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General Surgery > Acute abdomen > Flashcards

Acute abdomen Flashcards

1
Q

Define Acute abdomen

A

Recent or sudden onset of unexpected signs or symptoms including abdominal pain

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2
Q

What is the significance of acute abdomen?

A

Potential for life-threatening infection or fluid/blood loss

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3
Q

Name 2 causes of abdominal visceral pain

A
  • Ischaemia
  • Distension
  • Tension - often colicky
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4
Q

What areas can be involved in Epigastric pain?

A
  • Stomach to the 2nd part of duodenum
  • Liver and biliary tree
  • Pancreas and spleen
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5
Q

What areas can be involved in Periumbilical pain?

A

2nd part of duodenum to proximal 2/3 transverse colon

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6
Q

What areas can be involved in Suprapubic pain?

A

Distal 1/3 transverse colon to anal verge

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7
Q

Where does biliary tract pain refer to?

A

Right inferior scapular area

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8
Q

Where does diaphragmatic irritation refer to?

A

Ipsilateral shoulder tip pain

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9
Q

Categorise the types of intra-abdominal causes of abdominal pain

A
  • Generalised peritonitis
  • Localised peritonitis
  • Motility disorders
  • Ischaemia
  • Ruptured AAA
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10
Q

Categorise the types of extra-abdominal causes of abdominal pain

A
  • Thoracic
  • Neurological disease
  • Metabolic
  • Toxins
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11
Q

Name two causes of generalised peritonitis ➔ abdominal pain

A
  • Perforated viscus
  • Primary infectious peritonitis
  • Rupture of cyst
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12
Q

Name 2 causes of localised peritonitis ➔ abdominal pain

A
  • Appendicitis
  • Cholecystitis
  • Pancreatitis
  • Diverticulitis
  • Abscess
  • Salpingitis/ruptured ectopic
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13
Q

Name 2 motility disorders causing abdominal pain

A
  • Obstruction - intestinal, ureteric, biliary
  • Spasm - irritable colon, uterine contraction
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14
Q

Name 2 ischaemic causes of abdominal pain

A
  • Mesenteric angina (chronic)
  • Splenic infarction
  • Torsion - testicle, ovarian cyst, omentum
  • Tumour necrosis - hepatoma, fibroid
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15
Q

Name 2 thoracic causes of abdominal pain

A
  • Lung disease
  • Ischaemic heart disease
  • Oesophageal disease
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16
Q

Name 1 neurological cause of abdominal pain

A
  • Shingles (Herpes zoster)
  • Spinal arthritis
  • Abdominal epilepsy (Seizures ➔ abdominal symptoms)
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17
Q

Name 2 metabolic causes of abdominal pain

A
  • Diabetes mellitus (Gastroparesis: delayed emptying. Commoner in T1DM)
  • Chronic renal failure
  • Porphyria (Porphyrin accumulation)
  • Acute adrenal insufficiency
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18
Q

Name 2 toxin causes of abdominal pain

A
  • Snake and insect bites
  • Lead poisoning
  • Strychnine (pesticide)
  • Peptic ulcer (H. pylori)
  • Inflammatory disease
19
Q

Name 4 differential diagnoses for acute abdominal pain

A
  • Nonspecific
  • Acute appendicitis
  • Acute cholecystitis and biliary colic
  • Peptic ulcer perforation
  • Small bowel obstruction
  • Gynaecological disease
  • Acute pancreatitis
20
Q

What features are suggestive of abdominal malignancy?

A
  • Intermittent pain of 48+hr
  • Altered bowel habit
  • Abdominal distension
  • Mass
  • Weight loss
21
Q

What features are suggestive of bowel obstruction?

A
  • Colicky severe pain
  • No aggravating factors
  • Vomiting and constipation
  • Previous surgery
  • Abdominal distension
  • High pitched tinkling bowel sounds
22
Q

What features are suggesting of a perforated viscus?

A
  • Sudden onset of pain
  • Constant severe pain
  • Pain aggravated by movement, coughing, sneezing
  • Diffuse tenderness
  • Silent rigid abdomen

N.B. This slightly raises serum amylase

23
Q

Which bedside investigations may be done in acute abdomen, and why?

A
  • BM (DKA)
  • Urinalysis
  • Pregnancy test*
  • ECG (exclude MI, and necessary for anaesthetic)
24
Q

What laboratory investigations may be done in acute abdomen, and why?

A
  • FBC (infection, rarely diagnostic)
  • U&Es
  • Serum amylase* (3x normal max ➔ acute pancreatitis)
  • LFTs
  • ABGs
  • CRP
25
Q

What radiological investigations may be done in acute abdomen and, why?

A
  • AXR - rarely diagnostic
  • Erect CXR*: pneumoperitoneum
  • Upper abdo USS: assess hepatobiliary pathology
  • Pelvic USS: tubo-ovarian disease
  • Contrast studies
  • Endoscopy
  • Abdominal CT: best Ix for generalised peritonitis
  • MRI

CT and MRI are not routine due to significant radiation.

26
Q

Outline the general management of acute abdomen

A

NBM Fluid balance: IV fluids + Catheter/NG tube Analgesia + antiemetic Observations Avoid ABX until a clear diagnosis is formed Treat underlying cause once management plan established.

27
Q

What radiological finding suggests viscus perforation?

A

Air under the diaphragm in an erect CXR

28
Q

Name 3 causes of acute abdomen that are surgical emergencies?

A
  • Generalised peritonitis (except acute pancreatitis)
  • Intestinal obstruction
  • Acute mesenteric ischaemia
  • Viscus perforation
  • Strangulated (irreducible, tender) hernia
29
Q

Name 3 causes of acute abdominal pain in Right hypochondriac region

A
  • Right lower lobe pneumonia/embolism
  • Cholecystitis
  • Biliary colic
  • Hepatitis
30
Q

Name 3 causes of acute abdominal pain in Epigastric region

A
  • Pancreatitis
  • Gastritis
  • Peptic ulcer
  • MI
31
Q

Name 2 causes of acute abdominal pain in Left hypochondriac region

A
  • Left lower lobe pneumonia/embolism
  • Large bowel obstruction
  • Splenic rupture
32
Q

Name 1 cause of acute abdominal pain in Right lumbar region

A
  • Renal colic Appendicitis
33
Q

Name 3 causes of acute abdominal pain in Umbilical region

A
  • Intestinal obstruction
  • Intestinal ischaemia
  • Aortic aneurysm
  • Gastroenteritis
  • Crohn’s disease
  • Early appendicitis
  • Pancreatitis
  • Umbilical hernia
34
Q

Name 1 cause of acute abdominal pain in Left lumbar region

A
  • Renal colic
  • Large bowel obstruction
35
Q

Name 2 causes of acute abdominal pain in Right iliac region

A
  • Appendicitis
  • Crohn’s disease
  • Right tubo-ovarian pathology
36
Q

Name 2 causes of acute abdominal pain in Suprapubic region

A
  • Cystitis
  • Urinary retention
  • Dysmenorrhoea
  • Endometriosis
37
Q

Name 2 causes of acute abdominal pain in Left iliac region

A
  • Sigmoid diverticulitis
  • Left tuba-ovarian pathology
38
Q

What clinical features suggest an inflammatory cause of acute abdominal pain?

A
  • Constant pain
  • Gradual onset
  • Progressive worsening
39
Q

What does poorly localised intermittent pain suggest?

A

Colic from a visceral structure

40
Q

What clinical feature is most suggestive of mesenteric ischaemia till proven otherwise?

A

Severe pain out of proportion to clinical signs

41
Q

Which structures can cause loin or back pain?

A

Retroperitoneal structures: esp pancreas, renal tract, and abdominal aorta

42
Q

How does management of generalised peritonitis differ if the cause if acute pancreatitis as opposed to other causes?

A

Majority of generalised peritonitis requires laparotomy/laparoscopy to perform a surgical washout and treat the underlying cause.

Acute pancreatitis differs as it can be treated without surgical incision. Instead it is treated with urgent endoscopic retrograde cholangio-pancreatography (ERCP) to remove gallstones.

43
Q

Why should serum amylase be investigated in all patients with acute abdomen?

A

Identify/exclude acute pancreatitis (Serum amylase 3x normal max). This is because management involves ERCP rather than surgery.

General Surgery (23 decks)

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