Acute abdomen Flashcards
acute abdomen
rapid onset of severe Sx
may indicate life threatening intra abdo pathology
pain usually, but not always a feature
pain free more likely in the elderly, children and 3rd trimester
major causes
acute cholecystitis acute appendix or meckel's diverticulum acute pancreatitis ectopics diverticulitis peptic ulcer disease PID obstruction gastroenteritis intestinal ischaemia/infarct GI haemorrhage renal colic acute urinary retention AAA torsion
also non-surgical disease, eg:
MI, pericarditis, pneumonia, sickle cell crisis, hepatitis, IBD, opiate withdrawal, typhoid, acute intermittent porphyria
RUQ pain
acute cholecystitis duodenal ulcer hepatitis congestive hepatomegaly pyelonephritis appendicitis pneumonia
epigastrium pain
MI
peptic ulcer
acute cholecystitis
perforated oesophagus
LUQ pain
ruptured spleen gastric ulcer aortic aneurysm perforated colon pyelonephritis pneumonia
RLQ pain
appendicitis salpingitis tubo-ovarian abscess ruptured ectopic renal/ureteric stone incarcerated hernia mesenteric diverticulitis meckel's crohn's perforated caecum psoas abscess
LLQ pain
higher: obstruction acute pancreatitis early appendicitis mesenteric thrombosis aortic aneurysm diverticulitis
lower: sigmoid diverticulitis salpingitis tubo-ovarian abscess ruptured ectopic incarcerated hernia perforation crohn's UC renal/ureteric stone
Hx
cover the following:
demographics, Hx of recent trauma
pain - SOCRATES
associated Sx - vomiting, melaena, stool/urine colour, new lumps, eating and drinking, bowels, fainting, dizziness or palpitations, fevers/rigors, rash, pruritus, urinary Sx, recent weight loss
PMH & surgical Hx
obs & gynae - contraception, LMP, STIs, PID, gynae/tubal surgery, ectopics, PV bleeding, DH & allergies
hospital care for acute abdo
NBM O2 as appropriate IV fluids ? NG tube if severe vomiting analgesia - via opiates antiemetics ABx - if septic, peritonitis, severe UTI suspected (IV cephalosporin + metronidazole) surgical/gynae review
red flags for serious pathology
hypotension confusion/impaired consciousness signs of shock systemically unwell/septic signs of dehydration rigid abdomen lying very still or writhing absent/altered bowel sounds associated testicular pathology marked involuntary guarding or rebound tenderness tenderness to percussion Hx of haematemesis/melaena or evidence of latter on PR suspicion of medical cause for pain
top 5 medical causes of acute abdomen in the elderly
inferior MI lower-lobe pneumonia/PE causing pleurisy DKA or HONK pyelonephritis IBD
