Acute Abdomen Flashcards
How may a patient present with an acute abdomen?
pain can be in any quadrant
pain can be dull, sharp, achy, or piercing
can radiate from a focal site
be accompanied by N&V
What DDx may you have if pain is in the epigastric region?
gastric ulcer +/- perforation pancreatitis perforated oesophagus Mallory-Weiss tear cholelithiasis MI
What DDx may you have if pain is in the RUQ?
Cholelithiasis Cholecystitis Hepatitis Hepatic Abscess Malignancy of colon Perforation of colon Pyelonephritis Kidney stones appendicitis displaced due to pregnancy
What DDx may you have if pain is in the LUQ?
splenic infarction ruptured splenic artery malignancy of colon perforation of colon pyelonephritis kidney stones
What DDx may you have if pain is in the LLQ?
sigmoid volvulus diverticulitis gynaecological - ovarian torsion, cysts, ectopic, PID Crohn's UC Kidney stones GI malignancy psoas abscess incarcerated hernia
What DDx may you have if pain is in the RLQ?
Appendicitis gynaecological concerns kidney stones GI malignancy psoas abscess incarcerated hernia
What DDx may you have if pain is in the Periumbilical region?
appendicitis radiating
acute mesenteric ischaemia
ruptured AAA
SBO
If pain radiates to the back, what might the cause be?
pancreatitis
abdominal aortic dissection
ruptured AAA
What does ___ bowel sounds mean on auscultation?
a. tinkling
b. hyper-resonant
c. absent
a. LBO
b. with decreased breath sounds may indicate pneumonia, with decreased heart sounds then pericarditis
c. perforated viscus or haemoperitoneum
If there is pain on percussion or any rebound tenderness, what might that mean?
peritonitis
What other exams must you consider when presented with an acute abdomen?
for men - scrotal/testicular exam –> epididymitis or testicular torsion
for women - pelvic exam –> ovarian torsion, ectopic pregnancy, PID
Rectal exam - occult/frank blood or pain or mass
What do radio-opaque stones mean on AXR?
Why might you perform an erect CXR?
cholecystitis
pancreatitis
kidney/ureter stones
aortic wall calcification –> AAA
perforated GI will result in the release of gas which will get trapped under the diaphragm
When might you use ___?
a. CT
b. USS
c. MRI
a. useful for pretty much any surgical-related abdominal pain
b. useful for RUQ pain –> gallstones, gallbladder thickening, pericholecystic fluid in cholecystitis, fibroscan to visualise liver
c. specifically for aortic dissection pancreatitis Crohn's endometriosis psoas abscess
What is Rigler’s sign?
double wall of intestine on AXR –> perforation
What bloods would you order if someone presented with an acute abdomen?
FBC WCC LFTs CRP U&Es Gas - Hb, glucose, pH, lactate, base excess Amylase
