Acute Abdomen Flashcards
What is the defn of “Acute Abdomen”
The presence of an abd pathology which if left untx (>72hrs) => pt morbidity + mortality
Sudden onset acute abd pain
Discuss the innervation, predisposing fx, site and character of visceral pain
Innervation - bilat. autonomic nn sys
Predisposing fx - stretch, inflammmation, ischaemia
Site - embryological origin detr location
Character - dullness, poor localization, cramping or burning
Discuss the innervation, predisposing fx, site and character of parietal pain
innervation - unilat. via spinal somatic nn that supply abd wall
predisposing fx - irritation of parietal peritoneum
site - well-localised pain
character - sharp, sev
Discuss the innervation, predisposing fx, site and character of referred pain
innervation - from central neural pathways common to somatic nn + visceral organs
predisposing fx - pain from sp organ that’s referred to a diff region
site - well-localised though distant from involved organ
character - prod sx not signs
Which classical signs can be illicited in pts w/ abd pain? (9)
1) Cullen’s - bluish periumbilical discolouration
2) Grey Turner’s - discolouration of flanks
3) Kehr’s - sev acute pain in tip of shoulder when lying down w/ legs up
4) Murphy’s - inspiratory arrest w/ continous palpation of gallbladder
5) Chandelier - cervical excitation => pt lifts buttocks off table
6) McBurney’s - tenderness, 1/3 distance from ASIS to umbilicus on R side
7) Iliopsoas - hyperextension of R hip => abd pain
8) Obturator’s - int rotation of L hip => abd pain
9) Rovsing’s - RLQ pain w/ palpation of LLQ
Name some of the life-threatening conditions of abd pain in adults
1) perforated viscus
2) ruptured AAA
3) mesenteric ischaemia
4) acute bowel obstruction
5) severe pancreatitis
6) ruptured HCC
7) Certain medical + obstetric conditions
Discuss the clinical presentation + causes of perforated viscus
Pt = younger age grp (20-30yo)
Clinical presentation: 2-3 day hx sudden epigastric pain, hx of PUD w/ development of sev, diffuse abd pain
Causes: perforated peptic ulcer/perforated oesophagus (Boerhaave syndrome)/perforated bowel/perforated appendix
Discuss the RFs + hallmarks of ruptured AAA
RF: advanced age (60yo), COPD, pulmonary ds, PVD, HTN, smoking + fam hx
Hallmark: pulsatile epigastric mass, if ruptured -> exsangunating haemorrhage, unstable hypotension
What are the RFs + hallmarks of mesenteric ischaemia
RF: advanced age, abd total hysterectomy, low cardiac o/p state, cardiac arrhythmias, sev CVD, recent AMI, intra-abd malignancy
Hallmark: acute onset of sev periumbilical abd pain out of proportion to findings on PE
What is the hallmark of acute bowel obstruction?
crampy abd pain, abd distension, obstipation, vomiting -> progession of pain to constant + more sev = strangulation
Name some of the medical conditions that are considered to be life-threatening
diabetic ketoacidosis
acute MI
Addison’s Ds (Addisonian crisis)
Name some of the obstetric conditions that are considered to be life-threatening
ruptured ectopic pregnancy
placental abruption
What are some of the DDx for R hypochondriac pain?
thoracic - pneumonia, pleural effusion
hepatic - hepatitis, hepatomegaly, abscess
biliary - cholangitis, cholecystitis, gallstone ds
others -sub-phrenic abscess, pancreatitis, PUD, appendicitis
What are some of the DDx for R lumbar pain?
biliary
urological - infxn (pyelonephritis, abscess), others (PKD, renal cyst, angiomyolipoma, infarction, obstruction (hydronephrosis, nephrolithiasis, ureteral obstruction), cancer (RCC, TCC renal pelvis, bladder Ca)
others - appendicitis
What are some of the DDx for RIF pain?
GI: appendicitis, terminal ileitis, Meckel’s diverticulitis, mesenteric ischaemia, mesenteric adenitis, IBD, colitis, colorectal Ca, hernia
O&G: ovarian cyst, ovarian torsion, ectopic pregnancy, PID
Orthos
What are some of the DDx for epigastric pain?
Thoracic: MI, pericarditis, aortic aneurysm
GI: oesophagitis, GERD, PUD, gastric outlet obstruction, stomach Ca
Others: pancreatitis
What are some DDx for umbilical pain?
GI: appendicitis (early), I/O, mesenteric ischaemia, colitis, IBD
Others: aortic aneurysm, pancreatitis
What are some DDx for hypogastric pain?
GI: colorectal Ca
Urological: acute urine retention, bladder calculi, cystitis/UTI
O&G: ectopic pregnancy, abortion, PID, uterine rupture, fibroid complications, adenomyosis, endometriosis
What are some DDx for L hypochondriac pain?
Thoracic: pneumonia, pleural effusion, MI
GI: PUD, diverticulitis, mesenteric ischaemia
Others: sub-phrenic abscess, splenomegaly, pancreatitis
What are some DDx for L lumbar pain?
Splenic ds
Urological as per RL pain
What are some DDx for LIF pain?
Orthos:
Infxn - septic hip arthritis, TB hip
degeneration - OA hip
inflammation - RA hip, ankylosing spondylitis, Reiter’s syndrome
infiltration - primary bone tumour (hip), metastasis to hip
destruction - fracture (NOF, pubic rami)
radiation - back pathologies
Paeds - transient synovitis, Perthe’s ds, SUFE
GI - diverticulitis, IBD, colitis, colorectal Ca, hernia
O&G: as per RIF pain
What are some DDx for a palpable R hypochondriac mass?
Liver:
massive - cancer (HCC, metastases, myeloproliferative ds); alcoholic liver ds; R hrt failure/tricuspid regurg
moderate - above causes, lymphoproliferative ds, haemochromatosis; amyloidosis
mild - above causes, infxns, biliary obstruction, cirrhosis
Gallbladder:
pancreatic/periampulllary Ca, acute cholecystitis, hydrops, empyema, Mirizzi syndrome
Ascending colon:
cancer, diverticular mass/abscess, faeces
Kidney:
As per in RL region
What are some DDx for a palpable R lumbar mass?
R Kidney:
hydro/pyonephrosis, cancer (RCC), polycystic ds, single cyst, amyloidosis, tuberous sclerosis, Von Hippel-Lindau ds
Liver:
As per RHC
Ascending colon:
cancer, diverticular mass/abscess, faeces
What are some DDx for a palpable RIF mass?
GI: appendiceal mass/abscess, TB gut, Ca caecum, distended caecum, Crohn’s ds
Orthos: chondroma/sarcoma of ilium, bony mets
O&G: ovarian cyst/tumour, fibroids
Urogenital: transplanted kidney, bladder diverticulum, ectopic/undescended testes
Vascular: iliac a aneurysm, iliac lymphadenitis
Skin & msk: psoas abscess
