27. Acute Abdomen

Question 1

What is an acute abdomen?

Answer 1

Presence of signs and symptoms of inflammation in the peritoneum for less than 24 hours

Question 2

What are the inflammatory causes of an acute abdomen?

Answer 2

Appendicitis
Diverticulitis
Pancreatitis
Cholecystitis

Question 3

What are the obstructive causes of an acute abdomen?

Answer 3

Biliary colic
Small or large bowel obstruction
Intussusception

Question 4

What are the perforation causes of acute abdomen?

Answer 4

Peptic ulcer

Ruptured AAA

Question 5

What are the ischaemic causes of acute abdomen?

Answer 5

Bowel/mesenteric ischaemia
Torsion
Gynaecological

Question 6

What causes are more related to steady pain?

Answer 6

Inflammatory

Question 7

What causes are more related to crampy pain?

Answer 7

Obstructive

Question 8

What are the causes of sudden pain in an acute abdomen?

Answer 8

Perforation
Haemorrhage
Infarct

Question 9

What are the causes of gradual pain in an acute abdomen?

Answer 9

Peritoneal irritation

Distension

Question 10

What does pain radiating to the right shoulder suggest?

Answer 10

Gall bladder related

Question 11

What does pain radiating to the flank or groin suggest?

Answer 11

Kidney or ureter

Question 12

What does pain radiating to the back suggest?

Answer 12

AAA
PUD
Pancreatitis

Question 13

What are the most common causes of small bowel obstruction?

Answer 13

Hernias

Adhesions

Question 14

What should be looked for on palpation?

Answer 14

Tenderness
Rigidity
Guarding
Masses
Also check for AAA and hernias

Question 15

What 3 tests will completely change the management of a patient with acute abdomen?

Answer 15

Serum amylase/lipase
B-HCG (ie a pregnancy test)
Chest X ray

Question 16

When is an MRI used in an acute abdomen?

Answer 16

Only if the patient is pregnant

Question 17

What can be picked up on an angiography in an acute abdomen?

Answer 17

Mesenteric ischaemia

Question 18

What is the general management for a patient with an acute abdomen?

Answer 18

Oxygen
Fluids 
Analgesia
NG tube if vomiting
Urinary catheter

Question 19

What does sudden relief of pain in acute appendicitis suggest?

Answer 19

Perforation

Question 20

What is the specific management of acute appendicitis?

Answer 20

Appendicectomy

IV antibiotics are only continued if perforated

Question 21

What are the complications of acute appendicitis?

Answer 21

Perforation
RIF abscess, pelvic abscess
Adhesions
Sepsis

Question 22

How do posterior peptic ulcers present?

Answer 22

Can erode through the gastroduodenal artery, causing a haemorrhage

Question 23

How do anterior peptic ulcers present?

Answer 23

Perforation and acute abdomen

Question 24

How do perforated peptic ulcers present?

Answer 24

Intense steady pain
Patient feels they need to lie still
Well localised burning/gnawing/aching pain

Question 25

What is the management of a perforated peptic ulcer?

Answer 25

Laparotomy

Graham patch

Question 26

What is a Graham patch?

Answer 26

Ulcer is covered with omentum

Question 27

Apart from pancreatitis, what disease can increase serum amylase to 3 times normal?

Answer 27

Mumps

Question 28

How is a small bowel obstruction seen on an abdominal x ray?

Answer 28

Horizontal lines