Acute Abdomen Flashcards
What is the acute abdomen?
Patient who becomes acutely ill and in whom symptoms and signs relate to the abdomen - initial assessment should determine if the patient has an acute surgical problem that requires immediate and prompt surgical intervention or urgent medical therapy.
Give some presentations that require urgent surgery.
Bleeding: ruptured AAA, ectopic pregnancy, gastric ulcer, trauma
Perforated viscus:
peptic ulcer/duodenal ulcer, appendix, diverticulum, bowel or gallbladder causing peritonitis.
Ischaemic bowel - severe pain out of proportion to the clinical signs
What are common causes of bleeding? How do patients present?
Ruptured AAA, Ruptured spleen, ruptured ectopic pregnancy, gastric ulcer, trauma.
Hypovolaemic shock, tachycardia, hypotension, pale and clammy and cool to touch with thready pulse, abdominal swelling may be seen..
What is peritonitis and how does it present?
Information of the peritoneum: generalised peritonitis is most commonly caused by perforation of abdominal viscus.
Signs: prostration, shock -tachycardia and hypotension
lying still , not to move their abdomen
+ve cough test,
tenderness ± rebound/percussion pain,
washboard abdominal rigidity,
involuntary guarding - tensing of abdominal muscles when touched,
no bowel sounds suggesting paralytic ileus
erect CXR may show gas under diaphragm
What are the causes of viscus perforation?
Peptic ulceration, small or large bowel obstruction, diverticular disease and inflammatory bowel disease
What investigations should you do in peritonitis?
Erect CXR for gas under diaphragm
Serum amylase to check for acute pancreatitis
What does a patient with severe abdominal pain out of proportion to the clinical signs have? How do they present? How is diagnosis made?
Ischaemic bowel
Academic with raised lactate
Diffuse and constant pain
CT scan with IV contrast
What is colic?
Abdominal pain that waxes and wanes, crescendos and then disappears, caused mud muscular spasm in a hollow viscus - gut, ureter, sapling, uterus.
Causes restlessness.
Biliary colic is not true colic as the pain does not go away completely - dull and constant
What is peritonism?
Localised inflammation of the peritoneum due to inflammation of a viscus that irritates the visceral and parietal peritoneum.
Eg diverticulitis, cholecystitis, salpingitis, appendicitis
Abdominal pain starts in one place (irritation of visceral peritoneum) before localising to another area or becoming generalised (irritation of the parietal peritoneum)
What investigations can you do for the acute abdomen?
U&E FBC Amylase / serum calcium-> pancreatitis LFT CRP G&S Xmatch ABG for bleeding/septic patients Lactate - mesenteric ischaemia Urine and serum hCG to exclude ectopic - infection, haematuriapregnancy Erect CXR - pneumoperitoneum AXR USS- KUB, Biliary tree, gynaecologist ECG for MI
What important hidden diagnoses should you be aware of in the acute abdomen?
Mesenteric ischaemia - raised serum lactate
Acute pancreatitis - raised serum amylase
Leaking AAA
Ectopic pregnancy - serum hCG raised
What are causes of RUQ pain?
Cholecystitis Duodenal ulcer Pyelonephritis Ureteric colic Hepatitis Pneumonia Congestive hepatomegaly
What are causes of LUQ pain?
Gastric ulcer Ruptured spleen Pyelonephritis Ureteric colic Pneumonia Aortic aneurysm Perforated colon
What are causes of RLQ pain?
Appendicitis Ureteric colic Inguinal hernia (strangulated) Inflammatory Bowel disease - crohn's Gynae - salpingitis, ruptured ectopic pregnancy, tubo-ovarian abscess Renal stone UTI Meckel's diverticulitis PErforated caecum Testicular torsion
What are causes of LLQ pain?
Sigmoid diverticulitis Strangulated inguinal hernia Ureteric colic - stones UC/Crohn's Gynae - salpingitis, ruptured ectopic pregnancy, tube-ovarian abscess Perforated volon Testicular torsion
