Acute Abdomen Flashcards
What is the definition of Acute Abdomen?
Sudden onset of severe abdominal pain
What are the Acute Abdomen syndromes that require laparotomy? (2 things)
- Organ rupture
- Peritonitis
What are the Acute Abdomen syndromes that DO NOT require laparotomy? (2 things)
- Local peritonitis
- Colic
What are the organs that rupture in Acute Abdomen that will require laparotomy? (3 things)
- Spleen
- Aorta
- Ectopic pregnancy
What is the leading signs of organ rupture in Acute Abdomen? (2 things)
- Hypovol Shock (Main) (present with tachycardia, hypotension, pale)
- Abdominal swelling (sometimes)
What are the causes of Peritonitis?
Perforation of
- Peptic ulcer / duodenal ulcer
- Diverticulum
- Appendix
- Bowel
- Gall bladder
What are the signs of Peritonitis? (5 things)
- Rigidity (invol persistent tensing of abd wall muscles)
- Guarding (invol tensing of abd wall musc @ palpation)
- Percussion tenderness
- Rebound tenderness (rapid releasing pressure of abd –> worse pain)
- +ve Cough test (cough = abd pain)
What may a CXR of Peritonitis show?
Gas under diaphragm
(aka Pneumoperitonuem)
How do you differentiate between Peritonitis and Acute Pancreatitis?
Both show same signs
BUT
Acute Pancreatitis DOES NOT require laparotomy
+ Serum Amylase in Pancreatitis will be HIGH
What are the causes of Local Peritonitis? (4 things)
- Diverticulitis
- Cholecystitis
- Salpingitis (fallopian tube inflamm)
- Appendicitis (WILL NEED SURGERY)
When should a CT / US be done for Local Peritonitis?
When abscess formation suspected (swelling / swinging fever and high WBC)
What is a swinging fever?
Fever every few hours
How do you drain the abscess from Local Peritonitis?
- Percutaneous drainage (US / CT guided)
- Laparotomy
What can Peritonitis cause in the bowel?
Ileus (loss of peristalsis in bowel aka bowel asleep)
What is Colic?
Pain that comes and goes
What is colic pain caused by?
Muscular spasm in a hollow viscus (gut / ureter / salpinx / uterus / bile duct / gall bladder)
What is the pain like in gall bladder colic?
Dull and constant
How does colic present different to peritonitis in patients?
Colic causes restlessness –> patient can be pacing around
How do you differentiate a diagnosis for Acute Abdomen?
Divide abdomen into 4 quadrants
What are the differentials of Acute Abdomen in the RUQ? (5 things)
- Cholecystitis
- Hepatitis
- Pyelonephritis
- Ureteric colic
- Pneumonia
What are the differentials of Acute Abdomen in the LUQ? (4 things)
- Gastric Ulcer
- Pyelonephritis
- Ureteric colic
- Pneumonia
What are the differentials of Acute Abdomen in the RLQ? (7 things)
- Ureteric colic
- Appendicitis
- IBD
- Inguinal hernia
- UTI
- Gynaecological
- Testicular torsion
What are the differentials of Acute Abdomen in the LLQ? (7 things)
- Ureteric colic
- Diverticulitis
- IBD
- Inguinal hernia
- UTI
- Gynaecological
- Testicular torsion
What are the LAB investigations for Acute Abdomen? (4 things)
- Urine dipstick
- ABG
- Bloods
- Blood cultures
Why is urine dipstick done for Acute Abdomen?
For signs of infection / haematuria
Why is ABG done for Acute Abdomen?
Useful for bleeding / septic patients
Check pH, pO2, pCO2, lactate for tissue hypoperfusion signs + rapid Hb level
What routine bloods should be done for Acute Abdomen? (6 things)
- FBC
- U&Es
- LFTs
- CRP
- Amylase
- Group & save (G&S) if patient likely to need surgery soon
Why is Blood culture done for Acute Abdomen?
If infection is considered as potential diagnosis
What is the amylase level diagnostic of Pancreatitis?
3x greater than the upper limit
Raised level but below 3x could be:
Perforated bowel
Ectopic pregnancy
DKA
What imaging should be done for Acute Abdomen? (3 things)
- CXR
- US
- CT
Why should a CXR be done for Acute Abdomen? (2 things)
To check for:
- Abdominal air (pneumoperitonuem aka air under diaphram = Peritonitis)
- Lower lobe lung pathology (consolidation = Pneumonia)
Why should a US of kidneys, ureters, and bladder (‘KUB’) be done for Acute Abdomen? (2 things)
To check for:
- Hydronephrosis (kidney swelling)
- Cortico-medullary differentiation (= nephropathy)
Why should a US of Biliary tree and liver be done for Acute Abdomen? (3 things)
To check for:
- Gallstones
- Gallbladder thickening
- Duct dilatation
Why should a Transvaginal US be done for Acute Abdomen? (1 thing)
To check for:
1. Suspected tubo-ovarian pathology
In an emergency setting, what scan should a patient with Acute Abdomen also have?
ECG to exclude cardiac pathology as referred pain
What is the initial management for Acute Abdomen regardless of the cause?
- IV fluids
- Nil-by-mouth (NBM)
- Analgesia
- Antiemitics
- Initial imaging
- VTE prophylaxis
- Urine dip
- Bloods
- NG tube / catheter if necessary
What is the main cause of medical (non surgical) Acute Abdomen?
Irritable Bowel Syndrome (IBS)
What should you ask about to diagnose a patient with IBS? (4 things)
- Loose stools
- Bloating
- Urgency
- Pain relieved by defecation
What does air in the abdomen seen in a CXR indicate?
- Bowel perforation
- Gas-forming infection (C. perfringens)
- Iatrogenic (laproscopic surgery, air detectable in CXR for upto 10 days)
- Per vaginam (sexual activity)
What test is vital to rule out ectopic pregnancy in Acute Abdomen?
Urine + serum hCG
