Acute abdomen Flashcards
What is an acute abdomen?
Less than 10 days.
Progressive intra abdominal condition
Causing severe morbidity or threat to life
What are the common causes of an acute abdomen?
NSAP (acute nonspecific abdominal pain) Acute appendicitis Intestinal obstruction. Urological cause Gallstones Diverticular disease Trauma Malignancy Perforated ulcer Pancreatitis IBS Bacterial and viral infections Gynae things Odd things (back pain, Diabetic ketoacidosis
What are the rare causes of acute abdomen?
Ruptured AAA
IBD
Medical causes
Ischemic gut
Munchhausenen’s syndrome is a common cause of acute abdomen. WHat is this?
factitious disorder, a mental disorder in which a person repeatedly and deliberately acts as if he or she has a physical or mental illness when he or she is not really sick.
Drug seekers, manipulative, seem genuine.
What are the symptoms of acute abdomen?
Abdo pain (visceral, parietal, extra-abdominal)
Location
Radiation
Associated symptoms (Nausea and vomiting, burping, heart burn/indigestion, change in bowel habit, PR blood/mucus)
What do you want to ask about someone vomit?
Colour Green (Bile) or foodstuff? Projectile? Blood? Coffee grounds(coagulated blood)?
What signs are you looking for on abdominal examination of acute abdomen?
Pain Localised puritanism Generalised puritanism Guarding Rebound tenderness Rosvig's sign (palpation of the left => pain on the right)
WHen are bowel sounds absent?
Ileus
Very obese
What auscletation sounds may be seen in bowel obstruction?
Tinkling bowel sounds
What is the initial management of acute abdomen?
ABCDE Observations GIve oxygen Fluids Urinanalysis Analgesia Morphine/paracetamol IV with anti-emetic.
What is Cullen’s sign?
superficial edema and bruising in the subcutaneous fatty tissue around the umbilicus.
Seen in acute severe pancreatitis and ectopic pregnancy.
What is Grey Turners sign?
bruising of the flanks, the part of the body between the last rib and the top of the hip.
Seen in pancreatitis, trauma and ruptured AAA
What is erythema ab igne?
skin reaction caused by chronic exposure to infrared radiation in the form of heat.
What are striae?
Stretch marks
What are the initial investigations for acute abdomen>
Bloods (FBC, LFT, UE, CRP, Ca, Lactate, Coag) Amylase! AGs Plain radiology (AXR and erect CXR) Or CT
Why is a plain erect CXR important?
Useful if abnormal Eclude pneumonia Gas under diaphragm => rupture of bowel. Preoperative investigation. If too ill to stand consider lateral CXR
When would you consider an AXR?
Obstruction, colitis and perforation.
Over used and lots of radiation
What is the gold standard test for an acute abdomen?
CT
Early CT is associated with reduced mortality and decreased hospital stay.
When is an USS most useful?
RUQ and RIF pain (liver and appendix)
Children
Women with pelvic pain (transvagianl USS)
What is replacing contrast swallows/enemas?
CT scanning
When would you use MRI?
Only really in pregnant appendicitis.
Takes too long for acute abdomen
What are the life threatening conditions you must exclude with acute abdomen?
Acute pancreatits- amylase bloods
Symptomatic AAA- CT scan.
What is the treatment for acute abdomen?
Related to cause.
Often surgery. Laparotomy vs Laparoscopy
OR
Do nothing and actively observe the patient
What are the surgical emergencies which must go to theatre immediately?
Ruptured AAA
Faecal peritonitis
Ischemic gut
What are the signs of perforated duodenal ulcer?
Board like rigidity.
Ususlaly no history of dyspepsia
How is a perforated DU treated?
Resuscitate Antibiotics Theartre or not? Patch repair Eradicate H pylori and give PPI
What are the colonic emergencies?
Obstruction Volvulus Acute diverticulitis Toxic colitis Perforations
How is a sigmoid volvulus treated?
Decompress using a rigid sigmoidoscope
How is a colonic maligant obstruction treated?
Stent or operate
How is diverticulitis treated?
Depends on severity
Antibiotics up to Hartmann’s procedure (proctosigmoidoscopy)
What is Typhilitis and how is it treated?
Inflammation of the caecum.
Antibiotics or operate
How are bowel perforations managed?
Stercoral: contents of intestines in peritoneum => Remove colon
Leaks: theatre (assess and decide)
What are the operations to consider for diverticulitis?
Wash out
Harmanns
Laproscopic or open
The Hinchey Classification is the classification for diverticulitis. What are the 4 classes?
1= paracolic abscess 2= pelvic abscess 3= purulent peritonitis 4= faecal peritonitis
What is the hartmann’s procedure?
Remove sigmoid colon, leaving recum and bring out a colostomy.
