Acute Abdomen Flashcards
define acute abdomen
sudden onset severe abdominal pain of less than 24 hours duration
what is the first decision that needs to be made when seeing a patient that is presenting with an acute abdomen?
whether they are critically unwell
10 second assessment of their clinical state can be done by look at the patient, looking at their observations and whether they can talk to you
what do you do if you decide that a patient is critically unwell?
give oxygen, start suitable initial steps and call for help early before doing the history and examination
what are the common causes of acute abdomen that require surgery?
bleeding
perforated viscus
ischaemic bowel
what are other cases of acute abdomen that are less acute?
colic
peritonism
what are the common causes of bleeding, leading to an acute abdomen?
- ruptured abdominal aortic aneurysm - most serious
- ruptured ectopic pregnancy
- bleeding gastric ulcer
- trauma
patients who bleed in the abdomen can go into hypovolaemic shock. what are the signs of this?
- tachycardia
- hypotension
- pale and clammy
- cool to the touch
- thready pulse
what is the management of a bleed into the abdomen?
surgery
what are the common causes of a perforated viscus?
- peptic ulcer
- small or large bowel obstruction
- diverticular disease
- inflammatory bowel disease
what can a perforated viscus cause?
generalised peritonitis
what are the characteristic features of generalised peritonitis?
- patients often lay completely still and do not move their abdomen
- they look unwell
- tachycardia
- sometimes hypotension
- involuntary guarding
- completely rigid abdomen with percussion tenderness
- reduced or absent bowel sounds (paralytic ileus)
describe the characteristics of ischaemic bowel
- severe pain (any patient with severe pain out of proportion to the clinical signs has ischaemic bowel until proven otherwise)
- diffuse and constant pain
may be no signs on examination
what are the causes of colic?
ureteric obstruction bowel obstruction (biliary colic is not a true colic)
what is peritonism?
localised inflammation of the peritoneum (e.g. in appendicitis)
what are the common causes of right upper quadrant pain? (5)
- cholecystitis
- pyelonephritis
- ureteric colic
- hepatitis
- pneumonia
what are the common causes of left upper quadrant pain? (4)
- gastric ulcer
- pyelonephritis
- ureteric colic
- pneumonia
what are the common causes of right lower quadrant pain? (7)
- appendicitis
- ureteric colic
- inguinal hernia
- IBD
- UTI
- Gynaecological
- Testicular torsion
what are the common causes of left lower quadrant pain? (7)
- diverticulitis
- ureteric colic
- inguinal hernia
- IBD
- UTI
- Gynaecological
- testicular torsion
what are the common causes of epigastric region pain? (4)
- peptic ulcer disease
- cholecystitis
- pancreatitis
- myocardial infarction
what are the common causes of peri-umbilical pain (4)
- small bowel obstruction
- large bowel obstruction
- appendicitis
- abdominal aortic aneurysm
which investigations are carried out in an acute abdomen?
- urine dipstick
- pregnancy test
- ABG
- routine bloods (FBC, U&E, LFT, CRP, Amylase, serum calcium)
- blood cultures
what can be seen on a urine dipstick in an acute abdomen?
signs of infections/haematuria
what can be seen on an ABG in a patient with acute abdomen?
pH, pO2, pCO2 and lactate can be measured to check for tissue hypo perfusion in bleeding/sepsis
why is serum calcium measured in acute abdomen and what does it indicate?
when suspecting pancreatitis
high calcium levels can cause pancreatitis
why is serum amylase measured in acute abdomen and what does it indicate?
amylase 3x greater than upper limit is diagnostic of pancreatitis
raised value lower than this can be due to perforated bowel, ectopic pregnancy or DKA
what imaging should be done for a patient withy acute abdomen?
- ECG
- Ultrasound
- Erect chest Xray
which structures can be imaged using ultrasound in acute abdomen and why?
- kidneys, ureter and bladder for suspected renal tract pathology
- Biliary tree and liver - for suspected gallstone disease
- Ovaries, fallopian tubes and uterus - for suspected tuba-ovarian pathology
what is the management of acute abdomen?
- IV access
- NBM
- Analgesia
- +/- antiemetics
- imaging
- VTE prophylaxis (post-op)
- urine dip
- bloods
- consider urinary catheter and nasogastric tube if necessary
- Start IV fluids and monitor fluid balance
what signs are looked for on an erect chest Xray in an acute abdomen?
air under the diaphragm - suggests bowel perforation
