Rationale

Acute abdominal pain is common in adults, leading to frequent physician visits in both Emergency Department and office settings. Acute abdominal pain may result from serious intra-abdominal, intrathoracic, or retroperitoneal processes.

Causal Conditions

(list not exhaustive)

1. Localized pain

   1. Upper abdominal region

      • Biliary tract disease

      • Pancreatitis

      • Peptic ulcer disease, gastritis

      • Gastroesophageal reflux disease

      • Acute hepatitis, hepatic abscess

      • Splenic infarction, splenic abscess

      • Referred cardiothoracic pain

      • Musculoskeletal pain

   2. Lower abdominal region

      • Appendicitis

      • Mesenteric lymphadenitis

      • Diverticulitis

      • Incarcerated hernia

      • Pelvic inflammatory disease

      • Ectopic pregnancy

      • Ovarian (e.g., torsion or ruptured cyst)

      • Urinary tract infection

      • Renal colic

      • Inflammatory bowel disease

      • Bowel obstruction

2. Diffuse pain

   1. Generalized peritonitis

   2. Ruptured abdominal aortic aneurysm

   3. Ischemic bowel disease

   4. Gastroenteritis

   5. Initial or acute presentation of a chronic condition

Key Objectives

Given a patient with acute abdominal pain, the candidate will diagnose the cause, severity, and complications and will initiate an appropriate management plan. In particular, the candidate will identify those patients requiring emergency medical or surgical treatment.

Enabling Objectives

Given a patient with acute abdominal pain, the candidate will

1. list and interpret critical clinical findings, including

   1. historical features, such as

      • the onset, frequency, duration, location, radiation, quality, and severity of pain; and

      • aggravating and alleviating factors; and

   2. features of an appropriate physical examination, such as

      • results of an abdominal examination;

      • signs of peritonitis; and

      • results of rectal and genitourinary examinations if relevant;

2. list and interpret the critical investigations, including appropriate laboratory and diagnostic imaging investigations; and

3. construct an effective management plan, including

   1. determining whether the patient requires an emergency surgical procedure or emergency medical care;

   2. outlining a management plan for nonemergency conditions; and

   3. determining whether the patient needs specialized care and/or further investigation.