Acute abdomen Flashcards
What are the principle causes of acute abdominal pain?
Inflammation, perforation, obstruction or infarction of a viscus.
Intraabdominal or retroperitoneal haemorrhage.
Extra-abdominal or medical causes of acute abdo pain.
What are the clinical features of peritonitis?
Tenderness and guarding, rebound/percussion tenderness, localised pain during distant palpation.
Also - absence of bowel sounds, increasing tachycardia, pyrexia.
What are the cardinal symptoms of intestinal obstruction?
Pain, vomiting, distension, absolute constipation
Describe the pain of intestinal obstruction
True colic.
Small bowel: felt centrally. Occurs 2-20 mins.
Large bowel: usually lower third of abdomen. Occurs every 30+ mins.
Describe the characteristic vomit per level of obstruction.
Pyloric: watery and acidic.
High small bowel: greenish blue bile stained vomit.
Lower small bowel: brown, foul smelling. Faeculent vomit.
What are the important differentials of infarction of a viscus?
Perforated viscus causing peritonitis, severe acute pancreatitis, ruptured AAA.
What are the common conditions causing intra-abdominal or retroperitoneal haemorrhage?
Ruptured AAA, ruptured spleen, ruptured ectopic pregnancy.
What are the features of intrabdominal haemorrhage?
Rapid onset of pain; signs of shock and collapse may precede pain.
Exam: patient looks pale, sweating, restless and breathless. Tachycardia.
Clinical picture associated with bacterial peritonitis?
RED:
- vasodilated
- warm peripheries
- flushed
Clinical picture associated with chemical peritonitis / severe pancreatitis / MI / PE?
GREY:
- shutdown
- clammy/ sweaty
Clinical picture associated with hemorrhagic shock?
WHITE:
- pale, shut down
- cold peripheries
What are the tubulovarian causes of acute abdominal pain?
- Tort
- Bleed
- Rupture
