Acute Abdomen (1*)

Question 1

What is it?

Which scenarios would require urgent laparotomy?

Which scenarios wouldn’t require urgent laparotomy?

Answer 1

➊ Sudden onset of severe abdominal pain that may indicate a life-threatening pathology

➋ • Organ rupture - AAA, Spleen, Ectopic pregnancy
• Peritonitis - Perforation of Ulcer, Diverticulum, Appendix, Bowel, Gallbladder
‣ Presents with guarding, abdominal rigidity, and pneumoperitoneum on CXR

➌ • Colic - Bile duct, Bowels, Ureter
• Local peritonism - Diverticulitis, Cholecystitis, Appendicitis
‣ Unlike peritonitis, the pt will be restless

Question 2

What’s the aim of immediately investigating these pts?

Which investigations would you do? Give reasons for each

Answer 2

➊ To rule out the life-threatening pathologies that require urgent surgical intervention

➊ • Bloods - FBC, U&E, CRP, LFT, Lactate (mesenteric ischaemia), Amylase (pancreatitis)
• Erect CXR - for pneumoperitoneum
• Pregnancy test - rule out ectopic pregnancy
• ECG - to rule out cardiac pathology