a cute abdomen Flashcards
Statements
Notes
{{c1::Acute abdomen}} refers to a condition where symptoms and signs are primarily related to the {{c2::abdomen}}.
Acute abdomen requires careful evaluation, often necessitating repeated examination to decide if surgical intervention is needed.
Clinical syndromes that usually require {{c1::laparotomy}} include {{c2::rupture}} of an organ and generalized {{c2::peritonitis}}.
Laparotomy is often essential in cases of organ rupture (e.g., spleen, ectopic pregnancy) or when peritonitis is present.
A key sign of organ rupture is {{c1::shock}}, often accompanied by {{c2::abdominal swelling}}.
Shock indicates significant internal bleeding or trauma, which may require immediate surgical intervention.
Peritonitis presents with {{c1::board-like abdominal rigidity}} and {{c2::no bowel sounds}}.
These signs are classic indicators of peritonitis, a condition that often requires emergency surgery.
An {{c1::erect CXR}} may show {{c2::gas under the diaphragm}} in cases of perforated abdominal organs.
Free gas under the diaphragm on an erect chest X-ray suggests perforation, typically of the gastrointestinal tract.
{{c1::Local peritonitis}} may not require laparotomy and can be managed with {{c2::drainage}} or antibiotics.
Conditions like diverticulitis or cholecystitis can cause localized peritonitis, which might be treated with less invasive methods.
{{c1::Colic}} is characterized by {{c2::waxing and waning}} pain, often due to muscular spasm in a hollow viscus.
Unlike peritonitis, colic causes restlessness, and patients may be pacing around due to the intermittent pain.
Tests for acute abdomen include {{c1::U&E}}, {{c2::FBC}}, and {{c2::amylase}} to help identify the underlying cause.
These tests help assess the patient’s metabolic state, organ function, and potential causes like pancreatitis.
Preoperative management involves resuscitation, {{c1::imaging}}, and {{c2::IV antibiotics}} to stabilize the patient.
Before surgery, it is crucial to stabilize the patient to minimize anesthesia-related risks and prepare for potential complications.
Always consider hidden diagnoses like {{c1::mesenteric ischemia}}, {{c2::acute pancreatitis}}, and {{c2::leaking AAA}} in cases of acute abdomen.
These conditions can present with non-specific symptoms but are life-threatening and require a high index of suspicion.
{{c1::Shock}} in the context of an acute abdomen may indicate {{c2::rupture}} of an organ or severe {{c2::peritonitis}}.
Shock is a critical sign and often requires urgent surgical intervention to address the underlying cause.
{{c1::Delayed rupture}} of the spleen can occur {{c2::weeks}} after trauma.
Patients with a history of blunt abdominal trauma should be monitored for delayed splenic rupture, which may present later.
{{c1::Generalized peritonitis}} is characterized by {{c2::prostration}}, lying still, and a positive {{c2::cough test}}.
These signs suggest widespread inflammation within the abdominal cavity, often requiring immediate surgical exploration.
{{c1::Acute pancreatitis}} can mimic peritonitis but typically does {{c2::not require}} a laparotomy.
Acute pancreatitis is an important differential diagnosis in patients presenting with an acute abdomen.
Localized ileus with a {{c1::sentinel loop}} of gas on an AXR may indicate {{c2::peritoneal inflammation}}.
A sentinel loop on imaging suggests localized irritation of the peritoneum, often due to nearby infection or inflammation.
{{c1::Laparoscopy}} can sometimes {{c2::avert open surgery}} in the management of acute abdomen.
Minimally invasive techniques like laparoscopy can be diagnostic and therapeutic, reducing the need for more invasive procedures.
{{c1::Mesenteric ischemia}}, {{c2::acute pancreatitis}}, and {{c2::leaking AAA}} are often hidden diagnoses in acute abdomen cases.
These conditions can be easily missed due to their subtle presentation but are highly dangerous and require prompt recognition.
{{c1::CT}} and {{c2::US}} are valuable imaging modalities in evaluating an acute abdomen, especially when surgery is being considered.
These imaging techniques help confirm diagnoses like perforation, abscess, or fluid collections that guide further management.
In acute abdomen, {{c1::resuscitation}} before surgery is essential to avoid compounding {{c2::shock}}.
Proper stabilization of the patient before surgery reduces the risk of complications during and after the procedure.
A {{c1::positive urine hCG}} in a woman with acute abdomen symptoms may indicate an {{c2::ectopic pregnancy}}.
Ectopic pregnancy is a critical differential diagnosis in women of childbearing age presenting with acute abdominal pain.
{{c1::Ruptured ectopic pregnancy}} can lead to {{c2::life-threatening hemorrhage}} and requires immediate intervention.
Rapid diagnosis and treatment are critical to prevent severe blood loss and shock.
{{c1::Guarding}} and {{c2::rebound tenderness}} are classic signs of {{c2::peritonitis}}.
These physical exam findings indicate irritation of the peritoneum, often due to infection or perforation.
{{c1::Abscess formation}} in cases of localized peritonitis may require {{c2::drainage}}, either percutaneous or surgical.
Imaging, such as ultrasound or CT, is used to guide drainage and manage the infection.
{{c1::Colicky pain}} is typically due to {{c2::muscular spasm}} in a hollow organ and presents with {{c2::restlessness}}.
Colicky pain, often seen in conditions like ureteral stones or biliary colic, contrasts with the stillness of peritonitis.
{{c1::Erect CXR}} showing {{c2::gas under the diaphragm}} is suggestive of a {{c2::perforated viscus}}.
Free air in the abdomen indicates perforation, typically from the gastrointestinal tract, requiring urgent surgical attention.
{{c1::Appendicitis}} often presents with localized pain in the {{c2::right lower quadrant}} and may progress to {{c2::peritonitis}}.
Early diagnosis and surgical removal of the appendix are necessary to prevent complications like abscess or perforation.
{{c1::Sentinel loop}} on an AXR suggests localized {{c2::ileus}} due to peritoneal irritation.
The sentinel loop is a sign of a localized bowel obstruction or irritation, often near an inflamed organ like the pancreas.
{{c1::Leaking abdominal aortic aneurysm (AAA)}} presents with {{c2::back pain}}, hypotension, and a pulsatile abdominal mass.
This condition is life-threatening and requires immediate surgical intervention to prevent rupture and exsanguination.
{{c1::IV antibiotics}} are critical in managing {{c2::peritonitis}} to prevent the spread of infection and sepsis.
Early antibiotic administration can be life-saving, particularly in cases of bacterial peritonitis.
{{c1::Diabetic ketoacidosis (DKA)}} can present with {{c2::abdominal pain}} and mimics an acute abdomen.
DKA is a metabolic emergency often misinterpreted as a surgical abdomen but requires medical management.
{{c1::Myocardial infarction (MI)}} can present as an acute abdomen, particularly with {{c2::epigastric pain}}.
An MI should always be considered in patients with unexplained epigastric pain, especially in the elderly or those with risk factors.
{{c1::Pneumonia}} in the lower lobes can mimic {{c2::abdominal pain}} due to diaphragmatic irritation.
This type of referred pain can lead to a misdiagnosis of an acute abdomen, so a thorough chest exam is essential.
{{c1::Pancreatitis}} can cause severe {{c2::epigastric pain}} radiating to the back, often without the need for surgery.
Acute pancreatitis is primarily managed medically, although severe cases may require more intensive interventions.
{{c1::Ectopic pregnancy}} should always be excluded in women with acute abdomen using {{c2::serum or urine hCG}}.
This condition is a common and dangerous cause of abdominal pain in women of reproductive age.
{{c1::Perforated peptic ulcer}} typically presents with sudden, severe {{c2::epigastric pain}} and signs of peritonitis.
This is a surgical emergency, often requiring immediate laparotomy to prevent widespread peritonitis.
{{c1::Abdominal distension}} with absent bowel sounds suggests {{c2::bowel obstruction}} or {{c2::paralytic ileus}}.
Both conditions can present with similar symptoms but have different causes and management strategies.
{{c1::Rigler’s sign}}, seen on an AXR, indicates {{c2::free air}} on both sides of the bowel wall, suggestive of perforation.
Rigler’s sign is a key radiographic indicator of a perforated gastrointestinal tract.
{{c1::Cross-matching blood}} is essential before surgery in acute abdomen cases with potential {{c2::hemorrhage}}.
Ensuring adequate blood availability is crucial in managing patients who may require transfusions during surgery.
{{c1::Sickle-cell crisis}} can present with severe abdominal pain, mimicking {{c2::acute abdomen}}.
In sickle-cell patients, abdominal pain may be due to vaso-occlusive crises rather than a surgical emergency.
{{c1::Phaeochromocytoma}} can cause abdominal pain due to {{c2::hypertensive crises}} but is not a surgical abdomen.
This condition involves catecholamine-secreting tumors that lead to episodic hypertension and pain.
{{c1::Zoster (shingles)}} may present with abdominal pain before the {{c2::rash}} appears, mimicking an acute abdomen.
Zoster-related abdominal pain is due to nerve inflammation and should be differentiated from visceral causes.
{{c1::Periumbilical pain}} that migrates to the {{c2::right lower quadrant}} is a classic presentation of {{c2::appendicitis}}.
This migration of pain is due to the progression of inflammation in the appendix.
{{c1::Henoch-Schönlein purpura}} can cause abdominal pain due to {{c2::intestinal vasculitis}}, mimicking an acute abdomen.
This condition often presents with purpura, joint pain, and gastrointestinal symptoms, complicating the diagnosis.
{{c1::Lead colic}} presents with severe abdominal pain and is associated with {{c2::lead poisoning}}.
Lead colic is a rare cause of abdominal pain and requires a high index of suspicion, particularly in at-risk populations.
{{c1::Typhoid fever}} can cause {{c2::abdominal pain}} and mimic an acute abdomen due to {{c2::mesenteric lymphadenitis}}.
The abdominal pain in typhoid fever is typically accompanied by systemic signs like fever and malaise.
{{c1::Cholecystitis}} presents with right upper quadrant pain, often with {{c2::Murphy’s sign}} on examination.
Murphy’s sign is elicited by asking the patient to inhale while pressing under the right costal margin, causing pain if positive.
{{c1::Diverticulitis}} typically presents with {{c2::left lower quadrant}} pain and may lead to localized peritonitis.
The sigmoid colon is the most common site of diverticulitis, which can lead to abscess or perforation.
{{c1::Electrolyte imbalances}}, such as {{c2::hypokalemia}}, can cause ileus and mimic a bowel obstruction.
Electrolyte disturbances should be corrected to resolve the ileus and prevent further complications.
{{c1::Ultrasound}} is particularly useful in diagnosing {{c2::gallbladder disease}} and guiding drainage of abscesses.
Ultrasound is often the first-line imaging modality for evaluating biliary pathology and detecting fluid collections.
{{c1::Urinalysis}} is critical in excluding {{c2::urinary tract infection}} and {{c2::kidney stones}} in patients with abdominal pain.
Urinary tract pathology can present with lower abdominal pain and may be confused with gastrointestinal causes.
{{c1::Diverticulitis}} often presents with {{c2::left lower quadrant pain}} and may be accompanied by fever and leukocytosis.
Diverticulitis involves inflammation of diverticula in the colon, commonly the sigmoid, and can lead to complications like abscess or perforation.
{{c1::Rebound tenderness}} is a key sign of {{c2::peritonitis}}, indicating irritation of the peritoneal lining.
Rebound tenderness occurs when pain intensifies after pressure on the abdomen is quickly released.
{{c1::Murphy’s sign}} is positive when pain occurs upon palpation of the {{c2::right upper quadrant}} during inspiration, indicating cholecystitis.
This sign is useful in diagnosing gallbladder inflammation, typically caused by gallstones.
{{c1::Mesenteric ischemia}} presents with severe abdominal pain out of proportion to physical findings.
This condition is due to inadequate blood flow to the intestines and can lead to bowel necrosis if not treated promptly.
{{c1::Acute appendicitis}} often starts with vague periumbilical pain that later localizes to the {{c2::right lower quadrant}}.
The initial pain is due to visceral irritation, while later pain localizes as the parietal peritoneum becomes involved.
{{c1::Hyperactive bowel sounds}} followed by {{c2::silent abdomen}} may indicate bowel obstruction progressing to {{c2::paralytic ileus}}.
The transition from active to absent bowel sounds reflects worsening bowel function, often requiring surgical intervention.
{{c1::Upper GI perforation}} can cause {{c2::free air under the diaphragm}} visible on an erect CXR.
This finding is a key diagnostic clue in cases of perforated peptic ulcer disease.
{{c1::Pain radiating to the back}} is characteristic of {{c2::acute pancreatitis}} or an aortic aneurysm.
Both conditions can cause severe, deep-seated pain that radiates posteriorly, necessitating prompt evaluation and management.
{{c1::Abdominal pain with hypotension}} in an elderly patient may suggest a {{c2::leaking abdominal aortic aneurysm}}.
A leaking AAA is a vascular emergency that requires immediate surgical repair to prevent rupture and death.
{{c1::Shock with an acute abdomen}} may result from massive hemorrhage, often due to a ruptured {{c2::ectopic pregnancy}} or {{c2::splenic rupture}}.
Rapid identification and treatment of the source of bleeding are crucial to prevent further deterioration.
{{c1::Atypical myocardial infarction (MI)}} may present as {{c2::epigastric pain}}, especially in elderly or diabetic patients.
This presentation can be mistaken for a gastrointestinal issue, delaying appropriate cardiac treatment.
{{c1::Henoch-Schönlein purpura (HSP)}} can cause {{c2::abdominal pain}} due to vasculitis, often accompanied by a characteristic purpuric rash.
HSP affects small blood vessels, leading to gastrointestinal symptoms that may mimic surgical causes of abdominal pain.
{{c1::Peritonitis}} is suggested by a rigid, board-like abdomen and is often accompanied by {{c2::absent bowel sounds}}.
These physical exam findings indicate severe inflammation of the peritoneum, typically due to infection or perforation.
{{c1::Testicular torsion}} can present with lower abdominal pain, mimicking an acute abdomen, particularly in young males.
Testicular torsion is a urological emergency requiring prompt surgical intervention to save the testicle.
{{c1::Pancreatic pseudocysts}} can cause persistent epigastric pain and are a complication of {{c2::chronic pancreatitis}}.
These fluid-filled sacs can lead to pain, infection, or rupture and may require drainage or surgery.
{{c1::Laparotomy}} is often indicated in cases of {{c2::ruptured hollow viscus}}, such as a perforated bowel or stomach.
The primary goal of laparotomy is to repair the perforation and prevent widespread infection and sepsis.
{{c1::CT scanning}} is particularly useful for diagnosing {{c2::mesenteric ischemia}} and can help avoid unnecessary surgery.
CT can detect signs of bowel ischemia, such as bowel wall thickening and pneumatosis, providing a clear diagnosis.
{{c1::Pneumonia}} presenting with {{c2::abdominal pain}} is more common in the elderly and can be confused with an acute abdomen.
Diaphragmatic irritation in lower lobe pneumonia can cause referred pain to the abdomen, misleading the diagnosis.
{{c1::WBC count elevation}} in an acute abdomen suggests an {{c2::inflammatory or infectious}} process such as appendicitis or diverticulitis.
Leukocytosis is a common finding in abdominal infections and helps to differentiate between surgical and non-surgical causes.
{{c1::Kehr’s sign}} is left shoulder pain referred from {{c2::splenic injury}} or rupture.
This referred pain is due to irritation of the phrenic nerve, indicating possible splenic damage.
{{c1::Gastroenteritis}} can mimic an acute abdomen with symptoms like {{c2::diffuse abdominal pain}}, nausea, and vomiting.
Gastroenteritis is typically self-limiting but requires differentiation from more serious surgical conditions.
{{c1::Serum amylase levels}} are elevated in {{c2::acute pancreatitis}}, making it a key diagnostic test.
Elevated amylase, especially when combined with clinical findings, strongly suggests pancreatitis.
{{c1::Abdominal pain and bloody diarrhea}} may indicate {{c2::inflammatory bowel disease (IBD)}}, such as Crohn’s disease or ulcerative colitis.
IBD flares can present as acute abdomen and may require urgent intervention if complicated by perforation or severe inflammation.
{{c1::Pain worsening after eating}} is characteristic of {{c2::mesenteric ischemia}}, especially in patients with cardiovascular risk factors.
This postprandial pain is due to the increased demand for blood flow to the intestines during digestion, which is compromised in mesenteric ischemia.
{{c1::Bowel sounds}} that are {{c2::hyperactive}} early in obstruction followed by {{c2::silence}} suggest progression to bowel strangulation.
The progression from hyperactive to absent sounds indicates worsening bowel viability, often requiring urgent surgical intervention.
{{c1::Diabetes}} may complicate the clinical picture by presenting with {{c2::atypical abdominal pain}}, masking conditions like DKA or ischemic bowel.
In diabetic patients, abdominal pain should prompt evaluation for metabolic disturbances and vascular events.
{{c1::Murphy’s sign}} can help distinguish {{c2::cholecystitis}} from other causes of right upper quadrant pain.
A positive Murphy’s sign, especially with fever and leukocytosis, strongly indicates cholecystitis, often related to gallstones.
{{c1::Narcotic addiction}} may present with {{c2::opioid-induced constipation}}, mimicking bowel obstruction in an acute abdomen.
Chronic opioid use slows bowel motility, leading to severe constipation and abdominal pain that can be mistaken for an obstruction.
{{c1::Urine hCG test}} is critical in ruling out {{c2::ectopic pregnancy}} in women of reproductive age presenting with abdominal pain.
An undiagnosed ectopic pregnancy can be life-threatening if it ruptures, making this test essential in acute abdominal evaluations.
{{c1::Porphyria}} can present with {{c2::severe abdominal pain}} and is a non-surgical cause of acute abdomen, often misdiagnosed.
Acute porphyria attacks are due to a buildup of porphyrins, leading to neurological and abdominal symptoms, often requiring specific biochemical tests for diagnosis.
{{c1::Abdominal guarding}} is a sign of {{c2::peritonitis}} and indicates involuntary tensing of abdominal muscles.
Guarding occurs as a protective response to prevent movement of the inflamed peritoneum, suggesting severe underlying pathology.
{{c1::Cullen’s sign}}, a bluish discoloration around the umbilicus, indicates {{c2::hemoperitoneum}} often associated with acute pancreatitis or ectopic pregnancy.
Cullen’s sign reflects blood in the peritoneal cavity and is a late sign of severe intra-abdominal bleeding.
{{c1::Grey Turner’s sign}} is bruising of the flanks and suggests {{c2::retroperitoneal hemorrhage}}, such as from acute pancreatitis.
This sign indicates severe intra-abdominal bleeding and is associated with high mortality if not promptly addressed.
{{c1::Acute urinary retention}} can present as lower abdominal pain and mimic {{c2::acute abdomen}}.
This condition is often caused by obstruction or neurological disorders and can be relieved with catheterization.
{{c1::Hiccups}} persisting in a patient with an acute abdomen may indicate {{c2::diaphragmatic irritation}}.
Persistent hiccups can be a subtle sign of conditions like subphrenic abscess or diaphragmatic peritonitis.
{{c1::Ectopic pregnancy}} should be suspected in a woman of childbearing age with {{c2::unilateral abdominal pain}} and a positive pregnancy test.
Rupture of an ectopic pregnancy is a surgical emergency due to the risk of severe internal bleeding.
{{c1::Volvulus}} presents with sudden onset of {{c2::colicky abdominal pain}}, distension, and vomiting, typically in elderly patients.
Volvulus involves the twisting of the bowel on itself, leading to obstruction and possibly ischemia, requiring urgent surgical intervention.
{{c1::Biliary colic}} is characterized by right upper quadrant pain that often radiates to the {{c2::right shoulder}} or back.
Biliary colic is due to gallstones obstructing the cystic or common bile duct, and the pain is often episodic and triggered by fatty meals.
{{c1::Inguinal hernia}} can present as acute abdomen if it becomes {{c2::incarcerated}} or {{c2::strangulated}}.
A strangulated hernia is a surgical emergency as it can lead to bowel necrosis due to compromised blood flow.
{{c1::Murphy’s sign}} is assessed by palpating the right upper quadrant during {{c2::inspiration}}, which causes pain in cholecystitis.
It is a specific sign for gallbladder inflammation, differentiating it from other causes of upper abdominal pain.
{{c1::Trauma history}} should raise suspicion of {{c2::spleen or liver rupture}} in a patient with an acute abdomen.
Even minor trauma can result in delayed rupture of solid organs like the spleen, leading to life-threatening hemorrhage.
{{c1::Perforated peptic ulcer}} often presents with sudden, severe {{c2::epigastric pain}} and rigidity of the abdomen.
The release of gastric contents into the peritoneal cavity causes chemical peritonitis, necessitating emergency surgery.
{{c1::Bowel ischemia}} can present with {{c2::metabolic acidosis}} and severe abdominal pain, often out of proportion to physical findings.
Ischemia leads to tissue necrosis, which releases lactic acid, contributing to metabolic acidosis.
{{c1::Right lower quadrant pain}} in a young woman could be due to {{c2::appendicitis}} or a {{c2::ruptured ovarian cyst}}.
Both conditions can present similarly, but a careful history and examination, along with imaging, can help differentiate them.
{{c1::Diabetic ketoacidosis (DKA)}} can present as {{c2::abdominal pain}}, nausea, and vomiting, mimicking an acute abdomen.
DKA is a life-threatening condition in diabetics, where lack of insulin leads to high blood glucose and ketone production, causing systemic symptoms.
{{c1::Hypovolemia}} is a common cause of shock in surgical patients, often due to {{c2::blood loss}}.
Assessing hypovolemia is critical, with symptoms including rapid pulse, low blood pressure, and reduced urine output.
In cases of Class I blood loss (<750mL), the pulse remains {{c1::<100 bpm}}, and blood pressure is {{c2::normal}}.
Class I blood loss represents a mild stage, where the body compensates effectively without significant changes in vital signs.
{{c1::Class III}} blood loss (1500-2000mL) is characterized by a pulse >120 bpm and {{c2::confusion}} as a mental state.
This stage of blood loss indicates a severe reduction in blood volume, leading to marked physiological changes.
The presence of free air under the diaphragm on an erect CXR suggests {{c1::bowel perforation}}, commonly from a {{c2::peptic ulcer}}.
This is a critical finding that often requires immediate surgical intervention to prevent peritonitis.
In cases of hypovolemic shock, treat immediately with {{c1::crystalloid}} and {{c2::blood}} to restore circulating volume.
Prompt fluid resuscitation is vital to prevent organ failure and stabilize the patient before surgery.
Pain localized to the {{c1::right lower quadrant (RLQ)}} can indicate appendicitis, whereas pain in the {{c2::epigastrium}} may suggest pancreatitis or peptic ulcer disease.
The location of abdominal pain helps narrow down potential diagnoses based on common patterns.
{{c1::Class IV}} blood loss (>2000mL) typically results in a pulse >140 bpm and {{c2::lethargy}} or unconsciousness.
This represents a life-threatening stage of hemorrhagic shock where immediate intervention is critical.
Causes of abdominal pain in the {{c1::right upper quadrant (RUQ)}} include cholecystitis, hepatitis, and {{c2::pneumonia}}.
RUQ pain is commonly associated with hepatobiliary disorders, but conditions like pneumonia can also refer pain to this area.
{{c1::Left lower quadrant (LLQ)}} pain could indicate conditions like {{c2::diverticulitis}} or ectopic pregnancy.
LLQ pain is commonly associated with diverticulitis in older adults and gynecological issues in women of childbearing age.
{{c1::Left upper quadrant (LUQ)}} pain can be caused by splenic issues such as {{c2::splenic rupture}} or infarction.
The spleen is the primary organ in the LUQ, and trauma or hematological issues can lead to pain in this area.
In Class II blood loss (750-1500mL), the pulse is typically {{c1::100-120 bpm}}, and patients may feel {{c2::anxious}}.
Class II represents moderate blood loss, where compensatory mechanisms start to fail, leading to noticeable symptoms.
