Medical causes of acute abdomen

Dr L.N. Manamela

• Abdominal and thoracic organs send pain signals through specific spinal cord levels via autonomic nerves (vagus, splanchnic, and sacral parasympathetic pathways)
• Early visceral pain may be vague and dermatomal before becoming localized when peritoneal irritation occurs
• Foregut organs = T5-T9; Midgut organs = T10-T12; Hindgut organs = L1-S2 and Pelvic organs = S2-S4

CHEST

• Lower-lobe pneumonia
• Shared nerve pathways between the diaphragm, pleura, and upper abdominal viscera
• Irritation of the diaphragm (C3-C5) and lower intercostal nerves (T7–T12) produces referred abdominal pain rather than chest pain
• Inferior wall myocardial infarction
• Cardiac visceral pain pathways overlap with upper abdominal sensory pathways
• The inferior wall of the heart sends pain signals via sympathetic afferents entering spinal cord levels T7–T9
• Pericarditis
• Cardiac and upper abdominal organs share thoracic spinal segments
• Pulmonary embolism

METABOLIC AND ENDOCRINE CAUSES

• Diabetic ketoacidosis
• Acidosis stimulates visceral nociceptors leading to diffuse abdominal pain
• Pain often improves after correcting acidosis
• Acute intermittent porphyria
• Neurovisceral dysfunction from accumulation of porphyrin precursors due to impaired heme synthesis
• Severe poorly localized abdominal pain
• Uremia/renal failure
• Accumulation of uremic toxins can inflame serous membranes leading to abdominal pains mimicking a surgical abdomen
• Hypercalcemia
• Addisonian crisis
• Lead poisoning

ABDOMINAL AND HAEMATOLOGICAL

• Herpes zoster (Abdominal wall)
• Acute gastroenteritis
• Abdominal tuberculosis
• Pyelonephritis

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• Sickle cell crisis
• Acute leukemia

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References

• Sabiston Textbook of Surgery
• Harrison’s Principles of Internal Medicine