Acute abdomen Flashcards by Amrita Heer

Define an acute abdomen

Abdominal pain of non-traumatic origin with a maximum duration of 5 days

How well did you know this?

Not at all

Perfectly

Causes for pain in upper abdomen

Acute pancreatitis
Herpes Zoster
Pneumonia
Interrupted blood flow to heart - MI
Inflammation of spinal nerve root
Peptic ulcer

How well did you know this?

Not at all

Perfectly

Causes of pain in upper left abdomen

Gastritis
Gastric Ulcer
Abscess in spleen
Ruptured spleen

How well did you know this?

Not at all

Perfectly

Causes of pain in upper right abdomen

Inflammation of gallbladder
Enlargement of liver
Hepatitis
Abscess in liver
Perforated duodenal ulcer

How well did you know this?

Not at all

Perfectly

Causes of pain in the lower left abdomen

Diverticulitis

How well did you know this?

Not at all

Perfectly

Causes of pain in the lower right abdomen

Appendicitis
Diverticulitis
Meckel diverticulitis
Enlarged lymph nodes in abdomen
Crohns

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

Causes of widespread abdominal pain

Acute pancreatitis
DKA
Early appendicitis
Gastroenteritis
Intestinal obstruction
Ischaemia
Peritonitis
Sickle cell crisis
Typhoid fever

How well did you know this?

Not at all

Perfectly

What causes of abdominal pain should you never miss?

Perforation
Aneurysms
Ectopics
MI
Torsion of ovaries/testes
Pancreatitis

How well did you know this?

Not at all

Perfectly

Urgent causes of abdominal pain

Bleeding = AAA, ulcer, ectopic, trauma
Perforation = ulcer, obstruction, IBD, diverticulitis
Ischaemia = mesenteric, cardia

How well did you know this?

Not at all

Perfectly

Abdominal pain associated symptoms

Bowel habit changes
Nausea/vomiting
Bleeding

How well did you know this?

Not at all

Perfectly

What to look for on examination

Analgesia on side/IV
Scars/stomas
Distention
Tenderness
Perionism
Herniae
PR
Genitalia
General appearance
Neck
CV?
Chest
Extremities

How well did you know this?

Not at all

Perfectly

Basic Ix

ECG
Urine Dip
HCG
Bloods = ABG, Hb, glucose, pH, lactate, base excess, creatinine, FBC, U&E, LFT, CRP, amylase/lipase

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

What is US good and bad for?

Good for biliary pathologies, gynaeocological

Bad for appendicitis

How well did you know this?

Not at all

Perfectly

What imaging to use in pregnancy

US and MRI

CT if necessary

How well did you know this?

Not at all

Perfectly

Alvarado Score

Air Score

Score for likelihood of appendicitis

How well did you know this?

Not at all

Perfectly

Acute appendicitis

Peaks around 30 years
More males slightly
Can become inflamed, gangrenous, perforated
Caused by mechanical blockage, infection, hygiene changes in flora

How well did you know this?

Not at all

Perfectly

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