Acute abdomen: investigations

The term 'acute abdomen' encompasses a spectrum of medical and surgical conditions ranging from the trivial to the life threatening that require hospital admission, investigation and treatment. A careful, methodical approach (including history taking, clinical examination and investigation) is necessary in the management of acute abdomen. The immediate goal is to ascertain if emergency surgery is indicated. Patients must be adequately resuscitated while being investigated if immediate surgery is not required. Initial management includes assessment of the airway, breathing and circulation, and establishing respiratory and cardiovascular stability. Occasionally, resuscitation and surgical intervention may have to be undertaken simultaneously. A detailed clinical history must be obtained because it provides important clues to the differential diagnosis. The initial step in the clinical examination is to document the vital signs (including pulse rate and rhythm, blood pressure, respiratory rate, temperature, Glasgow Coma Score). A thorough general physical examination, abdominal examination and examination of other relevant systems must be performed. The signs must be interpreted in conjunction with history, general condition, age, sex and potential risk factors. Investigations must be aimed at establishing the diagnosis, determining the need for surgical intervention and assessing the fitness of the patient for intervention. The common laboratory and radiological tests used in the diagnosis of the acute abdomen are discussed in this contribution. A laparotomy or a laparoscopy may be the ultimate diagnostic investigation in the difficult patient (in addition to being therapeutic).