Acute Abdomen

Question 1

Caused by perforation

Answer 1

Cause: usually peptic ulcer
Features: sudden onset, constant, generalized, severe pain, reluctant to move, protective of abdomen, tenderness, muscle guarding, rebound, silent abdomen.
Dx: free air under diaphragm on x-ray.
Tx: surgery

Question 2

Caused by obstruction

Answer 2

Cause: obstructed narrow duct (ureter, cystic, common)
Features: sudden onset colicky pain, typical radiation and location from source, moving constantly to find comfort.

Question 3

Caused by inflammatory process

Answer 3

Features: gradual onset, slow build, constant, ill-defined then localizes with typical radiation patterns, peritoneal irritation in affected area, fever, leukocytosis.

Question 4

Ischemic Processes

Answer 4

severe abd pain and blood in lumen of gut

Question 5

Primary Peritonitis

Answer 5

in kid with nephrosis and ascites
in adult with ascites and mild generalized acute abd, equivocal findings, fever, leukocytosis
Dx: ascites culture with one organism
Tx: abx

Question 6

Generalized Acute Abdomen

Answer 6

rule out primary peritonitis, MI, lower lobe pneumonia, PE, pancreatitis, urinary stones
Dx: EKG, troponins, CXR, spiral CT, amylase/lipase, CT abd
Tx: exploratory laparotomy

Question 7

Acute Pancreatitis

Answer 7

alcoholic with upper acute abd
Features: rapid onset, pain is constant, epigastric, radiates to back, nausea, vomiting, retching.
Dx: serum or urinary amylase or lipase (serum 12-48hr, urine 3-6 day), CT
Tx: NPO, NG suction, IV fluids

Question 8

Biliary Tract Disease

Answer 8

in fat woman in 40’s who is fertile with RUQ pain

Question 9

Ureteral Stones

Answer 9

Features: sudden onset colicky pain radiating to inner thigh or scrotum/labia, with urgency/frequency, microhematuria on UA.
Dx: CT

Question 10

Acute Diverticulitis

Answer 10

acute abd pain in LLQ
middle aged pt
Features: LLQ pain, fever, leukocytosis, peritoneal irritation in LLQ, palpable tender mass.
Dx: CT
Tx: NPO, IV fluids, abx, surgery if doesn’t get better or more than 2 attacks

Question 11

Volvulus of Sigmoid

Answer 11

elderly
Features: signs of intestinal obstruction, severe abd distention.
Dx: x-ray with air-fluid level in small bowel, distended colon, air-filled loop in RUQ that tapers to LLQ in shape of “parrot’s beak”.
Tx: proctosigmoidoscopic exam with rigid instrument leaving rectal tube in, recurrence => elective sigmoid resection.

Question 12

Mesenteric Ischemia

Answer 12

elderly
Features: acute abd in pt with a fib or recent MI, blood in bowel lumen, acidosis, sepsis.
Tx: when caught early: arteriogram and embolectomy