Acute Abdomen Flashcards
what is the acute abdomen?
A combination of symptoms and signs including abdominal pain, which results in the patient being referred for an urgen general surgical opinion
What is the aetiology of acute abdomen?
Non-specific pain
Acute appendicitis
Acute cholecystitis
Peptic ulcer perforation
Urinary retention
What should be considered for the pathophysiology of acute abdomen?
Peritonitis
Intestinal obsruction
Abdominal pain
Ischaemia
What is the surface area of the peritoneum?
About 2m2
What activity is done by the peritoneum?
Fibrinolyric (blood clotting)
what are the 2 layers of the peritoneum?
Parietal and visceral
What is peritonitis?
Infections of the peritoneum
What are some routes of infection for peritonitis?
Perforation of GI/biliary tract
Female genital tract
Penetration of the abdominal wall
Haematogenous spread
Are anaerobes or aerobes more likely to cause diffuse pritonitis?
Aerobes
Are anaerobes or aerobes more likely to cause abscess?
Anaerobes
What are the 2 vague kinds of peritonitis?
Localsied or generalised
When does generalised peritonitis occur?
Contamination too rapid
Contamination persists
Abscess ruptures
What are cardinal features of intestine obstruction?
Pain
Vomiting
Distension
Constipation
Borborygmi
What do symptoms of obstruction depend on?
Site (proximal vs distal)
What abdominal pain, what must be asked?
Character of pain
Site of pain
Severity of pain
Systemic upset
what is intestinal ischaemia?
Severe abdominal pain not corresponding to abdominal examination findings.
Imaging modalities.
Gas exchange and metabolic acidosis.
Medical and social background
what are cardinal features of intestinal obstruction?
Pain
Vomiting
Distension
Constipation
Borborygmi
But depends on site (proximal vs. distal)
what are the three characters of abdominal pain?
i. Visceral
ii. Somatic
iii. Referred
What receptors are responsible for visceral pain?
Pain receptors in smooth muscle
Afferent impulses run with sympathetic fibres accompanying segmental vessels (CP, SMA, IMA)
Poorly localised
Where does afferent impulses of viseral pain run?
Afferent impulses run with sympathetic fibres accompanying segmental vessels (CP, SMA, IMA)
Is visceral pain well or poorly localised?
Poorly localised
What receptors are responsible for somatic and reffered pain?
Receptors in parietal peritoneum or abdominal wall
What do afferent signals of somatic and referred pain travel with?
Afferent signals pass with segmental nerves
Is the localisation of somatic and refered pain good or bad?
Accurate localisation but can be referred
What are the clinical consequences of peritonitis and intestinal obstruction?
fluid loss
sepsis
circulatory collapse
What are the steps for managing acute abdomen?
GP
hospital admission/walk in clinic?
home?
Ambulatory clinic activity
- Patients seen in the SAC
- Admissions
- Re-attenders requiring surgery
33%
30%
2%
What is required for the assessment of acute abdomen?
Assess (+ resuscitate)
Investigate
Observe
Treat
What investigations can be done for acute abdomen?
History
Examination
Investigation
Consider:
Capacity
Level of care-intervention
vs. palliation
Acute Abdomen:Investigation
Ward tests: urine + bHCG
Lab tests: FBC, U+Es, LFTs & Amylase
Radiology: plain,US, axial (CT) ?other
Laparoscopy vs. laparotomy
What steps are involved in resuscitation for acute abdomen?
Restore circulating fluid volume
Ensure tissue perfusion
Enhance tissue oxygenation
Treat sepsis
Decompress gut
Ensure adequate pain relief
when is active observation useful?
Active observation: useful when diagnosis is uncertain and risk of alternative intervention is greater
What is the treatment for acute abdomen?
Pain relief
Antibiotics
Definitive interventions- i.e.surgery
Be “tough on sepsis and the causes of sepsis!”
Consider Alternative options and associated risks and benefits.
Cause No harm.
