Editing The acute abdomen (section)

=== Specific syndromes ===

** Ischaemic bowel - almost all visceral, until transmural ischaemia is present
** Splenic infarct - almost all peritoneal
** Acute salpingitis - all peritoneal
** Acute appendicitis - visceral then peritoneal
** Perforation - chemical peritonitis causes severe peritonitis, whereas gas does not cause as much peritonitis
*** Sigmoid diverticulitis - generally not much peritonism
*** Perf gastric ulcer - rapid pain and peritonism
** Acute pancreatitis - both visceral and peritoneal
** Capsule stretching - visceral (ovary, liver)
** Biliary obstruction - epigastric discomfort
** LBO - hypogastric discomfort
** Ureteric colic - peristalsis is less prominent, so pain is somewhat constant, with exacerbations. Can radiate to groin or even lower, to the testicle or labia, but does not radiate to the back of the leg. 
** Kidney pain - constant gnawing pain in loin/renal angle.

* Patients experiencing paroxysms colic should be unable to lie still. This pain relates to distension and would be experienced in areas of visceral pain referral. Once the actual somatic nerves in parietal peritoneum are affected, pain localises.
* Beware patients taking steroids, who may have a smaller inflammatory response and therefore less tenderness and systemic infective features.