Abdominal pain - acute

Most people are affected by abdominal pain at some point in their lives. The intensity, location and symptoms can vary. Numerous diseases of the digestive tract and metabolic disorders manifest themselves with the symptom of abdominal pain.

Acute abdominal pain can be triggered by a variety of illnesses. Often a heart attack, a hernia or kidney stones can also cause pain in the abdominal area.

Common causes of abdominal pain are

• Inflammation of the appendix (appendicitis)

• Gallbladder inflammation due to a gallbladder stone

• Intestinal obstruction

• Stomach and intestinal ulcers

• Inflammation of the pancreas

• Chronic intestinal diseases (e.g. Crohn's disease, ulcerative colitis)

• Acute inflammation of the mucous membranes (mucositis)

Rare causes of acute abdominal pain are pneumonia, pulmonary embolism, cardiovascular diseases (e.g. heart attack or aortic aneurysm), urogenital diseases (e.g. kidney stones), lead poisoning and neurological diseases (e.g. herpes zoster). In older patients, abdominal pain is often triggered by ileus, diseases of the gallbladder, constrictions caused by tumors (e.g. colon carcinoma) or vascular diseases. Young patients, on the other hand, suffer more frequently from appendicitis or gynecological problems (e.g. rupture of an ovarian cyst).

An acute abdomen is characterized by the sudden onset of severe pain in the abdominal area. In addition, the abdomen often shows a hard abdominal tension. An unclear abdomen is first clarified internally or with the help of imaging. In contrast, an acute abdomen with a hard abdomen usually requires surgery (e.g. appendicitis).

Around 10% of all patients present to the emergency department with abdominal pain. Of these, 20 % have an acute abdomen (emergency) and 30 to 40 % suffer from non-specific abdominal pain (abdominal complaints).

Leading symptoms of abdominal pain:

• Abdominal tenderness (diffuse or localized)

• diarrhea

• Nausea and vomiting

• Flatulence and stool changes (e.g. constipation)

• Circulatory problems (up to and including shock)

• Reduced general condition

• Fever

• Relaxed posture and breathing

• Transmission of pain to associated dermatomes

In the case of acute and severe abdominal pain, the attending physician should always ask 6 main questions:

• When: After what event did the pain occur?

• How long: Time course of the pain and urgency of the situation

• Why: In what context did the pain occur?

• How: Sudden pain or slowly increasing tendency

• Where: Localization in the abdomen

• Character of the pain: e.g. burning, cramping, pressing, etc.

In the case of an acute abdomen, the following parameters should be determined as standard:

• Blood count (hemoglobin, leukocytes, hematocrit)

• Serum parameters (CRP, electrolytes, glucose, lipase, troponin, creatine kinase, liver parameters, procalcitonin)

• Blood gas analysis

• Urine status

Further helpful imaging to clarify abdominal pain are abdominal ultrasound (sonography), X-ray examinations or computer tomography (CT). A gastroscopy or colonoscopy is often performed in the pain-free interval to clarify the cause.

The treatment of abdominal pain varies depending on the cause, and sometimes patients even require intensive medical care.

Basic monitoring in the clinic for abdominal pain includes

• Heart rate

• blood pressure

• temperature

• blood sugar

• Fluid balance (focus on balancing)

Depending on the condition and cause of the abdominal pain, drug therapy may include

• Painkillers (e.g. metamizole)

• oxygen therapy

• Antiemetics (e.g. ondansetron)

• Infusion therapy (if necessary, nutrition via the vein)

The prognosis for abdominal pain varies depending on the trigger.