Acute abdomen

Question 1

what is the definition of an acute abdomen

Answer 1

combination of symptoms and signs, including abdominal pain, which results in a patient being referred for an urgent general surgical opinion.

very sudden onset

Question 2

what are the 3 most likely causes of acute abdomen

Answer 2

non-specfic pain

acute appendicitis

acute cholecystitis/colic

Question 3

what three things must you consider in acute abdomen pathophysiology (think non-specific)

Answer 3

Peritonitis
Intestinal obstruction
Abdominal pain

Question 4

what is the structure of the peritoneum

Answer 4

2 layers

Surface area = 2m2

Semi-permeable
membrane

Specialised lymphatics

Fibrinolytic activity (if it stops, the surfaces stick together)

Question 5

how can the peritoneum become infected (peritonitis)

Answer 5

Perforation of GI/ biliary tract

Female genital tract

Penetration of abdominal wall

Haematogenous spread

Question 6

what happens to the bacteria of the peritoneum as the infection progresses

Answer 6

aerobes use up all the O2 and disappear

allows for increase in anaerobes

Question 7

what are the different types of peritonitis

Answer 7

localised

general

Question 8

when does general peritonitis occur

Answer 8

present when failure of localisation and occurs when:
Contamination too rapid
Contamination persists
Abscess ruptures

Question 9

what are the three types of intestinal obstruction

Answer 9

blocked inside
blockage in wall
caused by pressing from outside

Question 10

what are the cardinal features of intestinal obstruction

Answer 10

Pain
Vomiting
Distension
Constipation
Borborygmi*

*rumbling or gurgling noise made by the movement of fluid or gas in the intestines

BUT depends on site (proximal vs distal)

Question 11

what are the different characters of abdominal pain

Answer 11

visceral - associated with systemic upset – eg flu like symptoms, vomiting, etc

somatic - without systemic upset

referred

Question 12

what else must you take into account for abdominal pain

Answer 12

Site of pain
Severity
Systemic upset

Question 13

how does visceral pain occur

Answer 13

Pain receptors in smooth muscle

Afferent impulses run with sympathetic fibres accompanying segmental vessels (CP, SMA, IMA)

Poorly localised

Question 14

how does somatic and referred pain occur

Answer 14

Receptors in parietal peritoneum or abdominal wall

Afferent signals pass with segmental nerves

Accurate localisation but can be referred

Question 15

what usually happens to visceral pain as it progresses

Answer 15

can change to somatic pain – eg appendicitis – as it worsens goes from mid-gut pain to localised area

Question 16

what are the effects of peritonitis and obstruction on the body

Answer 16

1. fluid loss, bacteraemia, endotoxaemia
2. leads to circulatory collapse
3. can lead to death

Question 17

what are the 5 parts of management of the acute abdomen

Answer 17

Assess
Resuscitate
Investigate
Observe
Treat

Question 18

what is involved in the assessment of the acute abdomen

Answer 18

What is the problem?
What are its effects?
What should I do?

History
Examination
Investigation

Consider:
Capacity
Level of care-intervention
vs. palliation

Question 19

what investigations can be done for the acute abdomen

Answer 19

Ward tests: urine

Lab tests: FBC, U+E, LFT

Radiology: plain,US, axial (CT) ?other

Laparoscopy vs. laparotomy

Question 20

what is involved in the resuscitation stage of acute abdomen management

Answer 20

Restore circulating fluid volume

Ensure tissue perfusion

Enhance tissue oxygenation

Treat sepsis

Decompress gut

Ensure adequate pain relief

Question 21

what is the treatment for acute abdomen

Answer 21

Definitive surgery

Be tough on sepsis and the causes of sepsis