The surgical abdomen

Introduction Abdominal pain is the most common reason for emergency department visits and is a leading cause of hospital admissions in the United States. Acute abdominal pain is defined as sudden-onset pain lasting less than 7 days. It is a generic term and the pain can be due to many possible causes that range from benign to life threatening. Once an etiology that requires surgical intervention is suspected, involvement of appropriate consultants should not be delayed. Classic and critical presentations The patient can present with anything from mild to severe abdominal pain. Depending on the etiology and severity of the disease, the pain could be vague and dull, or severe and localized. This is because of the following pathophysiology: The location and characterization of the pain can help distinguish between different etiologies of the abdominal pain (see Figure 40.1). Additionally patients could present with referred pain, which is pain experienced at a site (or sites) distant from the initiating organ due to a shared neural origin with another body organ, such as right shoulder pain due to biliary colic or back pain due to pancreatitis. Acute-onset pain lasting longer than 6 hours in a previously healthy patient is often due to a surgical condition.