12. Acute Abdomen Flashcards
What is the acute abdomen?
Severe abdominal pain
Duration 5 days or less
Very wide range of differnetials (may include basal pneumonias and MI’s)
What is important to keep in mind before delivering an abdominal x-ray
patient must be erect/semi erect for ten minutes to get rid of intra-peritoneal gas
When is a supine abdo x-ray useful?
Sigmoid volvulus, possible toxic megacolon, confirming obstructoin, looking for kidney stones but avoiding CT dose
What other abdominal investigation is useful?
Ultrasound of abdo and pelvis. Good for
Acute cholycystitis, ovarian athology, acute appendicitis (rule out everything except appendicitis), renal swellings.
What are emergency conditions for patients with abdominal pain?
Intra-abdominal heamorrhage
Viscus organ perforation
Mesenteric ischaemia
Bowel obstruction
Describe the course of a perforation
Typically caused by a perforated ulcer or colonic diverticulitis.
Leads to perotinitis inflammation in the peritoneum
Requires prompt surgical management and a washout to prevent bowel contents from causing abdominal sepsis
What are the symptoms of peritonitis?
Rock solid abdomen (involuntary guarding)
Patient lying completely still
Increased lactate and inflammatory markers
What is the first line investigation for a perforated bowel?
Erect chest x-ray, sensitive to free gas. must be upright for at least 10 minutes.
What is a bowel obstruction?
Physical obstruction of the bowel causing widening of proximal bowel and collapse of distal bowel.
What are the symptoms of a bowel obstruction?
Choliky abdominal pain
Nausea and vomiting
Absolute constipation (no constipation or faeces)
Absent bowel sounds
Deranged obs, increased blood lactate and inflammation
What is the best test for a bowel obstruction?
CT is test of choice to see obstruction
Abdo x-ray may look normal. Only test of choice when individual has had a previous sigmoid volvulous
What is a sigmoid volvulus?
Twisting of sigmoid colon causing obstruction. More common after surgery causing adhesions in the bowel.
What are the causes of a small bowel obstruction?
Adhesions, hernias - most common
May also be strictures, tumours, intusussception, volvulus, foreign bodies
How do you diagnose an abdominal adhesions from a CT
It is a diagnosis of exclusion as they cant be seen on CT
What is meant by the coffee bean sign?
In reference to a sigmoid volvulus, dialted, necrotic sigmoid colon has the appearance of a coffee bean on an abdominal x-ray.
What are the symptoms of a ruptured AAA?
Generalised abdominal back pain/loin pain Collapse Hypotensive Pulsatile abdominal mass Lower limb ischemia
What is mesenteric ischemia?
Injury to the small intestine typically due to vascular disease leading to ischemic changes.
What are the signs of mesenteric ischemia?
Generalised abdo pain out of proportion to the examiantion
Unremarkable abdominal exam
High lactate
What abdominal issues may be present if there is pain in the right upper quadrant?
Cholecystitis Pyelonephritis Ureteric colic Hepatitis Pneumonia
What abdominal issues may be present if there is pain in the left upper quadrant?
Gastric Ulcer
Pyelonephritis
Ureteric colic
Pneumonia
What abdominal issues may be present if there is pain in the right lower quadrant?
Appendicitis Ureteric Colic Inguinal hernia IBD UTI Gynaecological Testicular torsion
What abdominal issues may be present if there is pain in the left lower quadrant?
Diverticulitis Ureteric colic Inguinal hernia IBD UTI Gynae problems Testicular torsion
Describe the presentation of cholecystitis?
Sudden RUQ pain radiating to the back
Murphy’s sign (palpate and breathe in, gall bladder hits hand. Big ouchy). Increased inflammatory markers
Charcot’s triad- fevre, RUQ pain, Jaundice
Shock and altered mental state- obstructive picture
What is the diagnostic criteria of pancreatitis?
acute onset of severe epigastric pain
Elevated amylase/lipase
Imaging features consistent on CT, MRI, US
