Acute Abdomen Flashcards
What is defined as the acute abdomen?
A combination of symptoms and signs, including abdominal pain, which results in a patient being referred for an urgent surgical opinion
What are the most common causes of acute abdomen?
Non-specific pain
Acute appendicitis
Acute Cholecystitis / Colic
Peptic ulcer perforation
Urinary retention
Acute pancreatitis
What are the routes of infection for peritonitis?
- Perforation of GI/ biliary tract
- Female genital tract
- Penetration of abdominal wall
- Haematogenous spread
How do the bacteria change in peritonitis?
When is peritonitis generalised?
Contamination too rapid
Contamination persists
Abscess ruptures
What are the cardinal features of intestinal obstruction?
Pain
Vomiting
Distension
Constipation
Borborgymi (a rumbling or gurgling noise made by the movement of fluid and gas in the intestines)
What is visceral pain associated with?
Systemic upset – nauseated sick, feel pretty dreadful , green colour looking
Somatic pain doesn’t have the additional systemic upset
What are the three characters of abdominal pain?
Visceral
Somatic
Referred
Where are the pain receptors in somatic and visceral pain?
Somatic: Parietal peritoneum or abdominal wall
Visceral: Pain receptors are in smooth muscle
What is the travel of afferent signals in somatic pain?
Travels with segmental nerves
Accurate localisation but it can be referrred
How can peritonitis and intestinal obstruction cause death?
Causes fluid loss and bacteraemia / endotoxaemia
Resulting in circulatory collapse
What are the investigations for acute abdomen?
- Ward tests: urine
- Lab tests: FBC, U+E, LFT
- Radiology: plain,US, axial (CT) ?other
- Laparoscopy vs. laparotomy
What is management for acute abdomen?
Assess and resuscitate
Investigate
Observe
Treat
What is involved in acute abdomen resuscitation?
- Restore circulating fluid volume
- Ensure tissue perfusion
- Enhance tissue oxygenation
- Treat sepsis
- Decompress gut
- Ensure adequate pain relief
What does the observation in acute abdomen involve?
Useful when diagnosis is uncertain and risk of alternative intervention is greater
What is the presentation for infection / inflammation?
Localised pain and tenderness
Fever
Chills Myalgias
What is the presentation for perforation?
Shoulder tip pain may happen as a result of sub diaphragmatic air
What is the presentation for obstruction?
What is the presentation of Ischaemia?
Don’t forget, MI can present itself with epigastric pain
