31st July 2023

Management

Focused management depends on the underlying cause, as outlined above.

Immediate management follows the ABCDE approach, as patients with an acute abdomen are often acutely unwell and may be haemodynamically unstable.

The key aspects of management may include:

• Oxygen, titrated as required
• Fluid resuscitation with IV fluids  – patients with blood loss or acute pancreatitis may need aggressive fluid resuscitation
• Blood products  – group and save/cross matches should be immediately sent in patients at risk of blood loss/actively bleeding, and massive haemorrhage protocol may be required
• Analgesia  – including the use of parenteral opioids
• Antiemetics  – often needs to be given IV
• Antibiotics  – depending on underlying cause
• Nasogastric tube  – especially if severe vomiting or suspicion of bowel obstruction

Generally, definitive management is surgical. Any patient presenting with an acute abdomen should therefore be urgently referred to the surgical or gynaecological team, as appropriate, once the most likely diagnosis is established. Any patient presenting with an acute abdomen should be kept nil by mouth until review by the specialty team, in case emergency surgery is required.