Abdominal pain pathophysiology, classification and causes. Nonobstetrical acute abdomen during pregnancy crosbi. Your healthcare provider will ask about your signs and symptoms. This topic presents a framework for the evaluation of nonpregnant adult women with acute pelvic pain, with an emphasis on gynecologic conditions. Non obstetric causes and presentation of acute abdomen. Hydrosalpinx with acute abdominal pain during the third. Introduction acute abdomen is a general term for acute abdominal diseases accompanied primarily by sudden abdominal pain for which a decision to perform emergency surgery must be made in a very short time. Pregnant women who previously had bariatric surgery may develop acute abdominal pain during pregnancy. Management of the pregnant woman with a surgical cause of abdominal pain requires collaborative, multispecialty practice to optimise care of the mother and baby. Many adaptive or physiologic changes of pregnancy affect the presentation. As defined in the 27th edition of stedmans medical dictionary, acute abdomen is any serious acute intraabdominal condition attended by pain, tenderness, and muscular rigidity, and for which emergency surgery must be considered. The commonest causes of acute abdomen in pregnancy are acute appendicitis followed by acute cholecystitis.
Acute low back pain should be more rigorously evaluated when associated with a history of trauma, vaginal bleeding, severe abdominal pain, loss of fluid, uterine contractions, uterine tenderness. A multidisciplinary approach should be considered in pregnant women with acute abdominal pain when the diagnosis is not reached within 6 to 8 hours. Management of acute abdominal pain in pregnancy should follow the same principles as in the nonpregnant state. Although a common presentation, abdominal pain must be approached in a serious manner, as it is often a. Acute abdomen and abdominal pain in pregnancy sciencedirect. Assessment of acute abdominal pain in the pregnant patient. The following section lists the more likely causes of abdominal pain during pregnancy. The updated guidelines for the role of laparoscopy in pregnant. Jun 04, 2015 abdominal pain in pregnancy may be difficult to diagnose. Abdominal pain is one of the most common disorders of pregnancy. It may be the sole indicator of the need for surgery and must be attended to swiftly.
Urgent hospital referral is often required, unless a ben. Magnetic resonance imaging mri has been shown to be useful in the diagnosis. To develop a structured assessment process for pregnant women with abdominal pain. Urgent hospital referral is often required, unless a benign cause can be established with certainty in the absence of maternal or fetal distress.
A total of 4050% of women with abdominal pain in pregnancy have no identifiable pathology. Aug 22, 2019 with the exception of a urinary pregnancy test and urine dipstick, there are few tests that are useful in the community assessment of the patient with acute abdominal pain. Inevitable, uti incomplete or septic vaginal infections abortions c. Oct 30, 2011 ectopic pregnancy most common obstetric cause of acute abdomen pain usually onesided initially can be confused with appendix if on the right may be sharp initially later, may be diffuse and dull shoulder tip pain. Apr 30, 2020 acute pain serves a protective function to make the patient informed and knowledgeable about the presence of an injury or illness. Request pdf surgical causes of acute abdominal pain in pregnancy abdominal pain in pregnancy is common, with a differential diagnosis that can encompass obstetric, surgical and medical conditions. Maximum abdominal pain is not due to pregnancy itself.
Abdominal pain in pregnancy, abdominal pains patient. The diagnostic approach to pregnant patients with severe abdominal pain is very similar to that for nonpregnant patients with acute abdomen. The threat of morbidity and mortality to both mother and fetus necessitates quick and accurate imaging diagnosis, often via ultrasound. It can be challenging to determine if your pain is serious or mild. However, many of the common causes of acute abdominal pain are not readily diagnosed with sonography, and magnetic resonance imaging mri is.
Abdominal pain is usually a feature, but a painfree acute abdomen can occur, particularly in older people, children, and the immunocompromised, and in the last trimester of pregnancy. Evaluating abdominal pain requires an approach that relies. Sep 26, 2012 melena suggests an upper source of bleeding, while frank blood can indicate a lower source or a massive upper bleed with rapid transit time. Abdominal pain is the most common reason for a visit to the emergency department ed, accounting for 8 million 7% of the 119 million ed visits in 2006.
Ultrasound remains the primary imaging investigation of the pregnant abdomen. Apr 07, 2020 acute abdominal pain in the pregnant patient due to pancreatitis, acute appendicitis, cholecystitis, or peptic ulcer disease. The initial assessment should attempt to determine if the patient has an acute surgical problem that requires immediate and prompt surgical. Additional issues in pregnant women include consideration of the effects of physiologic changes related to pregnancy, causes of acute abdominal.
Oct 17, 2012 a 39 year old primigravid woman who was 36 weeks pregnant presented to the maternity unit with a one day history of worsening intermittent abdominal pain and vomiting. Common causes of right flank and right upper quadrant pain include urolithiasis, pyelonephritis, and acute cholecystitis table. Acute abdomen and abdominal pain in pregnancy elearning. The initial assessment should attempt to determine if the patient has an acute surgical problem that requires immediate and prompt surgical intervention, or urgent medical therapy. Acute abdominal pain in pregnancy presents diagnostic and therapeutic challenges. It has a large number of possible causes and so a structured approach is required. The request to image a pregnant patient with abdominal pain often leads to concern and frustration for the.
Urgent hospital referral is often required, unless a benign cause can be established with certainty in the absence of maternal or foetal distress. Acute abdominal pain gastrointestinal disorders msd. Abdominal pain is one of the common causes of acute hospital admission. Conditions associated with early pregnancy pregnancy o abortion. This was a cross sectional hospitalbased study among 128 pregnant women by face to face interview using a semistructured questionnaire. Abdominal pain inpregnancy associate professor dr hanifullah khan 2. Abdominal pain is usually a feature, but a pain free acute abdomen can occur, particularly in older people, children, and the immunocompromised, and in the last trimester of pregnancy. To identify the nonobstetric causes and presentation of acute abdomen among pregnant women. Aug 30, 20 acute abdominal pain in pregnancy presents diagnostic and therapeutic challenges.
Surgical causes of acute abdominal pain in pregnancy. Studies have proven the ability of mri to diagnose appendicitis and differentiate other causes of acute abdominal pain. Acute abdominal pain in pregnancy remains a clinically challenging presentation, often requiring imaging. Nov 01, 2018 acute low back pain should be more rigorously evaluated when associated with a history of trauma, vaginal bleeding, severe abdominal pain, loss of fluid, uterine contractions, uterine tenderness. Since the differential diagnosis of abdominal pain varies widely ranging from benign to lifethreatening conditions, a stepwise approach is required to identify the. The clinician addressing the patient with acute abdominal pain ideally should eliminate acute medical causes of abdominal pain and recognize the proper setting for surgical consultation. Tell the provider when your symptoms started and about any recent travel or surgery. Updating knowledge and assessment skills is essential in the management of abdominal pain in obstetric triage settings. Diagnosis of the acute abdomen in pregnancy remains one of the most. Magnetic resonance imaging mri has been shown to be useful in the diagnosis of gynaecological. Pregnant patient with acute abdominal pain and previous.
Acute myocardial infarction pain referred to the left arm and jaw. The patients both had diffuse abdominal pain in combination. Acute appendicitis is the most common cause of an acute abdomen during pregnancy. The relative advantages of using ultrasound, ct, and mri to help. Full text management of acute abdomen in pregnancy. However, the physiologic changes associated with pregnancy must be considered in the interpretation of findings from the history and physical examination. The term acute abdomen refers to any serious acute intra abdominal condition accompanied by pain, tenderness, and muscular rigidity, for which emergency surgery should be contemplated.
The physiological signs that occur with acute pain emerge from the bodys response to pain as stressor. Acute abdomen during pregnancy linkedin slideshare. The approach to acute abdominalpelvic pain in pregnancy is similar to that in the nonpregnant state, with some additional challenges. Administration guidelines state that the safety of. Acute abdominal pain can represent a spectrum of conditions from benign and selflimited disease to surgical emergencies. The urge to defecate in a patient with acute abdominal pain has been described as a harbinger of serious disease including a ruptured aneurysm in the older patient or ruptured ectopic pregnancy in the young. Acute abdomen in pregnancy aap represents a unique diagnostic and therapeutic challenge.
The patients both had diffuse abdominal pain in combination with. The pain may be sharp and stabbing, or dull and achy. Women tend to visit doctors often as they are concerned about the health of their fetus. Acute appendicitisthe most common cause of acute abdominal pain in pregnancy is acute appendicitis, affecting as many as 1 in 766 pregnancies. Due to the nature of the female pelvic anatomy, the underlying etiology includes a wide range of differential diagnoses. The approach to acute abdominal pelvic pain in pregnancy is similar to that in the nonpregnant state, with some additional challenges. The reported frequency of ectopic pregnancy varies from 1. Acute abdominal pain in pregnancy can occur due to obstetric factors as well. However, many of the common causes of acute abdominal pain are not readily diagnosed with sonography, and magnetic resonance imaging mri is increasingly. Other mechanical stimuli, such as expansion, contraction, compression, pulling, and twisting of the viscera, also induce pain. Mr evaluation of acute abdominal pain in pregnant patients.
Hydrosalpinx is often a sequel to chlamydial infection, which affects fallopian tube epithelial transporters and. In early pregnancy, ectopic pregnancy must be excluded before diagnosing any other cause of abdominal pain. In pregnancy, intractable abdominal pain can be safely evaluated using mri. The term acute abdomen designates symptoms and signs.
The unexpected onset of acute pain reminds the patient to seek support, assistance, and relief. Jan 11, 2019 management of the pregnant woman with a surgical cause of abdominal pain requires collaborative, multispecialty practice to optimise care of the mother and baby. Diagnosis of pain in pregnancy is rendered challenging by. As an expectant mother, it is important to educate yourself on all potential causes so you are able to recognize symptoms that. Abdominal pain occurs when mechanical or chemical stimuli trigger the pain receptors in the abdomen. Additional issues in pregnant women include consideration of the.
Surgical causes of abdominal pain to consider in pregnancy include. Non obstetric causes and presentation of acute abdomen among. When evaluating the gravid patient with acute abdominal pain. The pain was colicky in nature, with no radiation, and it was worse when she was lying flat. Also tell him what makes the pain better or worse, and what treatments you have tried. Mri evaluation of acute abdominal pain in the pregnant patient. Patients require a careful assessment in order to reduce anxiety and give reassurance. Acute pain nursing diagnosis is defined as an unpleasant sensory and emotional experience arising from actual or potential tissue damage or described in terms of such damage international association for the study of pain. Vascular causes of acute abdomen that are incidental to pregnancy include. Pelvic pain frequently occurs with abdominal pain and can be a challenging complaint because of the need to consider a wide array of possible conditions. How is the cause of acute abdominal pain diagnosed. Urinary tract infections uti or stones and cholecystitis are also fairly common tablefig2 lists the common aetiologies of acute abdomen in pregnancy.
Call your healthcare provider if your pain doesnt go away after several minutes of rest, or if you also have any of the following. Cause grouping differentials classical history classic examination findings investigation findings initial test, diagnostic test definitive management. There are several reports of the acute abdomen during pregnancy 6,7 but no report of hydrosalpinx with acute abdomen in the third trimester of pregnancy. Approach to acute abdominal pain in pregnancy and postpartum. A 39 year old primigravid woman who was 36 weeks pregnant presented to the maternity unit with a one day history of worsening intermittent abdominal pain and vomiting. Appendiceal perforation is, however, more common in the last trimester, perhaps owing to the stretched peritoneum.
For example, acute appendicitis typically changes from a dull, poorly localized, moderate pain to an intense and focal pain as the inflammation extends from the. The term acute abdomen refers to any serious acute intraabdominal condition accompanied by pain, tenderness, and muscular rigidity, for which emergency surgery should be contemplated. Acute abdomen in pregnancy remains one of the most challenging diagnostic and therapeutic dilemmas today. Evaluation and management of acute abdominal pain in the. In day to day practice, physicians have to face pregnant women presenting acute abdomen. Acute appendicitis is the commonest cause of an abdominal pain in a pregnant woman not in labour. Approach to acute abdominal pain in pregnant and postpartum. On the whole, if you are concerned enough to be ordering blood tests or imaging, the patient should be referred to secondary care.
Medications used in therapeutic doses for acute and chronic pain appear to be relatively safe in pregnancy. Acute abdomen and abdominal pain in pregnancy request pdf. Evaluation of abdominal pain in pregnancy differential. Any cause for acute abdomen can occur coincident with pregnancy. There had been no vaginal bleeding, no change in bowel habit, and no urinary symptoms. Occasional abdominal pain during pregnancy is a common and often harmless complaint, but it can also be a sign of a serious problem. Ultrasound remains the primary imaging investigation of the pregnant abdomen because of its availability.
Abdominal pain during pregnancy can be a normal part of the process as your body changes to accommodate your growing baby. The acute abdomen is defined as a sudden onset of severe abdominal pain of less than 24 hours duration. Acute appendicitis is the most common acute surgical cause of abdominal pain in pregnancy, affecting 1 in 8001500 pregnancies. Evaluation of acute abdomen differential diagnosis of. The initial goal is to identify patients who have a serious or even lifethreatening etiology for their symptoms and require urgent intervention. Acute upper abdominal pain in early pregnancy federal. Acute and severe abdominal pain, however, is almost always a symptom of intraabdominal disease. Abdominal pain and cramping during pregnancy babycenter.
Anatomical and physiological changes in pregnancy will influence the clinical evaluation. Urinary tract infection uti or stones and cholecystitis are also relatively common. Acute abdominal pain in the pregnant patient due to pancreatitis, acute appendicitis, cholecystitis, or peptic ulcer disease. Surgical diseases that cacise abdominal pain occur in approximately two in pregnancies. Patients with urolithiasis will typically present with sudden onset of colicky flank pain, which may radiate to the inguinal region, with or without nausea and vomiting. For a more extensive list of non pregnancy related causes, see separate abdominal pain article. Acute abdominal pain is a common clinical presentation in the emergency department and primary care setting. Gangrene and perforation of the gut can occur pregnancy. Standard imaging techniques need to be adapted to reduce harm to the fetus from xrays due to their teratogenic and carcinogenic potential.
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