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INTRODUCTION

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Correctly interpreting acute abdominal pain can be quite challenging. Few clinical situations require greater judgment, because the most catastrophic of events may be forecast by the subtlest of symptoms and signs. In every instance, the clinician must distinguish those conditions that require urgent intervention from those that do not and can best be managed nonoperatively. A meticulously executed, detailed history and physical examination are critically important for focusing the differential diagnosis, where necessary, and allowing the diagnostic evaluation to proceed expeditiously (Table 20-1).

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TABLE 20-1Some Key Components of the Patient’S History
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The etiologic classification in Table 20-2, although not complete, provides a useful framework for evaluating patients with abdominal pain.

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TABLE 20-2Some Important Causes Of Abdominal Pain
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The most common causes of abdominal pain on admission are acute appendicitis, nonspecific abdominal pain, pain of urologic origin, and intestinal obstruction. A diagnosis of “acute or surgical abdomen” is not acceptable because of its often misleading and erroneous connotations. Most patients who present with acute abdominal pain will have self-limited disease processes. However, it is important to remember that pain severity does not necessarily correlate with the severity of the underlying condition. The most obvious of “acute abdomens” may not require operative intervention, and the mildest ...

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