Acute abdomen SDL Flashcards by Elizabeth McCabe

What is an acute abdomen problem?

Often sudden onset severe abdominal pain

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What presentations of acute abdomen problems need urgent attention?

Acute bleeding
Perforated viscus
Ischemic bowel

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What are the different types of intra-abdominal bleeding?

Intra-luminal - Into GIT
Extra-luminal - into abdominal cavity

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What are some common causes of intra-abdominal bleeding?

Ruptured ectopic pregnancy
Bleeding peptic ulcer
Traumatic injury

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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

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What are the key features of treatment for acute intra-abdominal bleeding?

Blood products available - major haemorrhage protocol
Resuscitation
Early investigations and interventions

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What are some common causes of gastrointestinal perforation?

Peptic ulcer disease
Untreated bowl obstruction
Diverticular disease
Inflammatory bowel disease

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How do patients with located gastrointestinal perforation tend to present?

Localised pain and peritonitis
Tachycardia
Pyrexia
(May not look unwell)

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How do patients with generalised peritonitis typically present?

Tachycardia +/- hypotension
Pyrexia
Rigid abdomen
(Look unwell)

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What is the typical management plan for patients with suspected perforated viscus?

Urgent resuscitation
Cross sectional imagaing prior to final management decision

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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

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What investigations can indicate a bowel obstruction?

Raised WCC and CRP
Raised lactate and acidosis
Definitive diagnosis via CT with intravenous contrasts

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What is colic?

Abdominal pain the crescendos to very severe and then goes away completely.

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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

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What is peritonism?

Locaised inflammation of the peritoneum, often due to inflammation of the viscus that then irritates peritoneum

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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.

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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.