Acute Abdomen

Question 1

Nonsurgical causes of the acute abdomen

Answer 1

Endocrine and Metabolic Causes:
Acute intermittent porphyria Addisonian crisis
Diabetic crisis
Hereditary Mediterranean fever Uremia

Hematologic Causes:
Acute leukemia
Sickle cell crisis

Toxins and Drugs:
Black widow spider poisoning Lead poisoning
Other heavy metal poisoning Narcotic withdrawal

Question 2

Treatment of primary ACS

Answer 2

Primary ACS is due to a disease process within the abdomen that is best treated with decompressive laparotomy and correction of the inciting disease process.

Question 3

Treatment of secondary ACS

Answer 3

Initial management of secondary ACS without evidence of end organ damage should be treated medically. Medical management includes correcting a positive fluid balance, evacuating intraluminal contents via a nasogastric tube, Foley and enemas, relaxing the abdominal wall with adequate sedation and pain control, and drainage of peritoneal fluid

Question 4

Indications for surgery in GI hemorrhage

Answer 4

Hemodynamic instability despite vigorous resuscitation (>6-unit transfusion)
Failure of endoscopic techniques to arrest hemorrhage
Recurrent hemorrhage after initial stabilization (with up to two attempts atobtaining endoscopic hemostasis)
Shock associated with recurrent hemorrhage
Continued slow bleeding with a transfusion requirement exceeding 3 units/
day