Acute abdomen Flashcards
Define an acute abdomen
Abdominal pain of non-traumatic origin with a maximum duration of 5 days
Causes for pain in upper abdomen
Acute pancreatitis Herpes Zoster Pneumonia Interrupted blood flow to heart - MI Inflammation of spinal nerve root Peptic ulcer
Causes of pain in upper left abdomen
Gastritis
Gastric Ulcer
Abscess in spleen
Ruptured spleen
Causes of pain in upper right abdomen
Inflammation of gallbladder Enlargement of liver Hepatitis Abscess in liver Perforated duodenal ulcer
Causes of pain in the lower left abdomen
Diverticulitis
Causes of pain in the lower right abdomen
Appendicitis Diverticulitis Meckel diverticulitis Enlarged lymph nodes in abdomen Crohns
Causes of pain in the lower abdomen
Abscess Kidney stone Ruptured AAA Ectopic pregnancy Torsion of ovarian cyst/testis Haematoma Cystitis Endometriosis Trapped/strangulated hernia IBD
Causes of widespread abdominal pain
Acute pancreatitis DKA Early appendicitis Gastroenteritis Intestinal obstruction Ischaemia Peritonitis Sickle cell crisis Typhoid fever
What causes of abdominal pain should you never miss?
Perforation Aneurysms Ectopics MI Torsion of ovaries/testes Pancreatitis
Urgent causes of abdominal pain
Bleeding = AAA, ulcer, ectopic, trauma Perforation = ulcer, obstruction, IBD, diverticulitis Ischaemia = mesenteric, cardia
Abdominal pain associated symptoms
Bowel habit changes
Nausea/vomiting
Bleeding
What to look for on examination
Analgesia on side/IV Scars/stomas Distention Tenderness Perionism Herniae PR Genitalia General appearance Neck CV? Chest Extremities
Basic Ix
ECG
Urine Dip
HCG
Bloods = ABG, Hb, glucose, pH, lactate, base excess, creatinine, FBC, U&E, LFT, CRP, amylase/lipase
Imaging
CT!
Sometimes CXR but not great for abdo diagnoses
US
Laparoscopy = for women of child bearing age, if imaging inconclusive, suspicion of urgent cause high
What is US good and bad for?
Good for biliary pathologies, gynaeocological
Bad for appendicitis
What imaging to use in pregnancy
US and MRI
CT if necessary
Alvarado Score
Air Score
Score for likelihood of appendicitis
Acute appendicitis
Peaks around 30 years
More males slightly
Can become inflamed, gangrenous, perforated
Caused by mechanical blockage, infection, hygiene changes in flora
Clinical features of acute appendicitis
Central migrating to RIF Anorexia Nausea Tachycardia Low grade fever
Position of appendix significance
Retrocaecal - RIF more masked as less irritation to peritoneum
Management of acute appendicitis
Surgical = open or laparoscopic keyhole
Non surgical
Open incision scar for appendectomy
grid iron incision at Mcburnery’s point, oblique
2-5 cm above AIIS to 1/3 of the way between AIIS and umbilicus (McBurney’s point)
Complications of appendicitis
Perforation
Appendix mass
Appendix abscess
Appendicular tumours
Rosving’s sign
Palpation of LLQ initiates pain in RLQ
Causes of acute pancreatitis
Gallstones
Alcohol
Hyperlipidaemia
Imaging for pancreatitis
US - gall stones?
Management of acute pancreatitis
Conservative - main = analgesia, anti-emetics, fluids
Further imaging
Treat cause = gall stones?
Treat complications
Perforations of GI tract
Multiple sites
Multiple causes
Most common cause is peptic ulcer in foregut = H pylori, smoking, NSAIDs, alcohol, steroids
management of perforation
Operation
Non surgical
H Pylori eradication if they have it
Nutrition as GI tract out of action for a while
Ruptured AAA
Degeneration of the aorta
Vascular RF
Rupture is bad
Rupture RF - diameter, volume, wall stress
Management of AAA
Treat shock
Operative = open/endovascular
Peptic ulcers 2 types
- duodenal ulcers = epigastric pain relieved by eating
- gastric ulcers = epigastric pain worsened by eating
- features of GI haemorrhage = haematemesis, maelena
Symptoms of acute pancreatitis
Severe epigastric pain Vomiting Tenderness Low grade fever Cullen's and Grey Turner's sign rare
Cullen’s sign
Periumbilical discolouration
Grey Turner’s sign
Flank discolouration
Biliary Colic features
RUQ pain
Radiates to the back and interscapular region
After a fatty meal
Can persist for hours
Obstructive jaundice = pale stools and dark urine
Who gets biliary colic?
4 F's female fat forties fair
Acute cholecystitis
Gallstone symptoms
Continuous RUQ pain
Fever, raised inflammatory markers
Positive Murphy’s sign
Diverticulitis
Colicky pain in LLQ
Fever, raised inflammatory markers and WCC
Symptoms of AAA
Severe central abdominal pain radiating to back
Catastrophic presentation = sudden collapse
Or sub-acute = persistent severe central abdominal pain with shock
History of CV disease?
Intestinal obstruction
Malignancy/previous operation history
Vomiting
Not opened bowels
Tinkling bowel sounds
GI causes of clubbing
IBD
GI Lymphoma
Coeliac
Hepatic Cirrhosis
5 F’s causing distension
Fat (obesity) Faeces (constipation) Fetus (pregnancy) Flatus (GI) Fluid (ascites)
What is the purpose of light/superficial palpation?
Check for guarding/rebound tenderness
What to do if there is ascites?
Shifting dullness
Fluid thrill
How to do a fluid thrill test?
Have patient push hands down on midline of abdomen
Tap one flank and feel for thrill in other
Macroscopic blood types
- bright red
- dark
- clots
- melaena
