Acute Abdomen – Severe Abdominal Pain | Online Treatment

Acute Abdomen – Severe Abdominal Pain | Online Treatment. Most often we doctor have to face the case of acute abdomen. It is both medical and surgical emergency. At first a patient with acute abdomen should be made relax with conservative management. After clinical examination and with the aid of important investigation findings we have to go for further evaluation and better management.

Get a brief discussion of Acute Abdomen here. In this article hospital management as well as outdoor treatment is discussed in short which will be helpful for new doctors, intern doctors and as well as medical students.

Acute Abdomen

Acute Abdomen refers to a sudden severe abdominal pain. This accounts for approximately 50% of all urgent admissions to general surgical units. The acute abdomen is a consequence of one or more pathological processes.

Differential Diagnosis of Acute Abdomen

[Ref. Davidson’s Principles and Practice of Medicine- 22nd Edition]

How to Exclude the D/D of Acute Abdomen

1) Perforation

  • Obliteration  of liver dullness
  • broad like rigidity
  • rebound tenderness ( peritonitis )

2) Appendicitis                                                                                                                                                    

  • Pain in Right Iliac Fossa (McBurney’s point tenderness)
  • Rebound tenderness (Peritonitis)

CBC urine RME

3) Intestinal obstruction

  • Cramping pain
  • Abdominal distension by percussion
  • Vomiting & constipation
  • Bowel sound present/absent

4) Inflammation

a) Pancreatitis

  • Pain in epigastric region
  • Not relief by ordinary treatment

b) Cholecystitis Cholelithiasis

  • Murphy sign to exclude cholecystitis

c) Cystitis and UTI

  • burning sensation micturation
  • suprapubic tenderness

d) Pyelonephritis

  • Fever and Renal Angle Tenderness

If  female patient  with lower abdominal pain

5) Ectopic pregnancy — H/O amenorrhea

6) PID by married women and pelvic discharge

If the patient is middle aged

7)  MI / Angina- ECG

8) Peptic Ulcer Disease

Fever with upper abdominal pain never think PUD, think infective cause Cholecystitis , Liver abscess, Pylonephritis, Pancreatitis

Investigation of Choice

1) Plain x-ray of the abdomen in erect posture including both dome of diaphragm.

  • It can exclude perforation and intestinal obs. sub-acute obs.

2) USG of whole abdomen

  • It can exclude  Pancreatitis, Cholecystitis Cholelithiasis, Liver Abscess

3) CBC

4) Urine R/E

5) Serum Amylase, Serum Lipase, Urinary Amylase

Rx of Acute Abdomen During Hospital Admission 

  • Bed rest
  • NPO-TFo
  • NG suction 2 hourly
  • Inf. Normal Saline  1000 ml
    • +
  •  Inf. Hartman Solution1000 ml

I/V @ 20 drop / min

  • Inj. Ciprofloxacin 100 ml [Square-Ciprocin]

1 bag  I/V  stat and bd

  • Inj. Anadol 100mg

1 amp I/M stat and 8 hourly

[Anadol Suppository 100 mg. 1stick P/R stat and SOS if pain is not controlled]

  • Inj. Algin / Norvis

2 amp  I/V stat and 8 hourly  if ( clamping pain )

  • Inj. Ranison 50 mg    or          Iinj P.P.I  40 mg [Health Care- Sergel. Renata-Maxpro, Square-Nexum]

1 amp  I/V stat and 8 hourly         1 vial  I/V stat and daily

If suspected  appendicitis or peritonitis

  • Inj . Metronidazole 500mg

1 bag  I/V stat and 8 hourly


Never use Toradolin  in upper abdominal pain if u cannot exclude PUD. Toradolin is used in renal colic and UTI

No antibiotic is needed in PUD.

If pain is subsided by conservative management then the patient should be referred for surgical intervention if there is surgical emergency otherwise the patient may be discharged

Rx of Acute Abdomen During Discharge or Out Door Treatment of Acute Abdomen

1) Tab. Ciprofloxacin 500 mg [Square- Ciprocin, Beximco-Neofloxin, Opsonin- Ciprox, Aristopharma- Aprocin]

1+0+1 ———7 days

2) Tab. Metronidazole 400 mg [Square- Amodis, Beximco-Filmet, Incepta- Flamyd, Opsonin- Metryl]

1+1+1———-3 to 5 days

3) Tab. Algin/Norvis/Timozin 50 mg

1+0+1 (A/M)———-7 days

4) Cap. Anadol 50 mg

1+0+1 (A/M)————–5 to 7 days

5) Tab. Esomeprazole 20 mg [Health Care- Sergel. Renata-Maxpro, Square-Nexum]

1+0+1 (B/M)————7 days

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