acute abdomen Flashcards
To remember common causes of acute abdomen)
Mnemonic for Causes – “SIP ME FAST”
S – Stones (gallstones, kidney stones)
I – Infection (appendicitis, diverticulitis, PID)
P – Perforation (ulcer, bowel)
M – Mesenteric ischemia
E – Ectopic pregnancy
F – Functional (e.g., ileus)
A – Aneurysm (ruptured AAA)
S – Strangulation (hernia, volvulus)
T – Trauma
what is acute abdomen
Acute abdomen is defined as any sudden, spontaneous, non-traumatic, severe abdominal pain of <24h in duration.
Emergency laparotomy is indicated in:
1)Generalized peritonitis
2)Signs of advanced or non-improving bowel obstruction»_space; Unstable patient
with abdominal distention, vomiting, & obstipation.
3)Radiological evidence of pneumoperitoneum (air under diaphragm).
4)Uncontrolled massive or ongoing bleeding.
5) All penetrating abdominal traumas.
Abdominal examinations shows in acute abdomen»
(1) involuntary guarding with broad rigidity
(2) diffuse abdominal pain
(3) rebound tenderness
types of visceral pain
Comes from internal organs (viscera)
🧠 Features:
Dull, crampy, or aching pain
Poorly localized (hard to pinpoint)
Often felt midline (because visceral organs have bilateral innervation)
May be associated with autonomic symptoms: nausea, vomiting, sweating
🧬 Caused by:
Stretching, distension, or ischemia of hollow organs (e.g., intestines, stomach, ureters)
✅ Examples:
Early appendicitis → dull pain near umbilicus
Bowel obstruction → crampy abdominal pain
Gallbladder distension → vague RUQ pain
type of somatic pain
Comes from irritation of the parietal peritoneum (lining of abdominal wall)
🧠 Features:
Sharp, stabbing, or well-localized pain
Patient can often point to the exact spot
Worsens with movement, coughing, or pressure (guarding, rebound tenderness)
🧬 Caused by:
Inflammation of the peritoneum (e.g., due to infection, perforation, or blood)
✅ Examples:
Late appendicitis → sharp pain in right lower quadrant
Peritonitis → severe, localized pain with rigid abdomen
Perforated ulcer → sudden sharp epigastric pain
what are endocrine diseases that cause diffuse abdominal pain
DKA
addisonian crisis
DDx of diffuse abdominal pain in GI
Bowel obstruction (small or large).
Peritonitis (+ its causes).
Mesenteric ischemia (may be LUQ or epigastric).
Gastroenteritis
genitourinary DDx of acute abdominal pain
ruptured ectopic pregnancy, testicular or ovarian torsion.
DDx of pain in RUQ pain
Liver»_space; hepatitis, abscess. biliary tract»_space; biliary colic, acute cholecystitis or cholangitis, obstructive jaundice.
GI»_space; perforated duodenal ulcer, appendicitis in pregnancy
GU»_space; nephrolithiasis, urolithiasis,pyelonephritis.
Others»_space; right lower lobe pneumonia.
LUQ pain
GI»_space; splenic rupture, perforated ulcer, diverticulitis, UC.
GU»_space; nephrolithiasis, urolithiasis, pyelonephritis.
RLQ pain
GI»_space;
hypogastric pain
Peri-umbilical»_space; acute
appendicitis (early), acute pancreatitis, AAA rupture, gastroenteritis, IBS.
Suprapubic:
GI»_space; sigmoid diverticulitis, strangulated groin hernia.
GU»_space; cystitis, acute retention.
what is murphys sign
hand is placed below the right costal margin and asked to breath in, if the patient stops breathing due to
Rovsing sign >
palpation of LLQ cause pain in RLQ, suggesting appendicitis.
Courvoisier sign
firm & painless gallbladder, suggest malignancy or chronic biliary tree obstruction.
General investigations in any patient with abdominal pain:
-CBC»_space; assess leukocytosis & anemia.
-Electrolytes panel»_space; assess any disturbances (especially with vomiting).
-Amylase & lipase»_space; assess pancreatitis or perforation (amylase are high in perforation).
-LFTS»_space; baseline + assess any abnormalities.
-RFTs»_space; baseline + assess any abnormalities.
-Pregnancy test»_space; in any childbearing aged women.
-Urinalysis»_space; if cystitis or pyelonephritis is suspected.
imaging done in acute abdomen
-Plain radiographs (abdomen & chest X-rays)
-Ultrasound (rapid, bedside)- kidney stones, gallstones, or AAA
-Abdominal CT
