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CHAPTER 47
ACUTE tive intervention and initiate appropriate mining whether the pain is visceral, parietal, or referred is
therapy. Many diseases, some of which are not surgical or even important and can usually be done with a careful history.
intra-abdominal,1 can produce acute abdominal pain and ten- Introduction of bacteria or irritating chemicals into the
derness. Therefore, every attempt should be made to make a peritoneal cavity can cause an outpouring of fluid from the
correct diagnosis so that the therapy selected, often a laparoscopy peritoneal membrane. The peritoneum responds to inflamma-
or laparotomy, is appropriate. tion by increased blood flow, increased permeability, and forma-
The diagnoses associated with an acute abdomen vary tion of a fibrinous exudate on its surface. The bowel also develops
according to age and Appendicitis is more common in local or generalized paralysis. The fibrinous surface and decreased
younger individuals, whereas biliary disease, bowel obstruction, intestinal movement cause adherence between the bowel and
intestinal ischemia and infarction, and diverticulitis are more omentum or abdominal wall and help localize inflammation. As
common in older adults. Most surgical diseases associated with a result, an abscess may produce sharply localized pain, with
an acute abdomen result from infection, obstruction, ischemia, normal bowel sounds and gastrointestinal function, whereas a
or perforation. diffuse process, such as a perforated duodenal ulcer, produces
Nonsurgical causes of an acute abdomen can be divided generalized abdominal pain, with a quiet abdomen. Peritonitis
into three categories, endocrine and metabolic, hematologic, ma