Acute abdomen Flashcards
1
Q
Definition
A
Any patient who becomes acutely ill and in whom symptoms and signs are chiefly related to the abdomen.
2
Q
History
A
- Site of pain
- Type of pain
- Duration of pain
- Associated symptoms
- Previous episodes/previous investigations
3
Q
Clinical examination
A
- abdominal examination
- guarding
- rebound tenderness
- palpable tender mass e.g gallbladder, diverticular mass
- rectal examination
4
Q
Types of pain
A
- Localised pain is generally somatic, ie that it originates from the site of disease process.
- Generalised pain is usually visceral, ie diffuse, midline and difficult to localize.
- Colicky pain is usually due to obstruction of the gut, biliary system, urogenital system or uterus.
- Viscus obstruction causes waves of pain, whereas obstruction by stones etc causes sharp pain which is not eaisly relieved.
- Constant pain tends to be more associated with inflammation and will be supported by other features.
- Peritonism – Board-like abdomen, rigidity, guarding, no bowel sounds. Can be localised or general – General = PERFORATION until otherwise proven
5
Q
Investigations of acute abdomen
A
- Blood tests – full blood count, U+Es, LFTs, amylase
- Erect chest X-ray
- Ultrasound
- CT scan
- Arterial blood gases
- Erect chest X-ray in perforated ulcer showing free gas under diaphragm
- Blood cultures
- Pregnancy test
6
Q
Treatment of acute abdomen
A
Treatment - Depends on cause diagnosed.
- IV access x 2
- Treat shock
- IV fluid resus – aggressive if shocked, control in elderly
- IV antibiotics – broad spectrum
- Catheterise
- Involve anaesthetics early if theatre needed
- Give adequate analgesia
- Renal pathology – diclofenac (voltarol) 100mg PR
- Intra-abdominal pathology – 5-10mg morphine IV
- Sepsis 6
- Theatre If needed
- Admit or discharge
7
Q
Upper abdominal pain causes
A
Upper abdominal pain
- Gastritis/peptic ulcer
- Acute cholecystitis
- Acute pancreatitis
- Perforated duodenal/gastric ulcer
- Referred pain from thorax – MI, pneumonia
8
Q
Lower abdominal pain
A
Lower abdominal pain
- Acute appendicitis
- Diverticulitis
- Ovarian cyst/ruptured cyst/torsion
- Ectopic pregnancy
- Ureteric stones
- Urinary retention
9
Q
Generalised abdominal pain
A
- Perforated viscus
- Mesenteric ischaemia
- Diabetes – ketoacidosis
- Bowel obstruction – may be more localised
- Gastroenteritis
10
Q
A