Acute Abdomen

Question 1

What is the Acute Abdomen?

Answer 1

A recent rapid onset of urgent abdominal or pelvic pathology, usually presenting with abdominal pain.

Question 2

What are the 9 regions of the abdomen?

Answer 2

1. Right Hypochondriac.
2. Epigastric.
3. Left Hypochondriac.
4. Right Lumbar.
5. Umbilical.
6. Left Lumbar.
7. Right Iliac.
8. Hypogastric.
9. Left Iliac.

Question 3

Give 3 diseases that causes loin-to-groin pain.

Answer 3

1. Ruptured AAA.
2. Renal and Ureteric Stones.
3. Pyelonephritis.

Question 4

Give 4 diseases that cause central/generalised pain.

Answer 4

1. Ruptured AAA.
2. Ischaemic Colitis.
3. Intestinal Obstruction.
4. Peritonitis.

Question 5

What is Peritonitis?

Answer 5

Inflammation of the peritoneum - lining of the abdomen.

Question 6

What is Localised Peritonitis caused by?

Answer 6

Underlying organ inflammation e.g. cholecystitis, appendicitis.

Question 7

What is Generalised Peritonitis caused by?

Answer 7

Perforation of an abdominal organ e.g. duodenal ulcer or ruptured appendix - this results in the release of the contents into the peritoneal cavity to cause peritonitis.

Question 8

What is Spontaneous Bacterial Peritonitis caused by?

Answer 8

Spontaneous infection of ascites in cirrhotic liver disease - treated with antibiotics - poor prognosis.

Question 9

Give 4 signs of Peritonitis.

Answer 9

1. Guarding.
2. Rigidity.
3. Rebound Tenderness.
4. Coughing Test.
5. Percussion Tenderness.

Question 10

What is Guarding?

Answer 10

Involuntary tensing of the abdominal wall muscles when palpated to protect the painful area below.

Question 11

What is Rigidity?

Answer 11

Involuntary persistent tightness/tensing of the abdominal wall muscles.

Question 12

What is Rebound Tenderness?

Answer 12

Rapidly releasing pressure on the abdomen creates worse pain than the abdomen.

Question 13

What is Coughing Test?

Answer 13

Asking the patient to cough to see if it results in abdominal pain.

Question 14

What is Percussion Tenderness?

Answer 14

Pain and tenderness when percussing the abdomen.

Question 15

Give 7 medical causes of Acute Abdomen.

Answer 15

1. Vascular e.g. MI, Pericarditis, PE.
2. Infective e.g. Gastroenteritis, Pneumonia, Mesenteric Adenitis.
3. Inflammatory e.g. Vasculitis - HSP.
4. Metabolic e.g. DKA, Addison’s, Hypercalcaemia, Acute Intermittent Porphyria.
5. Neurological e.g. Abdominal Migraine, IBS.
6. Toxin e.g. Lead/Corrosive Substance, Withdrawal Syndromes.
7. Haematological e.g. Sickle-Cell Crisis.

Question 16

What radiological investigation is useful in checking for Acute Abdomen?

Answer 16

ERECT CXR : Pneumoperitoneum - intra-abdominal perforation.

Question 17

Give 2 other causes of Pneumoperitoneum.

Answer 17

1. Gas-Forming Infections e.g. C. perfringens.

2. Iatrogenic e.g. Laparoscopic Surgery.

Question 18

What is Rigler’s Sign?

Answer 18

Double Wall Sign.