Acute Abdomen

Question 1

Define acute abdomen

Answer 1

abdominal condition causing severe pain requiring surgical intervention

Question 2

what are the commonest causes of acute abdomen

Answer 2

intestinal obstruction (35%)
acute appendicitis (25%)

Question 3

what is Cope’s psoas sign?

Answer 3

pain on extension and flexion of the hip

appendicitis

Question 4

what Imaging Ix for:
RUQ
LUQ
RLQ
LLQ
SP?

Answer 4

RUQ - USS
LUQ - CT
RLQ - contrast-enhanced CT
LLQ - contrast-enhanced CT
SP - USS

Question 5

what can plain XR see in the abdomen?

Answer 5

free air
calcifications
obstruction

CT is generally baseline Ix for acute abdomen

Question 6

where can colicky pain present?

Answer 6

in any hollow viscus with smooth muscle

• intestine
• gallbladder
• biliary tree
• ureter

Question 7

what does biliary colicky pain feel like

Answer 7

misnomer - not peak and trough, just comes on few hours after meal, lasts few hours then subsides

Question 8

why does CECT work on abdominal inflammation?

Answer 8

more inflammation = more blood flow = more uptake of contrast

Question 9

what is a phlegmon

Answer 9

inflammatory mass

sometimes the body can make a phlegmon during appendicitis, blocking the appendix off from the intestine, and this can be managed conservatively

Question 10

sequence of appendicitis?

Answer 10

mucocele
venous pressure build up 
arterial ischaemia
gangrene
perforation

normally at day 3 the omentum forms mass around appendix to limit spread of infection