Acute Abdomen

Question 1

What 4 signs should you look for if Acute Appendicitis is suspected?

Answer 1

1. McBurney’s – Tenderness upon palpation of McBurney’s point located at 1/3 along the line joining right ASIS and umbilicus
2. Psoas – RLQ pain upon hyperextension of the right hip
3. Obturator – RLQ pain upon internal rotation of the flexed right hip
4. Rovsing’s – RLQ pain upon LLQ palpation

Question 2

What type of metabolic disturbance would happen in severe vomiting and why?

Answer 2

• HypoK
• HypoCl
• Metabolic alkalosis with paradoxical aciduria

Pathophysi

• Vomit → lose H+, K+, Cl- & H2O → Hypovolaemia sensed by juxta-glomerular apparatus → ↑RAAS → ↑Na and H2O retention by ↑Na/K exchange → ↓K
• Body tries to conserve K by ↑K+/H+ exchange → ↑H+ in urine despite alkalosis
• Alkalosis also → ↓ionised Ca2+