Acute Abdomen

Question 0

Acute abdomen caused by perforation – time course? Type of pain? Signs? Confirm diagnosis with? Most common example? Surgery when?

Answer 0

Sudden onset; constant, generalized, severe

Signs of peritoneal irritation – tenderness, guarding, rebound, silent abdomen

X-ray showing free air under diaphragm

Perforated peptic ulcer

Immediately

Question 1

General causes of acute abdominal pain?

Answer 1

#Perforation
#obstruction 
#inflammation 
#ischemic process

Question 2

Signs of peritoneal irritation

Answer 2

tenderness, guarding, rebound, silent abdomen

Question 3

Acute abdomen caused by obstruction of duct – potential sources? Describe pain? Signs?

Answer 3

Ureter, cystic, CBD

Sudden onset of colicky pain with radiation

Few exam findings, limited to area where the process is

Question 4

Abdominal pain caused by inflammatory process – time course? Pain course? Signs?

Answer 4

Granule onset and slow buildup

Starts as ill-defined, eventually locates to area of inflammation, with constant pain and radiation

Signs of peritoneal irritation in the affected area, fever, leukocytosis

Question 5

Hallmark of acute abdomen 2/2 ischemic process?

Answer 5

Severe pain with blood in the lumen of gut

Question 6

When to suspect primary peritonitis in child? In adult? Cultures will show? Treatment? When surgery?

Answer 6

Nephrosis and ascites;

#ascites 
#mild generalized acute abdomen 
#mild fever
#mild leukocytosis

Culture of ascitic fluid yields single organism

Antibiotics; no surgery

Question 7

Treatment for generalized acute abdomen? If not primary peritonitis, rule out? (How?)

Answer 7

Exploratory laparotomy

Myocardial ischemia (ECG)
lower lobe pneumonia (Chest x-ray)
PE
pancreatitis (amylase)
urinary stones (CT scan of abdomen)

Question 8

Alcoholic develops acute abdomen – suspected diagnosis? Diagnosed with?

Answer 8

Acute pancreatitis

#Serum amylase/lipase from 12-48 hrs.
#Urinary amylase/lipase from day 3-6

Question 9

Inflammatory processes giving acute abdomen and lower left quadrant? Diagnosed with? Surgery when?

Answer 9

Diverticulitis or TOA; CT scan

#Emergency surgery the patient does not improve with NPO, IV fluids, antibiotics
#Elective surgery for those with two or more attacks

Question 10

Volvulus of the sigmoid – imaging study and finding? Management? Surgery when?

Answer 10

X-ray – air-fluid levels and small bowel, distended colon, air-filled loop in the right upper quadrant

Proctosigmoidoscopy with rigid instrument

Recurrent attacks

Question 11

Patient with atrial fibrillation or recent

MI presents with acute abdomen – suspected diagnosis? Associated findings? Management?

Answer 11

Mesenteric ischemia; acidosis and sepsis

Arteriogram and embolectomy