General Surgery for NEET-PG
Acute Abdomen for NEET-PG
Acute abdomen is the sudden onset of severe abdominal pain requiring urgent evaluation and often surgical intervention. For NEET-PG, the priority is pattern recognition: correlating the site and character of pain with the likely organ and disease, and distinguishing conditions that need immediate surgery from those managed medically. Common causes include acute appendicitis, perforated peptic ulcer, acute cholecystitis, acute pancreatitis, intestinal obstruction, mesenteric ischaemia, and ruptured ectopic pregnancy in women. Pain that begins periumbilically and shifts to the right iliac fossa suggests appendicitis, while sudden severe epigastric pain with board-like rigidity and free gas under the diaphragm points to perforation. Peritonitis produces guarding, rigidity, and rebound tenderness with absent bowel sounds, whereas colicky pain with distension and vomiting suggests obstruction. Referred pain patterns, such as shoulder-tip pain from diaphragmatic irritation and testicular pain from ureteric colic, help localise. Erect chest and abdominal radiographs detect free air and dilated bowel loops, ultrasound assesses the gallbladder and pelvis, and contrast computed tomography is the most informative imaging. Serum amylase and lipase confirm pancreatitis, and a pregnancy test is mandatory in women of reproductive age. Recognising peritonitis signs, the classic pain migrations, and the indications for urgent laparotomy are consistent exam anchors.
MedNext Academy | 3 min read
Acute Abdomen for NEET-PG
Acute abdomen is the sudden onset of severe abdominal pain requiring urgent evaluation and often surgical intervention. For NEET-PG, the priority is pattern recognition: correlating the site and character of pain with the likely organ and disease, and distinguishing conditions that need immediate surgery from those managed medically. Common causes include acute appendicitis, perforated peptic ulcer, acute cholecystitis, acute pancreatitis, intestinal obstruction, mesenteric ischaemia, and ruptured ectopic pregnancy in women. Pain that begins periumbilically and shifts to the right iliac fossa suggests appendicitis, while sudden severe epigastric pain with board-like rigidity and free gas under the diaphragm points to perforation. Peritonitis produces guarding, rigidity, and rebound tenderness with absent bowel sounds, whereas colicky pain with distension and vomiting suggests obstruction. Referred pain patterns, such as shoulder-tip pain from diaphragmatic irritation and testicular pain from ureteric colic, help localise. Erect chest and abdominal radiographs detect free air and dilated bowel loops, ultrasound assesses the gallbladder and pelvis, and contrast computed tomography is the most informative imaging. Serum amylase and lipase confirm pancreatitis, and a pregnancy test is mandatory in women of reproductive age. Recognising peritonitis signs, the classic pain migrations, and the indications for urgent laparotomy are consistent exam anchors.
Acute abdomen is the sudden onset of severe abdominal pain requiring urgent evaluation and often surgical intervention. For NEET-PG, the priority is pattern recognition: correlating the site and character of pain with the likely organ and disease, and distinguishing conditions that need immediate surgery from those managed medically. Common causes include acute appendicitis, perforated peptic ulcer, acute cholecystitis, acute pancreatitis, intestinal obstruction, mesenteric ischaemia, and ruptured ectopic pregnancy in women. Pain that begins periumbilically and shifts to the right iliac fossa suggests appendicitis, while sudden severe epigastric pain with board-like rigidity and free gas under the diaphragm points to perforation. Peritonitis produces guarding, rigidity, and rebound tenderness with absent bowel sounds, whereas colicky pain with distension and vomiting suggests obstruction. Referred pain patterns, such as shoulder-tip pain from diaphragmatic irritation and testicular pain from ureteric colic, help localise. Erect chest and abdominal radiographs detect free air and dilated bowel loops, ultrasound assesses the gallbladder and pelvis, and contrast computed tomography is the most informative imaging. Serum amylase and lipase confirm pancreatitis, and a pregnancy test is mandatory in women of reproductive age. Recognising peritonitis signs, the classic pain migrations, and the indications for urgent laparotomy are consistent exam anchors.
Key points
- **Definition:** Sudden severe abdominal pain of recent onset needing urgent assessment, often requiring emergency surgical intervention.
- **Appendicitis pain:** Pain starts periumbilically and migrates to the right iliac fossa. McBurney point tenderness, Rovsing, and psoas signs support it.
- **Perforation:** Sudden severe epigastric pain, board-like rigidity, and free gas under the diaphragm on erect film indicate hollow viscus perforation.
- **Peritonitis signs:** Guarding, rigidity, rebound tenderness, and silent abdomen signal peritoneal irritation requiring urgent surgical evaluation.
- **Obstruction:** Colicky central pain, distension, vomiting, and absolute constipation with dilated bowel loops and air-fluid levels on radiograph.
- **Biliary colic:** Right upper quadrant pain with a positive Murphy sign suggests acute cholecystitis, best assessed with ultrasound.
- **Pancreatitis:** Severe epigastric pain radiating to the back with raised serum lipase and amylase. Lipase is more specific than amylase.
- **Mesenteric ischaemia:** Pain out of proportion to examination findings in an elderly patient with atrial fibrillation suggests acute mesenteric ischaemia.
- **Gynaecological cause:** Always exclude ruptured ectopic pregnancy in women of reproductive age with a urine or serum pregnancy test.
- **Imaging:** Erect chest film shows free air, ultrasound assesses gallbladder and pelvis, and contrast CT is the most informative overall.
- **Referred pain:** Shoulder-tip pain reflects diaphragmatic irritation, and loin-to-groin pain suggests ureteric colic, aiding localisation.
Frequently Asked Questions
How does appendicitis pain typically present?
Pain starts around the umbilicus and migrates to the right iliac fossa, with tenderness at McBurney point and positive Rovsing and psoas signs.
What signs indicate peritonitis?
Guarding, board-like rigidity, rebound tenderness, and absent bowel sounds indicate peritoneal irritation and usually require urgent surgery.
Which imaging is most useful in acute abdomen?
Contrast-enhanced computed tomography is the most informative overall, while an erect chest radiograph is quick to detect free gas from perforation.
What must always be excluded in a woman with acute abdomen?
Ruptured ectopic pregnancy must be excluded in any woman of reproductive age using a pregnancy test before other workup.
Why is pain out of proportion important?
Severe pain with minimal examination findings, especially in an elderly patient with atrial fibrillation, suggests acute mesenteric ischaemia.
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