17. The Acute Abdomen

Question 1

Define acute abdomen.

Answer 1

A combination of symptoms and signs, including abdominal pain, which results in a patient being referred for an urgent general surgical opinion.

Question 2

List main causes of acute abdomen.

Answer 2

• Non-specific pain (30-45%)
• Acute appendicitis (20-25%)
• Acute cholecystitis/ colic
• Peptic ulcer perforation
• Urinary retention

Question 3

What is the pathophysiology of acute abdomen?

Answer 3

Consider:

• Peritonitis
• Intestinal obstruction
• Ischaemia
• Non-surgical abdominal pain

Question 4

Peritonitis: what are the routes of infection?

Answer 4

Perforation of GI/ biliary tract
Female genital tract
Penetration of abdominal wall
Haematogenous spread