1-The site of pain is of utmost importance: While the abdomen might be, as it was once called, a magic box for the physician the site of pain usually gives useful hints as to what lies inside and to what course of action our investigations should take. 2-Rigidity does not necessarily mean surgery: Extra-abdominal sources of abdominal pain should be kept in mind, such as the thorax, pelvis, the abdominal wall, as well as the metabolic and neurogenic conditions that might mimic intra abdominal pathology. 3-Guarding does not necessarily mean surgery either: Guarding is found also in conditions such as severe bowel inflammation or enterocolitis. It is more deceitful than rigidity, so one should use the old trick of distracting the patient's attention when trying to elicit it. 4-Light analgesia is not contraindicated even if acute abdomen is considered:There are many studies showing that the administration of analgesics to patients with acute abdominal pain effectively relieves pain while not altering the ability of physicians to accurately evaluate and treat patients. 5-The diagnosis might be difficult in extremes of age: One should be very careful when making the diagnosis of abdominal pain in the elderly. In these individuals mild complaints might hide surgical conditions. 6-Make use but not abuse of laparoscopy: While laparoscopy in emergencies might offer a definitive diagnosis to most and cure to many, with little discomfort to patients, it is an invasive technique that carries a specific morbidity. The diagnosis of acute abdominal pain is an exciting one. It can provide intellectual stimulation for physicians of all ages and much reward when timely action leads to the recovery of the patients.
