Acute Abdominal Pain Flashcards
What are the five types of pain in the abdomen?
Surgical abdomen
RUQ pain
Epigastric pain
Lower abdominal pain
Flank pain
What are surgical abdomens?
cases of acute abdominal pain which may require urgent surgical intervention -
obstruction and peritonitis
What is the aetiology of bowel obstruction?
2 most common causes of obstruction are adhesions from previous abdominal
surgery and incarcerated hernias
What are risk factors for bowel obstruction?
Previous abdominal or pelvic surgery
Abdominal wall or groin hernia
Intestinal inflammation
Increased risk or previous neoplasm
Previous irradiation
Foreign body ingestion
What is the pathophysiology of bowel obstruction?
Obstruction leads to progressive dilation of the intestine proximal to the blockage, while distal to the blockage the bowel will decompress as luminal contents pass. Swallowed air, and gas from bacterial fermentation, can accumulate, adding to bowel distention. As the process continues, the bowel wall becomes oedematous, normal absorptive function is lost, and fluid is sequestered into the bowel lumen
What is the presentation of bowel obstruction?
- abdo pain (cramping)
- nausea and vomiting
- bloating
- anorexia
- failure to pass bowel motions or flatus
What are exam positives in bowel obstruction?
- general abdo tenderness
- dehydration signs
- Increased RR
- bowel sounds absents
What are exam negatives in bowel obstruction?
ruling out other causes of colicky pain
What are investigations for bowel obstruction?
- Bloods (FBE, CRP, U + E as CT contrast and dehydration, LFTs)
- CXR (free gas)
- AXR (supine for dilated loops, erect for air fluid levels)
- CT (transition point)
What is the management of bowel obstruction?
- stabilise vitals (fluid replacement, 250 ml bolus, 2 L over 2-4 hours)
- Insert NGT
- Insert catheter
What is the presentation of peritonitis?
- generalised tenderness
- fever, sweats, rigors
- quite ill
What are exam findings for peritonitis?
- generalised pain
- guarding, rigidity
- pain on light percussion, palpation
- +ve rebound test
- tachycardia
- Increased RR (shallow)
- febrile
What are causes of peritonitis?
- haemorrhage (post. perforated duodenal ulcer into gastroduodenal artery)
- perforation (duodenal ulcer, infarcted bowel, perforated diverticulitis)
What are investigations for peritonitis?
- bloods
- CXR erect (free gas)
- AXR (erect and supine)
- CT (perforation)
What is the presentation of acute cholangitis?
Charcot’s triad (fever, jaundice, RUQ pain)
