Acute Abdomen Flashcards
Definition
Sudden onset of severe abdominal pain developing over a short period of time.
Initial assessment
Determine if the patient has an acute surgical problem that requires surgical intervention urgently, medical therapy or urgent resus.
“Are they critically unwell?”
10 second assessment of their clinical state (end-of-bed-o-gram)
What are the most serious causes of intra-abdominal bleedings?
Ruptured AA which requires swift referral to the vascular team and immediate surgical intervention.
This is the most urgent cause
Other include rupture ectopic pregnancy, bleeding gastric ulcers and trauma.
Patients generally present with hypovolaemic shock, tachycardia, hypotension, pala and clammy presentation + cool touch.
What is peritonitis?
Inflammation of the peritoneum
Generalised peritonitis is most commonly caused by perforation of an abdominal viscus.
Causes of perforation.
Peptic ulceration
Small or large bowel obs
Diverticular disease
IBD
Clinica features of generalised
Will often lay completely still and not move their abdomen
They will look unwell
In renal colic patients are constantly moving and cannot get comfortable
Examination findings in peritonitis
Tachycardia + potential hypotension
Completely rigid abdomen with percussion tenderness
Involuntary guarding - patient involuntarily tenses their abdominal muscles when you palpate the abdomen.
Reduced or absent bowel sounds that suggest the presence of paralytic ileus.
What does any patient who has severe pain out of proportion to the clinical signs until proven otherwise?
Ischaemic bowel
Signs of ischaemic bowel.
Acidaemic
Raised lactate
Physiologically compromised
Diffuse and constant pain
Examination is usually unremarkable
Definitive diagnosis of ischaemic bowel
CT scan with IV contrast
Explain colic
Abdo pain that crescendos to become very severe and then goes away completely.
Most common types of colic
Biliary colic
Ureteric colic
Bowel obstruction
What is perionism?
Not the same as peritonitis
Localised inflammation of the peritoneum usually due to inflammation of a viscus that then irritates the visceral and then parietal peritoneum.
Clinical features of peritonism
Pain that starts in one place before localising to another or becoming generalised.
A classic example is acute appendicitis
Dx of acute abdominal pain
Can also be cardiac, respiratory, gynae or testicular conditions
Important dx are:
Testicular torsion
Ruptured ectopic pregnancy
DKA
MI
