Identify a red flag in an adult acute abdomen history that requires urgent evaluation.

• A. Mild cramping relieved by antacids
• B. Sudden severe abdominal pain with peritoneal signs
• C. Chronic dull pain with stable vitals
• D. Gradual onset pain improving with food

Answer: (B)

A sudden onset of severe abdominal pain with signs of peritoneal irritation signals an acute surgical abdomen. When the abdomen is rigid, with guarding or rebound tenderness, it means the peritoneum is inflamed or irritated, often due to serious conditions like perforation, peritonitis, or intestinal ischemia. These situations can deteriorate quickly, so they require urgent evaluation, imaging, IV access, fluid resuscitation, and prompt surgical consultation. In contrast, mild cramping relieved by antacids, chronic dull pain with stable vitals, or gradual pain that improves with food typically point to non-urgent, non-emergent processes such as gastritis, functional pain, or peptic ulcers without current life-threatening signs.