute Abdomen

• Immediate medical attention is imperative.
• Further treatment will depend upon the diagnosis.
• Surgery is indicated frequently.

Dr. Hannah Cohen

She is a dedicated gastroenterologist, guides individuals to optimal digestive health. Her expertise ensures individuals enjoy a balanced and comfortable digestive system, contributing to overall well-being and vitality.