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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 and allowing the diagnostic evaluation to proceed expeditiously (Table 12-1).

TABLE 12-1Some Key Components of the Patient’s History

The etiologic classification in Table 12-2, although not complete, provides a useful framework for evaluating patients with abdominal pain.

TABLE 12-2Some Important Causes of Abdominal Pain

Any patient with abdominal pain of recent onset requires an early and thorough evaluation. The most common causes of abdominal pain on admission are nonspecific abdominal pain, acute appendicitis, 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. And, the presence or absence of various ...

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