Acute Abdomen

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Acute abdomen is sudden onset of severe abdominal pain, which may require surgical intervention. Some medical conditions may present as acute abdominal pain.

This section will only cover indications for antibiotic treatment, for full guidance on the treatment of acute abdomen see full Ghana STG.

Cause

  • Inflammatory conditions e.g. appendicitis, salpingitis, cholecystitis
  • Perforations e.g. typhoid, peptic ulcer, trauma 
  • Intestinal obstruction e.g. strangulated hernia, adhesions, volvulus
  • Haemorrhage e.g. ruptured ectopic pregnancy, ruptured spleen
  • Acute pancreatitis
  • Colics e.g. ureteric, biliary or intestinal 
  • Medical conditions e.g. diabetic ketoacidosis, gastro-enteritis, gastritis, malaria, pneumonia, UTI, sickle cell crises, adrenocortical crises, porphyria, nephrotic syndrome

Investigations

  • FBC
  • Blood film for malaria parasites
  • Sickling test
  • Chest X-ray  
  • Plain abdominal X-ray (erect and supine) 
  • 4-quadrant abdominal tap  
  • Random blood glucose
  • Urine examination 
  • BUE and Creatinine
  • Ultrasound scan of abdomen  

TreatmentTreatment Objectives

  • To control infection if present
  • To treat the underlying cause

Pharmacological treatment 

For infectious conditions, perforations and intestinal obstruction

1st Line Treatment 

Evidence Rating: [B]

  • Gentamicin, IV/IM,  

Adults

1-1.5 mg/kg 8 hourly

Children 

2.5 mg/kg 8 hourly  

Do not give if urine output is less than 30 ml/hour. Avoid in renal impairment.

And

  • Metronidazole, IV, 

Adults

500 mg 8 hourly 

Children 

7.5 mg/kg 8 hourly

2nd Line Treatment 

Evidence Rating: [B]

  • Ceftriaxone, IV, 

Adults 

1-2 g daily

Children 

50 mg/kg daily

Further treatment will depend on the diagnosis.

And

  • Metronidazole, IV, 

Adults

500 mg 8 hourly 

Children 

7.5 mg/kg 8 hourly

3rd Line Treatment 

Evidence Rating: [B]

  • Ciprofloxacin, IV,

Adults 

400 mg 8-12 hourly infused over 30-60 minutes (may be added for  typhoid perforation)

Children (Use only when benefit outweighs the risk)

5-12 years; 10 mg/kg 12 hourly

1-5 years; 5 mg/kg 12 hourly

< 1 year; not recommended

And

  • Metronidazole, IV, 

Adults

500 mg 8 hourly 

Children 

7.5 mg/kg 8 hourly