Acute abdomen Flashcards
How does visceral abdominal pain present?
Deep-seated and ill-localized
Location of visceral pain for
a) foregut structures (lower oesophagus to second part of duodenum)
b) midgut structures (dueodenum to splenic flexure)
c) hindgut structures (splenic flexure to rectum)
a) epigastrium
b) umbilicus
c) hypochondrium
What is the pattern of parietal abdominal pain?
Sharp, well-localized pain with reflex guarding and muscle rigidity
What causes colic?
Visceral pain arising from muscular structure with a hollow viscus which is blocked
How is the movement of patients affected in colicky pain versus irritation of the parietal peritoneum?
Colicky pain- can’t sit still
Parietal pain- don’t want to move
How does irritation of the diaphragmatic peritoneum present differently, depending on the location? (2)
Peripheral diaphragmatic peritoneum-lower spinal nerve distribution
Central diaphragmatic peritoneum- phrenic nerve distriubution (C3, C4, C5, shoulder and neck area)
What are the main “surgical” aetiologies of abdominal pain? (4)
Inflammation e.g. appendicitis, diverticulitis
Obstruction e.g. biliary colic, intestinal obstruction
Perforation e.g. peptic ulcer, diverticulum, appendix
Ischaemia e.g. mesenteric ischaemia, torsion
Pain which is helped by moving/drawing knees up to chest?
Obstructive colicky pain
Pain which comes on very suddenly and is constant?
Perforation
Pain on moving/coughing?
Suggests inflammation of the parietal peritoneum
Best indicators of peritonism? (4)
Pain on movement/coughing/going over speed bumps
Involuntary guarding
Generalized rigidity
Rebound tenderness
What does the loss of liver dullness on percussion suggest?
May represent free intra-peritoneal gas
What does “shifting dullness” suggest?
Free fluid in the abdomen (ascites)
Absence of bowel sounds over a period of 30 seconds suggests what clinical syndrome?
Ileus
Higher volume, frequency and pitch of bowel sounds suggests what clinical syndrome?
Obstruction
Catching of the breath when RUQ is palpated during inspiration?
Murphy’s sign- acute cholecystitis
Bruising around the umbilicus?
Cullen’s sign- acute pancreatitis
Bruising in the left flank?
Grey Turner’s sign- acute pancreatitis
Palpation in the left iliac fossa producing pain in the right iliac fossa?
Rosving’s sign- acute appendicitis
Patients with sepsis or ischaemic damage are likely to exhibit which bloodgas derangement?
Metabolic acidosis due to elevated lactate
Which test should always be requested in a female of child-bearing age with an acute abdomen?
Pregnancy test- can confirm ectopic pregnancy, and is important if radiographs are to be taken
Commonest cause of free intraperitoneal gas?
Perforation of the bowel viscera
What is the main purpose of contrast abdominal X-rays?
Determining the presence/absence of perforation or obstruction
Management of acute appendicitis?
Laparoscopic or open appendicectomy
Pre-operative antibiotics
