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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 < 7 days, due to a wide spectrum of causes that range from benign to life threatening. When the need for surgical intervention is suspected, prompt involvement of appropriate consultants is essential.
This chapter discusses the management of surgical abdomen. It presents special circumstances, which make management of surgical abdomen difficult in some patients, including children, developmentally delayed, or obtunded individuals (from illness or drugs), patients with spinal cord injuries, pregnant patients, elderly or immunosuppressed patients, and morbid obese patients. 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. As with the stable patient, a well-formulated differential diagnosis based on careful history and physical examination guides the plan of care far better than a shotgun approach of imaging and laboratory tests.
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