Orthostatic blood pressure and pulse changes help ascertain the patient's volume status. Fever occurs in inflammatory conditions. Tachycardia and hypotension would suggest circulatory or septic shock from perforation, hemorrhage, or fluid loss into the intestinal lumen or peritoneal cavity. Sudden onset suggests perforated ulcer, mesenteric occlusion, ruptured aneurysm or ruptured ectopic pregnancy.
Intestinal colic occurs as cramping abdominal pain interspersed with pain-free intervals.
Vomiting may result from intestinal obstruction or could result from a visceral reflex caused by pain. Acute cholecystitis Right upper quadrant tenderness and guarding, positive Murphy's sign, may radiate to right scapula. High Small Bowel obstruction Severe vomiting, dehydration, no distention Low Small Bowel obstruction Distention, hyperactive and high pitched bowel sounds, vomiting. The initial goal in evaluating a patient with abdominal pain is to determine whether or not surgical treatment is indicated to prevent further morbidity. Among the elderly and those on steroids , abdominal pain may be mild despite the presence of an acute abdomen.