Abdominal pain (acute and chronic)

Suspected rupture (pain + collapse + pulsatile mass) → immediate vascular surgery; do NOT delay a haemodynamically unsta

Severe pancreatitis (Glasgow ≥3 / persistent organ failure) → HDU/ITU, high mortality

Generalised peritonitis (perforation) → emergency

New/worsening pain + weight loss → exclude pancreatic cancer (chronic pancreatitis raises the risk)

Intestinal perforation/GI bleeding (third week) → surgical emergency

Generalised peritonitis with free gas → emergency resuscitation + surgery

Strangulation (tender, irreducible, red, painful lump + obstruction/peritonism) → emergency surgery

C. difficile with toxic megacolon, ileus, shock, or rising lactate/WCC → severe disease, surgical input

Severe dehydration/shock; bloody diarrhoea (dysentery); EHEC O157 → HUS (no antibiotics); enteric fever (typhoid — trave

Acute mesenteric ischaemia (pain out of proportion + raised lactate ± AF) → emergency surgery/revascularisation — high m

Strangulation/ischaemia (constant pain, peritonism, fever, raised lactate) → emergency surgery

Red flags → investigate, NOT IBS: rectal bleeding, weight loss, anaemia, nocturnal symptoms, family history of bowel/ova

Significant GI bleeding; obstruction/intussusception; diverticulitis/perforation

Do not miss appendicitis — if in doubt, observe/image/operate

Persistent bloating/abdominal symptoms in a woman >50 → check CA125 (and refer)

Thrombosis from hyperviscosity

ALARM features (dysphagia, weight loss, anaemia, GI bleeding, age ≥55 new dyspepsia) → urgent endoscopy

Generalised peritonitis + sepsis → emergency

Concealed abruption (shock disproportionate to visible blood), fetal distress, DIC, Couvelaire uterus

A non-blanching rash in an unwell/febrile patient (especially a child) = MENINGOCOCCAL SEPSIS until proven otherwise → i

OBSTRUCTED + infected kidney (pyonephrosis) — stone/obstruction with infection → EMERGENCY decompression (nephrostomy/st

STOP the transfusion immediately for any significant reaction and reassess (ABCDE); recheck the patient/unit identity

Fever, loin pain, rigors or systemic upset → pyelonephritis/urosepsis → escalate (see pyelonephritis)

ST elevation / new LBBB → primary PCI within 120 min of first medical contact (thrombolysis if PCI not available in time

Hypoglycaemia, coagulopathy, encephalopathy → fulminant hepatic failure; maternal and fetal emergency

Refractory shock with low Na+ / high K+ / low glucose → give hydrocortisone without waiting for cortisol result

SBP (ascitic neutrophils ≥250) → antibiotics + albumin; high mortality and recurrence

Acute severe flare, obstruction (stricture), abscess/fistula, perforation, toxic dilatation → urgent

Reduced consciousness, shock, K+ <3.5 before insulin, severe acidosis (pH <7.1) → HDU/ICU

Complicated diverticulitis (peritonitis, abscess, perforation, obstruction, fistula) → same-day surgical assessment + CT