Acute Abdominal Pain & Surgical Emergencies
Emergency triage of the acute abdomen: bedside aorta ultrasound, CT angiography for mesenteric ischemia, upright chest X-ray for free air, and antibiotic coverage for intra-abdominal sepsis.
Resuscitation Quick Ribbon (First 2 Minutes)
Bottom-Line Clinical Pearl
In elderly patients with severe abdominal pain out of proportion to physical exam, assume Acute Mesenteric Ischemia until ruled out with a dedicated biphasic CT mesenteric angiogram. In any patient over 50 presenting with acute flank, back, or abdominal pain with syncope or hypotension, assume Ruptured Abdominal Aortic Aneurysm (AAA); perform an immediate bedside aorta ultrasound before transporting out of the resuscitation bay. Peritoneal signs (rigidity, involuntary guarding, rebound) indicate an operative abdomen.
1. Can't-Miss Emergency Abdominal Life Threats
| Condition | Classic Presentation | Bedside / Imaging Test | Definitive Emergency Action |
|---|---|---|---|
| Ruptured AAA | Triad of flank/back pain, hypotension, and pulsatile mass | Bedside Ultrasound (Aorta > 3 cm) or CTA | Direct to OR for open repair / EVAR; activate MTP; permissive hypotension |
| Acute Mesenteric Ischemia | Severe pain out of proportion to exam, post-prandial pain, atrial fibrillation | CTA Abdomen/Pelvis with IV contrast (arterial phase) | Emergent vascular surgery consultation, IV heparin, broad-spectrum antibiotics |
| Perforated Viscus | Sudden onset severe epigastric/generalized pain, rigid abdomen | Upright Chest X-ray (free air under right hemidiaphragm) | Immediate surgical consult, IV broad-spectrum antibiotics, fluid resuscitation |
| Acute Cholangitis | Charcot triad (fever, jaundice, RUQ pain) + Reynolds pentad (+ shock, AMS) | RUQ Ultrasound (dilated biliary tree, choledocholithiasis) | Emergent ERCP for biliary decompression, ICU admission, IV antibiotics |
| Bowel Obstruction / Strangulation | Colicky pain, bilious vomiting, obstipation, prior surgeries | CT Abdomen/Pelvis with IV contrast, abdominal series | NG tube decompression, fluid replacement; emergent OR if closed-loop or bowel ischemia |
Test Your Acute Abdominal Pain & Surgical Emergencies Knowledge
Directly launch a targeted 5-question practice block from our 8,400+ board question bank.