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Alimentary System > Acute Abdomen > Flashcards

Acute Abdomen Flashcards

1
Q

what is the acute abdomen?

A

A combination of symptoms and signs including abdominal pain, which results in the patient being referred for an urgen general surgical opinion

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2
Q

What is the aetiology of acute abdomen?

A

Non-specific pain

Acute appendicitis

Acute cholecystitis

Peptic ulcer perforation

Urinary retention

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3
Q

What should be considered for the pathophysiology of acute abdomen?

A

Peritonitis

Intestinal obsruction

Abdominal pain

Ischaemia

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4
Q

What is the surface area of the peritoneum?

A

About 2m2

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5
Q

What activity is done by the peritoneum?

A

Fibrinolyric (blood clotting)

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6
Q

what are the 2 layers of the peritoneum?

A

Parietal and visceral

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7
Q

What is peritonitis?

A

Infections of the peritoneum

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8
Q

What are some routes of infection for peritonitis?

A

Perforation of GI/biliary tract

Female genital tract

Penetration of the abdominal wall

Haematogenous spread

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9
Q

Are anaerobes or aerobes more likely to cause diffuse pritonitis?

A

Aerobes

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10
Q

Are anaerobes or aerobes more likely to cause abscess?

A

Anaerobes

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11
Q

What are the 2 vague kinds of peritonitis?

A

Localsied or generalised

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12
Q

When does generalised peritonitis occur?

A

Contamination too rapid

Contamination persists

Abscess ruptures

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13
Q

What are cardinal features of intestine obstruction?

A

Pain

Vomiting

Distension

Constipation

Borborygmi

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14
Q

What do symptoms of obstruction depend on?

A

Site (proximal vs distal)

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15
Q

What abdominal pain, what must be asked?

A

Character of pain

Site of pain

Severity of pain

Systemic upset

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16
Q

what is intestinal ischaemia?

A

Severe abdominal pain not corresponding to abdominal examination findings.

Imaging modalities.
Gas exchange and metabolic acidosis.
Medical and social background

17
Q

what are cardinal features of intestinal obstruction?

A

Pain
Vomiting
Distension
Constipation
Borborygmi

But depends on site (proximal vs. distal)

18
Q

what are the three characters of abdominal pain?

A

i. Visceral
ii. Somatic
iii. Referred

19
Q

What receptors are responsible for visceral pain?

A

Pain receptors in smooth muscle
Afferent impulses run with sympathetic fibres accompanying segmental vessels (CP, SMA, IMA)
Poorly localised

20
Q

Where does afferent impulses of viseral pain run?

A

Afferent impulses run with sympathetic fibres accompanying segmental vessels (CP, SMA, IMA)

21
Q

Is visceral pain well or poorly localised?

A

Poorly localised

22
Q

What receptors are responsible for somatic and reffered pain?

A

Receptors in parietal peritoneum or abdominal wall

23
Q

What do afferent signals of somatic and referred pain travel with?

A

Afferent signals pass with segmental nerves

24
Q

Is the localisation of somatic and refered pain good or bad?

A

Accurate localisation but can be referred

25
Q

What are the clinical consequences of peritonitis and intestinal obstruction?

A

fluid loss
sepsis
circulatory collapse

26
Q

What are the steps for managing acute abdomen?

A

GP
hospital admission/walk in clinic?
home?

27
Q

Ambulatory clinic activity

  • Patients seen in the SAC
  • Admissions
  • Re-attenders requiring surgery
A

33%
30%
2%

28
Q

What is required for the assessment of acute abdomen?

A

Assess (+ resuscitate)
Investigate
Observe
Treat

29
Q

What investigations can be done for acute abdomen?

A

History
Examination
Investigation

Consider:
Capacity
Level of care-intervention
vs. palliation

30
Q

Acute Abdomen:Investigation

A

Ward tests: urine + bHCG
Lab tests: FBC, U+Es, LFTs & Amylase
Radiology: plain,US, axial (CT) ?other
Laparoscopy vs. laparotomy

31
Q

What steps are involved in resuscitation for acute abdomen?

A

Restore circulating fluid volume
Ensure tissue perfusion
Enhance tissue oxygenation
Treat sepsis
Decompress gut
Ensure adequate pain relief

32
Q

when is active observation useful?

A

Active observation: useful when diagnosis is uncertain and risk of alternative intervention is greater

33
Q

What is the treatment for acute abdomen?

A

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.

Alimentary System (44 decks)

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