Acute Abdomen Flashcards
Definition of acute abdomen?
Severe abdominal pain, lasting less than 10 days, usually requiring emergency surgery; it is caused by acute disease of/injury to the internal organs
4 common causes of RUQ (hypochondrium) pain?
Gall bladder - biliary colic, cholecystitis, cholangitis
Basal pneumonia
Musculoskeletal
Liver abscess/hepatitis
Presentation of gallstones?
Most common cause of RUQ pain and their presentation is with complications
Usually, they have a temperature and jaundice
How does biliary colic pain present: Site Radiation Duration of pain Temperature Jaundice?
Pain in the RUQ with radiation to the right shoulder blade; the pain is intermittent
There is no assoc. jaundice or temperature
How does cholecystitis pain present: Site Radiation Duration of pain Temperature Jaundice?
Pain in the RUQ with radiation to the right shoulder blade; the pain is constant
There is an assoc. temperature but no jaundice
How does choledocholithiasis pain present: Site Radiation Duration of pain Temperature Jaundice?
Presence of gallstones in the common bile duct presents with pain in the RUQ and no radiation; the pain is constant
There is no assoc. temperature but there is JAUNDICE
How does cholangitis pain present: Site Radiation Duration of pain Temperature Jaundice?
RUQ pain with no radiation; the pain is constant
There are assoc. symptoms of both a TEMPERATURE AND JAUNDICE
How does pancreatitis pain present: Site Radiation Duration of pain Temperature Jaundice?
Epigastric pain with radiation to the back; the pain is constant
There CAN BE assoc. symptoms of a TEMPERATURE AND JAUNDICE
5 common causes of pain in the epigastrium?
Pancreatitis Perforated duodenal ulcer AAA Gastritis/reflux Oesophagitis
History and examination of tenderness with pancreatitis pain?
Usually, there is a Hx of alcohol intake; there may have been occult injury to the pancreas, e.g: with trauma
These people are often very sore and “peritonitic” (lie still)
Ix for pancreatitis?
Amylase (>3 times the upper limit of normal is usually diagnostic)
Scoring
Ultrasound
CT scan (to look for peri-pancreatic fluid, etc)
History and examination of tenderness with a perforated duodenal ulcer?
Often assoc. with excess alcohol intake and NSAID use; the epigastric pain is sudden onset
Examination reveals peritonitic pain and a rigid abdomen
Ix for a perforated duodenal ulcer?
Erect CXR to look for free air under the diaphragm
History and examination of AAA?
Sudden onset epigastric pain which RADIATES TO THE BACK (mimics pancreatitis); there is usually a Hx of collapse and shock (low BP, tachycardia, etc)
Sometimes, there is a palpable tender aneurysm (usually felt in thin people)
Usually occurs in elderly males, with a cardiac history
Ix for AAA?
CT angiogram
History of gastritis/GORD/oesophagitis?
A tender epigastrium and there is usually a history of alcohol or reflux disease
Ix for gastritis/GORD/oesophagitis?
Oesophago-gastro-duodenoscopy (OGD)
3 common causes of LUQ pain?
Splenic (with injury, rupture or infarct)
Basal pneumonia
Musculoskeletal
Presentation of spleen injury, rupture, infarct, etc?
Normally, have a Hx of trauma or splenomegaly; most will present with shock
3 common causes of right AND left flank pain?
Pyelonephritis
Renal colic (this can sometimes lead to pyelonephritis)
Musculoskeletal
What is renal colic? Hx and examination findings?
Pain is in the flank and often radiates to the back (sometimes, mimics an AAA); these people are unable to get comfortable (move around a lot)
Assoc. symptoms are temperature and, sometimes, renal angle tenderness
Ix for pyelonephritis?
Urinalysis is +ve
Blood, nitrates, leukocytes
CTKUB (CT of kidney, ureter and bladder)
4 common causes of umbilical pain?
Obstruction
Early appendicitis
AAA
Meckel’s diverticulum (can also present in the LIF)
Hx and examination of obstruction?
Pain tends to be very general; assoc. symptoms of a distended abdomen, vomiting and constipation
