Acute abdomen Flashcards
Define acute abdomen.
Sudden-onset, severe abdominal pain of unknown aetiology lasting lasting <24h
Define peritonitis.
Inflammation of the peritoneum typically caused by blood borne bacterial infection or rupture abdominal organs.
Define guarding.
Voluntary: abdominal muscle spasm that can suppressed at will
Involuntary: abdominal muscle spasm, caused by retroperitoneal inflammation, which cannot be wilfully suppressed
Define rebound tenderness.
Pain on removal of pressure from the abdomen
Associated with peritonitis
How does an acute abdomen usually present?
- pain (less so in children, elderly + pregnant women in 3rd trimester)
- hypotension
- confusion/impaired consciousness
- signs of shock
- systemically unwell/septic
- signs of dehydration
- rigi abdomen
- lying very still or writhing
- absent/altered bowel sounds
associated testicular pathology - marked involuntary guarding/rebound tenderness
- tenderness to percussion
- history of haematemesis or maelena
What are the differential diagnoses for pain in the epigastrium?
- MI
- Peptic ulcer
- Acute cholecystitis
- Perforated oesophagus
What are the differential diagnoses for pain in the RUQ?
- Acute cholecystitis
- Duodenal ulcer
- Hepatitis
- Congestive hepatomegaly
- Pyelonephritis
- Appendicitis
- Pneumonia
What are the differential diagnoses for pain in the LUQ?
- Ruptured spleen
- Gastric ulcer
- Aortic aneurysm
- Perforated colon
- pyelonephritis
- Pneumonia
What are the differential diagnoses for pain in the RLQ?
- Appendicitis
- Salpingitis
- Tubo-ovarian abscess
- Ruptured ectopic pregnancy
- Renal/ureteric stone
- Incarcerated hernia
- Mesenteric adenitis
- Meckel’s diverticulitis
- Crohn’s disease
- Perforated caecum
- Psoas abscess
What are the differential diagnoses for pain in the LLQ?
Flank:
- Intestinal obstruction
- Acute pancreatitis
- Early appendicitis
- Mesenteric thrombosis
- Aortic aneurysm
- Diverticulitis
Groin:
- Sigmoid diverticulitis
- Salpingitis
- Tubo-ovarian abscess
- Ruptured ectopic pregnancy
- Incarcerated hernia
- Perforated colon
- Crohn’s disease
- UC
- Renal/ureteral stone
What are the absolute indications that a patient with an acute abdomen should be referred to A&E?
- Peritonitis
- Vital signs abnormal
- Definite diagnosis requiring admission
- Signs of obstruction
- Suspected AAA
- Unwell patient
- Opioid analgesia required
What are the relative indications that a patient with an acute abdomen should be referred to A&E?
- Uncertain diagnosis
- Fever of unknown origin
- Very young/elderly
- Pregnancy
With which conditions will a patient with an acute abdomen have raised WBC?
- appendicitis
- cholecystitis
- PID
- duodenal/gastric ulcer
- acute mesenteric ischaemia
- intussusception
- hepatic abscess
- pyelonephritis
- strangulated hernia
- pancreatitis
- diverticulitis
- infectious colitis
A patient with an acute abdomen has hypochloraemia and hypokalaemia. What is the most likely differentia diagnosis?
Intestinal obstruction
A patient with an acute abdomen has raised blood glucose. What is the most likely differentia diagnosis?
Pancreatitis
