Acute Abdomen Flashcards
definition of the acute abdomen
sudden onset of severe abdominal pain <24 hours duration
main differentials for RUQ pain
biliary colic acute cholecystitis acute cholangitis
main differentials for Right Iliac Fossa pain
acute appendicitis ectopic pregnancy ovarian cyst diverticulitis
main differentials for left iliac fossa pain
ectopic pregnancy ovarian cyst diverticulitis
main differentials for epigastric pain
pancreatitis peptic ulcer disease AAA
main differentials for central/generalised pain
AAA intestinal obstruction ischaemic colitis
main differentials for suprapubic pain
acute urinary retention pelvic inflammatory disease
main differentials for pain radiating loin to groin
renal colic (kidney stones) pyelonephritis
what laboratory investigations should patients receive
Urine dipstick + pregnancy test in females
FBC, LFTs, U+Es, CRP, Amylase
- consider measuring serum calcium in suspected pancreatitis
ABG
Blood cultures if suspected infection
imaging for patients with acute abdomen
ECG- to exclude MI
USS:
- KUB: for suspected renal tract pathology
- Biliary tree + liver: suspected gall stone diseae
- Ovaries, fallopian tube, uterus: for suspected gynae problem
Radiological:
Erect CXR to look for bowel perforation
dull peri-umbilical pain that then becomes sharp and localised to right iliac fossa
appendicits
symptoms of appendicitis
migratory pain - begins peri-umbilical and localises to RIF - pain worse on moving/laughing/coughing nausea, vomiting anorexia
examination findings in appendicitis
tachycardia, tachypnoea, pyrexia rebound tenderness: increasing pain when releasing deep palpation guarding Rovsings sign
what is Rovsings sign? what condition is it seen in?
palpation of LIF causes pain in RIF appendicitis
what differential diagnoses need to be excluded in appendicitis
ectopic pregnancy – pregnancy test UTI – urinalysis
definitive management of appendicitis
laparoscopic appendectomy
what is a diverticulum? what part of colon is most commonly affected?
out pouching of the bowel wall - most common in sigmoid colon
difference between: - diverticulosis - diverticulitis - diverticular disease
diverticulosis = presence of diverticula with no inflammation. Often incidental finding, asymptomatic. diverticulitis = inflammation of diverticula diverticula disease = symptoms arising from presence of diverticula
symptoms of diverticular disease
lower abdominal pain altered bowel habit nausea flactulence
presentation of acute diverticulitis
sharp abdominal pain - usually LIF - worse on movement nausea, anorexia, pyrexia bloody diarrhoea tenderness / guarding on examination
risk factors for the formation of diverticulum
age low fibre diet obesity smoking NSAID use family history
1st line imaging for suspected diverticulitis - what might be seen?
CT abdo-pelvis - thickening of colonic wall - pericolonic fat stranding - abscesses - air bubbles / free air
why should colonoscopy be avoided in acute diverticulitis
high risk of perforation
scoring system used to classify acute diverticulitis
Hinchey classification
management of acute diverticulitis
IV fluids, analgesia, antibiotics (cefotaxime + metronidazole) Hartmanns procedure indicated if: - failure to respond to treatment - perforation - overwhelming sepsis
what does this CXR show?
Air under diaphragm (pneumoperitoneum)
- strongly suggests bowel perforation
