Acute Abdomen Flashcards
What is acute abdomen?
A combination of signs & symptoms that lead to a patient being referred for an urgent general surgical opinion
What should be considered in acute abdomen? (4)
Peritonitis
Intestinal Obstruction
Ischaemia
Non-surgical abdominal pain
What are the routes of infection in peritonitis?
Perforation of GI/biliary tract
Female genital tract
Penetration of abdominal wall
Haematogenous spread
What is characteristic in ischaemia?
Soft belly + pain
What is characteristic in intestinal obstruction?
Severe abdo pain not corresponding with abdo examination findings
6 parts of resuscitation in acute abdomen?
Correct fluid loss Ensure tissue perfusion Enhance tissue oxygenation Treat sepsis (antibiotic) Decompress gut Ensure adequate pain relief
3 types of intestinal obstruction
Inside lumen
Inside wall
External compression
5 features of intestinal obstruction
Pain Vomitting Distension Constipation Borborygmi
What does vomiting indicate in obstruction?
Small bowel
Ileocaecal valve not competent
What is borborygmi?
A rumbling or gurgling noise made by the movement of fluid and gas in the intestines
7 causes of peritonitis
Medical procedures Ruptured appendix Stomach ulcer Perforated colon Pancreatitis Diverticulitis Trauma
5 signs of peritonitis
Fever Fatigue Law urine output Constipation Abdo tender
6 symptoms of peritonitis
Abdo pain Bloating N&V Loss of appetite Diarrhoea Thirst
7 Investigations of peritonitis
WBC count CRP Blood culture X ray CT Ultrasound Peritoneal fluid analysis
2 treatments of peritonitis
Antibiotics
Surgery
What is peritonitis?
Inflammation of serosal membrane. Peritoneum acts to pathologic stimuli.
What is intestinal obstruction?
Functional blockage, muscles fail.
Mechanical obstructions.
5 causes of intestinal obstruction
Adhesions after surgery Crohns Diverticulitis Hernais Colon cancer
2 signs of intestinal obstruction
Abdo distension
Borborygmi
2 symptoms of intestinal obstruction
N&V
Constipation
Colic pain
Anorexia
5 investigations for intestinal obstruction
Physical exam Xray CT scan Ultrasound Air/barium enema
3 treatment for intestinal obstruction
Low fibre diet
Surgery
Self expanding metal stent
What is appendicitis?
Gut organisms invade appendix wall after lumen obstruction –> oedema, ischaemic necrosis & perforation
4 signs of appendicitis
Abdo guarding
Rebound tenderness
Tachycardia
Fever
3 symptoms of appendicitis
N&V
Periumbilical pain - radiates to R iliac fossa
Anorexia
2 investigations for appendicitis
Blood tests
CT scan
2 specific blood tests for appendicitis
CRP (raised)
Neutrophil leukocytosis
3 treatment for appendicitis
Appendectomy
Antibiotics
Laparoscopy
