The differential diagnosis of<unk>  includes: #<unk>  appendicitis #<unk>  peptic ulcer and its complications #<unk>  cholecystitis #<unk>  pancreatitis #<unk>  intestinal ischemia (see section below) #<unk>  diverticulitis # Ectopic pregnancy with tubal rupture # Ovarian torsion #<unk>  peritonitis (including hollow viscus perforation) #<unk>  ureteric colic # Bowel volvulus # Bowel obstruction #<unk>  pyelonephritis # Adrenal crisis # Biliary colic #<unk> al aortic aneurysm # Familial Mediterranean fever # Hemoperitoneum # Ruptured spleen # Kidney stone # Sickle cell anaemia # Carcinoid Peritonitis<unk>  is occasionally used synonymously with peritonitis. While this is not entirely incorrect, peritonitis is the more specific term, referring to inflammation of the peritoneum. It manifests on physical examination as rebound tenderness, or pain upon removal of pressure more than on application of pressure to the<unk> . Peritonitis may result from several of the above diseases, notably appendicitis and pancreatitis. While rebound tenderness is commonly associated with peritonitis, the most specific finding is rigidity. Ischemic<unk>  Vascular disorders are more likely to affect the small bowel than the large bowel. Arterial supply to the intestines is provided by the superior and inferior mesenteric arteries (SMA and IMA respectively), both of which are direct branches of the aorta. The superior mesenteric artery supplies: # Small bowel # Ascending and proximal two-thirds of the transverse colon The inferior mesenteric artery supplies: # Distal one-third of the transverse colon # Descending colon # Sigmoid colon Of note, the splenic flexure, or the junction between the transverse and descending colon, is supplied by the most distal portions of both the inferior mesenteric artery and superior mesenteric artery, and is thus referred to medically as a watershed area, or an area especially vulnerable to ischemia during periods of systemic hypoperfusion, such as in shock.<unk>  of the ischemic variety is usually due to: # A thromboembolism from the left side of the heart, such as may be generated during atrial fibrillation, occluding the SMA. # Nonocclusive ischemia, such as that seen in hypotension secondary to heart failure, may also contribute, but usually results in a mucosal or mural infarct, as contrasted with the typically transmural infarct seen in thromboembolus of the SMA. # Primary mesenteric vein thromboses may also cause ischemic<unk> , usually precipitated by hypercoagulable states such as polycythemia vera. Clinically, patients present with diffuse<unk> al pain, bowel distention, and bloody diarrhea. On physical exam, bowel sounds will be absent. Laboratory tests reveal a neutrophilic leukocytosis, sometimes with a left shift, and increased serum amylase.<unk> al radiography will show many air-fluid levels, as well as widespread edema.<unk>  ischemic<unk>  is a surgical emergency. Typically, treatment involves removal of the region of the bowel that has undergone infarction, and subsequent anastomosis of the remaining healthy tissue.
Acute abdomen
Acute pancreatitis
Hemoperitoneum
Pneumoperitoneum
Devon colic
Gallstone ileus
Retroperitoneal bleeding
Abdominal compartment syndrome