27. Acute Abdomen Flashcards
What is an acute abdomen?
Presence of signs and symptoms of inflammation in the peritoneum for less than 24 hours
What are the inflammatory causes of an acute abdomen?
Appendicitis
Diverticulitis
Pancreatitis
Cholecystitis
What are the obstructive causes of an acute abdomen?
Biliary colic
Small or large bowel obstruction
Intussusception
What are the perforation causes of acute abdomen?
Peptic ulcer
Ruptured AAA
What are the ischaemic causes of acute abdomen?
Bowel/mesenteric ischaemia
Torsion
Gynaecological
What causes are more related to steady pain?
Inflammatory
What causes are more related to crampy pain?
Obstructive
What are the causes of sudden pain in an acute abdomen?
Perforation
Haemorrhage
Infarct
What are the causes of gradual pain in an acute abdomen?
Peritoneal irritation
Distension
What does pain radiating to the right shoulder suggest?
Gall bladder related
What does pain radiating to the flank or groin suggest?
Kidney or ureter
What does pain radiating to the back suggest?
AAA
PUD
Pancreatitis
What are the most common causes of small bowel obstruction?
Hernias
Adhesions
What should be looked for on palpation?
Tenderness Rigidity Guarding Masses Also check for AAA and hernias
What 3 tests will completely change the management of a patient with acute abdomen?
Serum amylase/lipase
B-HCG (ie a pregnancy test)
Chest X ray
When is an MRI used in an acute abdomen?
Only if the patient is pregnant
What can be picked up on an angiography in an acute abdomen?
Mesenteric ischaemia
What is the general management for a patient with an acute abdomen?
Oxygen Fluids Analgesia NG tube if vomiting Urinary catheter
What does sudden relief of pain in acute appendicitis suggest?
Perforation
What is the specific management of acute appendicitis?
Appendicectomy
IV antibiotics are only continued if perforated
What are the complications of acute appendicitis?
Perforation
RIF abscess, pelvic abscess
Adhesions
Sepsis
How do posterior peptic ulcers present?
Can erode through the gastroduodenal artery, causing a haemorrhage
How do anterior peptic ulcers present?
Perforation and acute abdomen
How do perforated peptic ulcers present?
Intense steady pain
Patient feels they need to lie still
Well localised burning/gnawing/aching pain
What is the management of a perforated peptic ulcer?
Laparotomy
Graham patch
What is a Graham patch?
Ulcer is covered with omentum
Apart from pancreatitis, what disease can increase serum amylase to 3 times normal?
Mumps
How is a small bowel obstruction seen on an abdominal x ray?
Horizontal lines
