Acute abdomen SDL Flashcards
What is an acute abdomen problem?
Often sudden onset severe abdominal pain
What presentations of acute abdomen problems need urgent attention?
Acute bleeding
Perforated viscus
Ischemic bowel
What are the different types of intra-abdominal bleeding?
Intra-luminal - Into GIT
Extra-luminal - into abdominal cavity
What are some common causes of intra-abdominal bleeding?
Ruptured ectopic pregnancy
Bleeding peptic ulcer
Traumatic injury
How may untreated acute bleeding of the abdomen present?
Hypovolemic shock
Clinical features - tachycardia, pale/clammy, hypotension
At this stage may or may not present with abdominal pain
What are the key features of treatment for acute intra-abdominal bleeding?
Blood products available - major haemorrhage protocol
Resuscitation
Early investigations and interventions
What are some common causes of gastrointestinal perforation?
Peptic ulcer disease
Untreated bowl obstruction
Diverticular disease
Inflammatory bowel disease
How do patients with located gastrointestinal perforation tend to present?
Localised pain and peritonitis
Tachycardia
Pyrexia
(May not look unwell)
How do patients with generalised peritonitis typically present?
Tachycardia +/- hypotension
Pyrexia
Rigid abdomen
(Look unwell)
What is the typical management plan for patients with suspected perforated viscus?
Urgent resuscitation
Cross sectional imagaing prior to final management decision
What is the key clinical symptoms of ischemic bowel?
Severe pain out of proportion to the clinical signs
Often severe and constant pain, otherwise unremarkable examination
What investigations can indicate a bowel obstruction?
Raised WCC and CRP
Raised lactate and acidosis
Definitive diagnosis via CT with intravenous contrasts
What is colic?
Abdominal pain the crescendos to very severe and then goes away completely.
What are the different types of colic?
Biliary colic
Uteric colic
Bowel obstruction
NOTE - hollow viscus pathology
Differentiate based on triggers, tomining, routine blood tests and imaging
What is peritonism?
Locaised inflammation of the peritoneum, often due to inflammation of the viscus that then irritates peritoneum
What is the typical pattern of pain in peritonism?
Pain starts in one place (Irritation of visceral peritoneum), then locaised to one area (irritation of parietal peritoneum) or becoming generalised
For example acute appendicitis.
What is the pattern of pain presentation in acute appendicitis?
When pain often migrates from the umbilical region (visceral peritoneum of the midgut) to the right iliac fossa (irritation of parietal peritoneum)
What conditions can result in pain in the RUQ of the abdomen?
Cholecystitis
Pyelonephritis
Uteric colic
Hepatitis
Pneumonia
What are the common causes of pain in the LUQ?
Gastric ulcer
Pyelonephrtitis
Ureteric colic
Pneumonia
What are the common causes of pain in the RLQ of the abdomen?
Appendicitis
Utertic colic
Inguinal hernia
IBD
UTI
Gynaecological
Testicular torsion
What are some common causes of pain in the LLQ of the abdomen?
Diverticulitis
Ureteric colic
Inguinal hernia
IBD
UTI
Gynaecological
Testicular torsion
What are some common causes of pain in the epigastric region?
Peptic ulcer disease
Cholecystitis
Pancreatitis
Myocardial infarction
What are some common causes of pain in the peri-umbilical region?
Small bowel obstruction
Large bowel obstruction
Appendicitis
Abdominal aortic aneursym.
What initial tests are often done in an acute abdomen scenario?
Urine dipstick - infection, haematuria, MC&S, pregnancy test
ABG - for tissue hypoperfusion and Hb level
Routine bloods - FBC, U&Es, LFT, CRP, amylase/lipase, cross match, G&S
ECG - pre-op and referred myocardial pain
What imaging tests are often done for an acute abdominal presentation?
Erect chest plain film radiograph - eCXR - for air or lower lobe lung pathology
Abdominal plain film radiograph - AXR - recurrent volvulus
Ultrasound - renal tract, biliary tree, liver, uterus and adenexa
CT - pathology in GIT bowel perforation
What is an acute abdomen presentation?
Abdominal pain that occurs suddenly and often severely
What are the four different four causes of acute abdominal presentations?
Infection
Inflammation
Obstruction
Vascular occlusion
What can cause pain in the right hypochondriac region?
Cholecystitis
Cholangitis
Hepatitis
Peptic ulcer disease
Fitzhugh curtis
Referred pain (pulmonary or cardiac)
What can cause pain in the epigastric region?
Visceral pain from stomach, proximal duodenum, liver, pancreas and biliary structures.
Peptic ulcer disease
Gastritis
Pancreatitis
Gastroparesis
Referred pain (pulmonary and cardiac)
What can cause pain in the lumbar regions of the abdomen?
Kideny stones
Complicated UTI
Anterior cutaneous nerve entrapment syndrome
Shingles
Referred pain from the UQ/LQ on associated side
Right lumbar may also be hepatitis
What can cause pain in the umbilical abdominal region?
Visceral pain from the distal small intestine and proximal colon
Pancreatitis
Early appendicitis
Incarcerated umbilical hernia
IBD
Small bowel obstruction
What can cause pain the right inguinal region of the abdomen?
Diverticulitis (asian descent)
Appendicitis
Inflammatory bowel disease
Kideny stones
Ovarian torsion
Ectopic pregnancy
Testicular torsion
What can cause pain the the hypogastric region?
Visceral pain from distal colon, rectum and intraperitoneal genitourinary structures.
Sigmoid volvulus
IBD
Distal kidney stones
Cystitis
What can cause pain in the left inguinal region of the abdomen?
Diverticulitis
Kidney stones
Ectopic pregnancy
Testicular torsion
What are important differentials to consider for the acute abdomen?
Cardiac related pain
Ectopic pregnancy
Bowel ischaemia
Renal causes
GI Ulcers
AAA
Why is an ectopic pregnancy important to consider in acute abdomen?
What are the symptoms?
Is an extra-uterine pregnancy
Is a common differential in women of child-bearing age with acute abdomen presentation
Sx: Abdo pain, vaginal bleeding, missed period, shoulder tip pain.
Must have a pregnancy test in all acute abdo female of correct age.
What cardiac condition can be a risk factors for acute bowel ischaemia?
Atrial fibrilation - increase risk of clot formation, cause sudden obstruction of blood supply to a section of the bowel.
What is the basic presentation of pyelonephritis?
Kidney infection =
Flank/back pain, feverish, urinary symptoms
What are the symtpoms of a renal stone?
Sever flank/groin/back pain
Nausea & vomiting
Blood in urine
How does a AAA present in acute abdomen?
Mostly asymptomatic
If rupture - severe abdo/back pain, hemodynamically unstable.
What is a laparotomy?
When a large surgical incision is made in the abdomen to examine its content (organs and peritoneal cavity)
What is a laparoscopy?
Minimally invasive procedure, small incision in the abdomen, insert a laproscops (thin tube with a camera and light attached)
Can be viewed on a monitor
Key hole surgery.
