The cute abdomen

The Acute Abdomen:
"An acute abdomen" is any sudden, spontaneous, nontraumatic disorder whose chief manifestation is in the abdominal area and for which urgent operation may be necessary. Because there is frequently a progressive underlying intra-abdominal disorder, undue delay in diagnosis and treatment adversely affects outcome.
The approach to a patient with an acute abdomen must be orderly and thorough. An acute abdomen must be suspected even if the patient has only mild or atypical complaints. The history and physical examination should suggest the probable causes and guide the choice of initial diagnostic studies..
History Abdominal Pain
History taking by an experienced physician is an active process whereby a cluster of diagnostic possibilities is considered in order to systematically eliminate less likely conditions. Pain is the most common and predominant presenting feature of an acute abdomen. Careful consideration of the location, the mode of onset and progression, and the character of the pain will suggest a preliminary list of differential diagnoses.
Location of Pain
Because of the complex dual visceral and parietal sensory network innervating the abdominal area, pain is not as precisely localized as in the extremities.. Visceral sensation is mediated primarily by afferent C fibers located in the walls of hollow viscera and in the capsules of solid organs. Unlike cutaneous pain, visceral pain is elicited by distention, by inflammation or ischemia stimulating the receptor neurons, or by direct involvement (eg, malignant infiltration) of sensory nerves. The centrally perceived sensation is generally slow in onset, dull, poorly localized, and protracted. Because of this, increased wall tension due to luminal distention