Acute Abdomen Flashcards
1
Q
What are the major causes of AA in the community?
A
- Acute cholecystitis.
- Acute appendicitis or Meckel’s diverticulitis.
- Acute pancreatitis.
- Ectopic pregnancy.
- Diverticulitis.
- Peptic ulcer disease.
- Pelvic inflammatory disease.
- Intestinal obstruction, paralytic ileus
- Gastroenteritis.
- Acute intestinal ischaemia/infarction or vasculitis.
- Gastrointestinal (GI) haemorrhage.
- Urinary tract stones.
- Acute urinary retention.
- Abdominal aortic aneurysm.
- Testicular torsion.
2
Q
What diseases are associated with the pain at different quadrants?
*see image
A
3
Q
Pt on what medictaions can mask signs of AA?
A
- corticosteroids
4
Q
Describe the use of SOCRATES in taking a hx for AA
* think in the context of AA
A
- Site: which quadrants
- Onset: How long, how did it start, any changes over time
- Character: burning, shooting, stabbing, dull
- Radiation
- Associated sx: N,V,D,C
- Timing: constant, colicky, relationship with food
- Exacerbating/relieving factors
- Severity
5
Q
What other associated sx would you consider?
A
- Nature of vomiting
- Fevers/rigors
- Rash/itchyness
- Urinary sx
- weight loss
- Gynaecological hx
6
Q
What gynaecological hx would you ask?
A
- Contraception (including intrauterine contraceptive device (IUCD) use).
- Last menstrual period.
- History of sexually transmitted infections/pelvic inflammatory disease.
- Previous gynaecological or tubal surgery.
- Previous ectopic pregnancy.
- Vaginal bleeding.
- Drug history and allergies - including any complementary medication.
7
Q
What Ex would you perform for AA?
A
- Basic obs
- Temp
- pulse
- BP
- Abdo exam
- check for guarding or rebound tenderness
- Rectal/vaginal exam if necessary
8
Q
How would you generally mx AA in primary care?
A
- Treat underlying cause
- If unsure - admit as surgical emergency to hospital
9
Q
What are the tx to consider in primary care for AA?
A
- NBM
- O2
- IV fluids
- Analgesia - back then was not adviced but now has been proven to be safe and wouldnt mask abdo finding
- IV abx (cephalosporins + metronidazole) if peritonitis suspected
- Arrange and admit urgent surgical and gynaecological review
10
Q
What are the redflags of suspecting serious pathology?
A
- Hypotension.
- Confusion/impaired consciousness.
- Signs of shock.
- Systemically unwell/septic-looking.
- Signs of dehydration.
- Rigid abdomen.
- Patient lying very still or writhing.
- Absent or altered bowel sounds.
- Associated testicular pathology.
- Marked involuntary guarding/rebound tenderness.
- Tenderness to percussion.
- History of haematemesis/melaena or evidence of latter on examination per rectum (PR).
11
Q
How would you mx biliary colic?
A
- Pethidine 50mg IM/po or
- Diclofenac 50-100mg IM/po/pr + Prochlorperazine 12.5mg IM or Domperidone 10mg po for nausea
- Admit as surgical emergency if
- uncertain diagnosis
- inadequate social support
- sx persist despite analgesia
- suspected cx
12
Q
How would you mx acute cholecystitis?
A
- Broad spec abx - Ciprofloxacin
- Admit as surgical emergency if
- generalised peritonism
- diagnosis uncertain
- dehydration, DM, addisons, pregnancy
- inadeqaute social support
- not responding to medication
13
Q
How would you mx acute pancreatitis?
A
- admit as surgical emergency
- Preventative measures
- avoid percipitationg factors (alcohol, drugs)
- advise low fat diet
- treat reversible causes (hyperlipidaemia, gallstones)
14
Q
What are the clincal features of bowel obstruction?
A
- Nausea
- Vomiting gives relief
- colicky central abdo pain
- distension
- absolute constipation (stool and gas)
- tinkling bowel sounds
- quiet bowel sounds (later)
15
Q
How would you mx bowel obstruction?
A
- admit as surgical emergency
