Acute abdomen

Question 1

what clinical syndromes usually require laparotomy?

Answer 1

rupture of an organ

peritonitis

Question 2

What are the causes of infected peritonitis?

Answer 2

1. perforation of GI tract or reproductive system
2. Disruption of peritoneum by surgery or trauma
3. SBP
4. Systemic infections e.g. tb

Question 3

What are the causes of non-infective peritonitis?

Answer 3

1. leakage of sterile bodily fluids into peritoneum - these become infected once in the peritoneal cavity
2. Autoimmune disease e.g. lupus

Question 4

What are the symptoms of peritonitis?

Answer 4

Sudden onset acute abdominal pain
Tenderness (+/- rebound/percussion pain)
Fever

Question 5

What are the signs of peritonitis?

Answer 5

Prostration  - lying stretched out on the ground
Lying still 
Washboard rigidity
\+ve cough test  
Guarding 
Shock
HR >100

Question 6

What investigations should you carry out in peritonitis and why?

Answer 6

Erect CXR - look for air under diaphragm
Serum amylase - acute pancreatitis causes similar presentation
US/CT to confirm diagnosis

Question 7

What are the causes of local peritonitis?

Answer 7

diverticulitis
cholecystitis
salpingitis
appendicitis

Question 8

What is the management of peritonitis?

Answer 8

1. IV fluids and electrolytes
2. IV abx
3. Laparotomy

Question 9

What is the management of abscess formation in local peritonitis?

Answer 9

Drainage - either percutaneous or laparotomy

Question 10

What is colic?What causes it?

Answer 10

regularly waxing and waning pain caused by muscular spasm in a hollow viscus

Question 11

How does colic differ to peritonitis?

Answer 11

colic causes restlessness and the pt may be pacing around whereas in peritonitis the pt is completely still and rigid

Question 12

Why shouldn’t a patient be rushed to theatre if they have an acute abdomen?

Answer 12

anaesthesia compounds shock, resuscitate properly first unless blood is being lost faster than it is being replaced

Question 13

What is aLWAYS important to exclude in acute abdomens?

Answer 13

PREGNANCY

Question 14

What are unsuspected easily undetectable causes of acute abdomen that are important to consider?

Answer 14

mesenteric ischaemia
acute pancreatitis
leaking AAA

Question 15

What are causes of RUQ abdominal pain?

Answer 15

acute cholecystitis
duodenal ulcer
hepatitis
congestive hepatomegaly
pyelonephritis
appendicitis
R sided pneumonia

Question 16

What are the causes of LUQ pain?

Answer 16

ruptured spleen
gastric ulcer
aortic aneurysm 
perforated colon
pyelonephritis
L sided pneumonia

Question 17

What are causes of RLQ pain

Answer 17

appendicitis
salpingitis
ruptured ectopic
renal/ureteric stone 
strangulated hernia
mesenteric adenitis
meckels diverticulum
crohns
perforated caecum
psoas abscess 
tubo-ovarian abscess

Question 18

What are causes of LLQ

Answer 18

Sigmoid diverticulitis
Salpingitis
tubo-ovarian abscess
ruptured abscess
strangulated hernia
perforated colon
crohns
UC
renal/ureteric stones

Question 19

What are the causes of epigastric pain

Answer 19

pancreatitis
MI
peptic ulcer
acute cholecystitis
perforated oesophagus

Question 20

What are causes of umbilical pain

Answer 20

intestinal obstruction
acute pancreatitis
early appendicitis
mesenteric thrombosis
aortic aneurysm 
diverticulitis