Acute abdomen Flashcards
1
Q
What is the definition of an acute abdomen
A
- Abdominal pain of non-traumatic origin with a maximum duration of 5 days
2
Q
How do you classify the cause of the acute abdomen
A
- think about it in terms of location and the anatomical causes that can be causing it
3
Q
what could it be if you had pain in the right upper quadrant
A
hepatitis
billary colic
cholecystits
4
Q
what could it be if you had pain in the left upper quadrant
A
Gastritis
gastric ulcers
spleen
5
Q
What could it be if you thinking about the epigastric region
A
- duodenal ulcer
- pancretitis
6
Q
If there is pain in the right lower abdomen what could it be
A
appendicitis
7
Q
if there is pain in the left lower abdomen what could it be
A
- diverticulum
8
Q
What is the most common urgent abdominal pain
A
appendicitis
9
Q
What are the uregent causes of abdominal pain that can be fatal
A
Bleeding • AAA • Ulcer • Ectopic • (Trauma)
Perforation • Ulcer • Obstruction • IBD • Diverticulitis
Ischaemia
• Mesenteric
• Cardiac
10
Q
how do you assess the patient
A
Airway
Breathing
Circulation
then
- history
- examination
- investigation
11
Q
How do you measure pain
A
SOCRATES
12
Q
What does SOCRATES stand for
A
S - site O - onset C - character R - radiation A - associated features T - timing E - exacerbating/relieving S - severity
13
Q
What are associated features with pain
A
- Bowel habit
- nauesa and vomitting
- bleeding
14
Q
What should be considered in a history
A
- Past medical history
- Drug history (inc allergies)
- Surgical history
- Gynaecological history
- Family history
- Social history
- Systems review
15
Q
What should they look for on examination
A
- Analgesia
- Scars/stomas
- Distention
- Tenderness
- Peritonism
- Herniae
- PR
- Genitalia
16
Q
what else should be examined
A
- Appearance • Neck
- CV
- Chest
- Extremities
17
Q
What are the basic investigations that should be done
A
- ECG
- Urine dip
- HCG
18
Q
What type of blood investigations should you do
A
- Blood gas
- Hb
- Glucose
- pH, lactate, base excess
- Creatinine
• FBC • U&E • LFT - CRP - Amylase/lipase - particulary for looking at pancreatitis
19
Q
What blood marker is used for pancreatitis
A
Amylase/lipase
20
Q
what radiograpsh are used for the abdomen
A
- erect chest
- suprine abdomen x rays
21
Q
Why are erect chest x ray good and bad for looking at the abdomen
A
Bad
- more useful for looking at primary chest pathology
- little effect of CXR on diagnosis
- poor senstivity for perforation (33%) - therefore if there is a perforation it could be missed
Good
- look for a performation under the diaphragm
- look for free air under the diaphargm which suggests perforation
22
Q
What are the good and bad uses of abdomen x ray
A
- can visulaise walls of the bowel
23
Q
How do you know that you are looking at the small intestines
A
in the centre
24
Q
How do you know you are looking at the large intestine
A
- Haustra
25
what is now hte imaging of choice for actue abdominal presentations
CT
26
What is the good and bad of using an abdominal CT
Good
- accurate across a range of diagnoses
- good sensitivity and specficity
- influences outcome and management
Bad
- high risk of ionising radiation
27
What are the good and bad of using an ultrasound
Bad
- operator depednent
- not suitable for surgical planning
- less senstiive than CT for most pathologies
- bad for diagnosing appendicitis
good
- good for evaluating potential gynaecological causes
- cost effective
- harmless
- readily avaliable
- highly sensitive and 1st line for biliary pathology
28
What is ultrasound used in for 1st line choice
in bilary pathology ultrasound is the 1st choice
29
what is the role of laproscopy
- less use now as imaging becomes more effective and widespread
- should be considered when imaging inconclusive adn suspicion of urgent cause is high
- most useful in women of childbearing age
30
when you are pregnant where does appedicitis present
- everything is pushed up so it could go to the right upper quadrant
31
Why should you consider someones age when imaging
- physioloigcal differences
- medications
- exisiting medical problems
- frailty
- cognitive bias
- low threshold for CT
32
analgesia does not mask ...
clinical signs in assesment of the acute abdomen and should not be withhled
33
How can you quantify the risk of someone having appendicitis
Alvarado score and AIR score
34
what is the peak around appendicitis
- peaks around 30 years
35
Who is appendicits more common in
- more common in males although appendicectomy slighly more common in females
36
what are the stages of appendcitis
- suppurative stage
- gangrenous stage
- perforated stage
37
what are the clinical features of appendicitis
- central pain migrating to RIF
- anorexia
- nausea
- tachycardia
- low grade fever
38
What is the most common position of the appendix
- retrocecal
39
How do you manage appendicitis
- surgical removal of the appendix - either by open or laparoscopic
40
what can cause complicated appendicitis
- perforation
- appendix mass
- appendix abscess
- appendicular tumours
41
What can cause acute pancreatitis
- gallstones
- alcohol
- hyperlipidaemia
42
What criteria is used for acute pancreatitis
SERS criteria
43
What imaging is used for actue pancreatits
Ultrasound
44
How do you treat acute pancreatits
- conservative management
- further imaging
- treat cause
- treat complications
45
what are the signs of abdominal aortic aneurysm
- back pain
46
What are rupture risk factors for an AAA
- diameter
- volume
- wall stress
47
What can sudden onset of pain be due to
- perforation
- rupture
- torsion (e.g. Ovarian cyst)
- acute pancreatitis
- infarction
48
What causes a gradual onset of pain
- inflammatory conditions (e.g. appendicitis)
49
What causes back pain
- pancreatitis
- rupture of aortic aneurysm
- renal tract disease
50
When is a laparotomy required
- rupture of an organ e.g. spleen, aorta, ectopic pregnancy
| - peritonitis
51
What are the symptoms of a rupture of the organ
- Shock leading sign; assess blood loss
- abdominal swelling
Any history of trauma
- blunt trauma - spleen (may be delayed by weeks)
- Penetrating trauma - liver
- peritoneum - may be mild
52
What can cause peritonitis
- perforation of peptic ulcer/duodenal ulcer
- diverticular
- appendix
- bowel
- gallbladder
53
What are the signs of peritonitis
- prostration
- shock
- lying still
- positive cough test
- tenderness (+- rebound/percussion pain)
- board-like abdominal rigidity
- guarding
- No bowel sounds
- Erect CXR may show gas under the diaphragm
54
When is a laparotomy not required
- Local peritonitis
| - colic
55
What can cause local peritonitis
- diverticulitis
- cholecystitis
- salpingitis
- appendicitis
56
What should you do instead of a laparotomy for local peritonitis
- if abscess formation suspected (swelling, swinging fever, increased WCC) do an US or CT
- drainage can be percutaneous (US or CT guided) or by laparotomy
-
57
What does colic feel like
- regularly waxing and waning pain
- caused by muscular spasm in a hollow viscus (e.g. gut, ureter, bile duct, gallbladder)
- Gallbladder in the latter pain is often dull and constant
- causes restlessness and the patient may be pacing around
