Rapid identification of surgical emergencies in new-onset and severe abdominal pain through clinical examination, blood tests, and imaging.
Indication
- Severe progressive abdominal pain developing over a few hours
- Abdominal rigidity and tenderness on palpation (signs of peritonitis)
- Right lower abdominal pain, nausea, fever (suspected appendicitis)
- Right upper abdominal pain, jaundice (gallbladder/liver origin)
- Flank/back pain, blood in urine (kidney stone)
- Sudden tearing-type abdominal-back pain with hypotension (suspected aortic aneurysm rupture)
- Abdominal pain in a non-pregnant reproductive-age woman (ectopic pregnancy, ovarian torsion)
Preparation
- The patient should not eat or drink while being brought to the emergency department (fasting is required for possible surgery)
- Medications used (blood thinners, painkillers, contraceptive pills) are reported
- Last menstrual period, pregnancy status, and surgical history are reviewed
- The onset, location, and progression of pain are communicated to the physician
How it's performed
- A detailed abdominal examination is performed; guarding, rebound, peristaltic sounds, and special maneuvers (McBurney, Murphy) are evaluated
- Complete blood count, biochemistry, lipase, lactate, urinalysis, and pregnancy test are ordered
- Abdominal ultrasound is the first-line imaging (especially in women, pregnant patients, and children)
- In unclear cases, abdominal CT (with oral/intravenous contrast) is the gold standard
- General surgery consultation is requested for surgical emergencies such as peritonitis, appendicitis, cholecystitis, diverticulitis, and mesenteric ischemia
- In suspected abdominal aortic aneurysm rupture, emergency vascular surgery and operating room preparation are arranged
Post-procedure
- If a surgical condition is identified, the patient is taken to the operating room; otherwise observation and medical treatment are continued
- Conditions such as appendicitis and cholecystitis yield the best outcomes with early surgery
- In unclear pain, 6-12 hours of observation and serial examinations are recommended
- At discharge, instructions on diet, medication, and follow-up are explained
- The patient is informed to seek immediate care if pain recurs, fever or vomiting develops
Risks
- Appendiceal perforation and sepsis with delayed diagnosis
- High mortality in aortic aneurysm rupture
- Bowel necrosis in mesenteric ischemia
- Radiation and contrast reactions during imaging
- Risk of unnecessary or delayed surgery in unclear cases
FAQ
Can I take painkillers before going to the emergency room?
Not recommended. Painkillers may mask the diagnosis and complicate physician assessment. In the emergency department, appropriate pain management is provided after the diagnosis is clarified.
How does appendicitis pain typically begin?
It usually starts as periumbilical pain, then migrates to the right lower abdomen within a few hours, accompanied by nausea, loss of appetite, and mild fever. However, not every case is typical.
For which abdominal pain should I definitely call emergency services?
Call an ambulance for severe sudden pain radiating to the back, blood in vomit/stool, altered consciousness, low blood pressure, or sudden pain during pregnancy.
Is acute abdominal pain in children evaluated differently?
Yes. Children may not clearly describe symptoms; physical examination and ultrasound take priority. Conditions such as appendicitis, intussusception, and testicular torsion should not be missed.
Related Information
Related Medical Services
Other services in the same specialty or with similar indications you may want to explore.
Abdominal CT
Medical Imaging Services
Abdominal CT — advanced imaging for abdominal pain, acute abdomen, cancer staging and organ evaluation.
Emergency Evaluation and Triage
Emergency Health Services
Emergency evaluation and triage — life-priority sorting and rapid medical assessment at presentation.
Chest Pain Evaluation
Emergency Health Services
Chest pain evaluation — differential diagnosis of heart attack, aortic dissection, and pulmonary embolism.
Cholecystectomy
Surgical Outpatient Services
Cholecystectomy — laparoscopic or open surgical removal of the gallbladder.
Laparoscopic Surgery
Surgical Outpatient Services
Laparoscopic surgery — minimally invasive general surgery procedures performed through small incisions using a closed approach.
Abdominal Ultrasonography
Medical Imaging Services
Abdominal ultrasonography — radiation-free, real-time examination of intra-abdominal organs using sound waves.
Trauma Care
Emergency Health Services
Trauma care — systematic management of multiple injuries using the ABCDE algorithm.
Cardiopulmonary Resuscitation
Emergency Health Services
Cardiopulmonary resuscitation (CPR) — restoring circulation and breathing after cardiac arrest.