Acute abdomen and critically ill ptnt recognition Flashcards
example of abdominal pathology presenting with inner thigh pain?
obturator hernia= Howship-Romberg sign
example of abdominal pathology presenting with shoulder tip pain?
subdiaphragmatic irritation by free blood or pus e.g. ruptured ectopic pregnancy, =Kehr’s sign
acute cholecystitis
why does an obstructed small bowel present initially with central abdominal colic?
small bowel= midgut structure, so pain referred to periumbilical area as viscus receives AN innervation which is poorly localised, in contrast to involvement of parietal peritoneum receiving somatic innervation which allows pain to be localised.
colicky as viscus overactivity in attempt to relieve obstruction.
why might vomiting not occur at all in large bowel obstruction?
ileo-caecal valve prevents vomiting
when does vomiting occur in small bowel obstruction and describe it
early and prominently
proximal obstruction= green vomitus as bile brought up
distal obstruction= more brown as faecal matter contained.
what does abdominal distension indicate in SBO?
obstruction has been of relatively long duration
symptoms of ectopic pregnancy?
acute abdominal pain, possibly shoulder tip pain, missed menstruation with vaginal bleeding
sign on inspection of abdomen indicating peritonitis?
abdomen doesn’t move with respiration, it is rigid-board like rigidity
why is it important to note old scars on abdominal inspection in cases of suspected SBO?
may indicate cause of SBO to be adhesions
exception to acute abdomen presenting with tenderness on palpation?
acute mesenteric infarction- causes exceptional pain but few signs
ultimate investigation for acute abdominal pain dependent on clinical picture?
laparotomy
contrast presentation of peritonitis with biliary, intestinal or renal colic
peritonitis= lie still colic= rolling around in agony
sign visible on supine AXR (occasionally erect CXR) which indicates bowel perforation?
Rigler’s sign= bowel wall clearly defined as free intra-abdominal gas next to gas filled bowel loop.
what should AF with abdominal pain always prompt thoughts of?
mesenteric ischaemia
classical clinical triad of acute mesenteric ischaemia?
acute severe abdominal pain- central and constant, or around RIF (almost always involves small bowel)
no adominal signs
rapid hypovolaemia, leading to SHOCK
degree of illness far out of proportion with clinical signs