From the Guidelines
To quickly evaluate for acute abdomen, a step-up approach for diagnosis should be used, starting with clinical and laboratory examination and progressing to imaging examinations, as this approach is tailored to the clinical setting and resources, and is recommended by the WSES 2016 consensus conference 1. This approach allows for the identification of life-threatening conditions requiring immediate intervention, such as perforated viscus, mesenteric ischemia, or ruptured aneurysm. The diagnosis of intra-abdominal infections is based primarily on clinical assessment, including a focused history and physical examination, and should be supported by basic laboratory tests like full blood count (complete blood count) 1. Some key points to consider when evaluating for acute abdomen include:
- A thorough abdominal examination, including inspection, auscultation, percussion, and palpation, to note tenderness, guarding, rigidity, and rebound tenderness
- Checking vital signs for tachycardia, hypotension, or fever
- Ordering basic laboratory tests, including complete blood count, comprehensive metabolic panel, lipase, urinalysis, and pregnancy test in women of childbearing age
- Using imaging studies, such as upright chest X-ray, abdominal X-ray, abdominal ultrasound, or CT scan, depending on the suspected diagnosis
- Considering the use of point-of-care ultrasound to rapidly identify gallstones, appendicitis, or free fluid The step-up approach for diagnosis, as recommended by the WSES 2016 consensus conference 1, is the most appropriate method for quickly evaluating for acute abdomen, as it allows for the efficient use of resources and the identification of life-threatening conditions requiring immediate intervention.
From the Research
Evaluation of Acute Abdomen
To quickly evaluate for acute abdomen, the following steps can be taken:
- Take a direct and concise history of the patient's symptoms, including the onset and severity of abdominal pain, as well as any associated symptoms such as nausea, vomiting, or fever 2
- Perform a thorough physical examination, including palpation of the abdomen to check for tenderness, guarding, or rigidity, and assessment of vital signs such as blood pressure and pulse 2, 3
- Use laboratory tests and imaging studies to help establish a diagnosis, such as complete blood count, blood chemistry tests, and abdominal X-rays or CT scans 4, 2
- Consider the patient's overall clinical presentation, including any signs of shock or impaired general well-being, and prioritize timely referral to a surgeon or gynecologist if an acute abdomen is suspected 4, 2
Key Indicators of Acute Abdomen
Some key indicators that may suggest the need for immediate surgical intervention include:
- Sudden onset of severe abdominal pain
- Guarding or rigidity of the abdominal muscles
- Signs of shock, such as hypotension or tachycardia
- Fever or other signs of infection
- History of trauma or previous abdominal surgery 4, 2
Limitations of Physical Examination
It's worth noting that physical examination has limited predictive value in diagnosing certain conditions, such as cholecystitis, and that digital rectal examination may not have added diagnostic value for appendicitis, peritonitis, or small bowel obstruction 3