Acute Abdomen Flashcards
What are the differentials for generalized abdominal pain
- Peritonitis,
- Ruptured AAA,
- Intestinal obstruction,
- Ischaemic colitis
What are the differentials for RUQ pain
- Biliary colic,
- Acute cholecystitis,
- Acute cholangitis
What are the differentials for epigastric pain
- Acute gastritis,
- Peptic ulcer disease,
- Pancreatitis,
- Ruptured AAA
What are the differentials for central abdominal pain
- Ruptured AAA,
- Intestinal obstruction,
- Ischaemic colitis,
- Early stages of appendicitis
What are the differentials for right iliac fossa pain?
- Acute appendicitis,
- Ectopic pregnancy,
- Ruptured ovarian cyst,
- Ovarian torsion,
- Meckel’s diverticulum
What are the differentials for left iliac fossa pain
- Diverticulitis,
- Ectopic pregnancy,
- Ruptured ovarian cyst,
- Ovarian torsion
What are the differentials for suprapubic pain
- Lower UTI,
- Acute urinary retention,
- PID
- Prostatitis
What are the differentials for loin to groin pain
- Renal colic,
- Ruptured AAA
- Pyelonephritis
What are the differentials for testicular pain
Torsion or epididymo-orchitis
What are signs of peritonitis?
- Guarding,
- Ridigity,
- Rebound tenderness,
- Coughing test,
- Percussion tenderness
|What is the initial assessment of an acute abdomen?
A-E assessment
What are the investigations for an acute abdomen?
- FBC,
-UEs, - LFTs,
- CRP
- Amylase,
- INR,
- Serum calcium,
- hCG,
- ABG,
- Lactate,
- Blood cultures,
- Abdo x ray,
- Erect chest x ray,
- Abdo ultrasound,
- CT scan
What is the management of an acute abdomen
- A-E assessment,
- Alert seniors,
- Nil by mouth,
- NG tube,]- IV fluids,
- IV antibiotics,
- Analgesia,
- Arrange investigations,
- VTE
What are the signs of peritonitis?
Abdominal rigidity
Involuntary abdominal guarding
Rebound tenderness
fever
vomiting
tachycardia
hypotension
What are the causes of peritonitis?
- Perforation of a hollow viscus eg, perforated oesophagus, perforated duodenal/gastric ulcer, perforated intestine.
- Infections eg, spontaneous bacterial peritonitis
What are some absolute and relative contraindications for laparoscopic surgery?
Absolute - Indication for open, acute intestinal obstruction, uncorrected coagulopathy, tense or distended abdomen, trauma with hemodynamic instability, clear indication of bowel injury.
Relative - ICU patients, anterior abdo wall infection, recent laparotomy, adhesions, pregnancy, cardiopulmonary compromise, morbid obesity
What is acute mesenteric ischaemia?
Sudden onset intestinal hypoperfusion. Most commonly occurs due to occlusion of SMA
Explain the presentation of acute mesenteric ischaemia
Sudden severe abdominal pain and guarding,
Nausea and vomiting,
Shock,
Metabolic acidosis,
PR bleeding
What are risk factors for acute mesenteric ischaemia?
AF
Atherosclerosis,
Coagulopathy
How do you diagnose acute mesenteric ischaemia?
CT Angiography
