Acute abdomen!

Question 1

define acute abdomen?

Answer 1

new onset abdo pain < 1 wk

Question 2

ΔΔ acute abdomen?

Answer 2

• INFLAMMATION: appendicitis, diverticulitis, cholecystitis, GE, salpingitis (PID), IBD, pyelonephritis
• RUPTURE/PERFORATION: spleen, AAA, peptic ulcer, appendix, bowel, GB, ectopic, ovarian cyst
• BOWEL: obstruction, ischaemia
• TORSION/STRANGULATION: hernia, ovarian cyst, testicular torsion
• CHEST: lower lobe pneumonia, inferior MI
• OTHER: renal colic, endometriosis, adhesions

Question 3

if pain is poorly localised, and colicky/ in waves?

Answer 3

due to obstructed viscus or lumen, peristalsis pushes against

Question 4

source of poorly localised pain in:

1) epigastric
2) umbilical
3) suprapubic

Answer 4

1) foregut, 2/3 oes to ampulla
2) ampulla to 2/3 transverse
3) 2/3 transerve to prox rectum

Question 5

general Ix for acute abdomen?

Answer 5

BEDSIDE:
• ECG (MI)
• pregnancy test (ectopic)
• urinalysis (UTI, pyelonephritis)

BLOODS:
• FBC, U+E, LFT
• ABG
\+/- coag, group + save, CRP, lactate
\+/- amylase, B-hCG

IMAGING:
• erect CXR (CAP, pneumoperitoneum)
• US (GS)
• AXR (bowel obstruction)
• CT abdo
• CT contrast (pancreatitis)

Question 6

general initial Tx for acute abdomen?

Answer 6

analgesia
Abx
IV fluids
NBM

Question 7

Ix if young female pt?

Answer 7

• pregnancy test
• blood B-hCG
• US +/- exploratory laparoscopy before CT abdo (radiation risk, less useful for gynae)

Question 8

ΔΔ if unstable patient with acute abdo?

Answer 8

• ruptured AAA
• acute pancreatitis
• ruptured ectopic

Question 9

Ix RIF pain?

Answer 9

BEDSIDE:
• urine dip

BLOODS:
• FBC, U+E, CRP
• B-hCG

IMAGING:
• US (female)

Question 10

Tx if suspected appendicits?

Answer 10

IVT

NBM

Question 11

Ix LIF pain?

Answer 11

female - US, B-hCG

diverticulitis if older (Abx, IVT, +/- CT)

Question 12

Ix RUQ pain?

key Qs in Hx?

Answer 12

Hx - previous GS? previous US?

BEDSIDE:
• urine dip

BLOODS:
• LFTs
• amylase
• FBC (perforated ulcer)
• group and save (surgical patient)
• U+E

IMAGING:
• US (GS, CBD duct dilation)
• MRCP if US shows dilated CBD and ↑LFTs

Question 13

indication to do an MRCP in RUQ pain?

Answer 13

if US shows dilated CBD and ↑LFTs

Question 14

key Hx Qs and Ix in epigastric pain?

Answer 14

Hx:
• previous reflux/peptic ulcer/OGD?
• previous GS?
• previous pancreatitis?
• any MI Sx?

BEDSIDE:
• ECG (MI)

BLOODS:
• FBC, U+E, LFTs
• amylase
• ABG, LDH, AST, Ca++, glucose*

IMAGING:
• erect CXR (CAP, pneumop)

*for Glasgow risk (pancreatitis)

Question 15

Hx + Ix generalised abdo pain?

Answer 15

Hx:
• bowel habit?
• Sx obstruction. perforation, ischaemia?

BEDSIDE:
• urinalysis

BLOODS:
• FBC, LFTs, amylase, CRP, lactate
• ABG (if suspected lactic acidosis)

IMAGING:
• CXR, AXR