Acute Abdominal Pain in Adults Flashcards
What are the possible causes of acute abdominal pain in adults?
- Inflammation
- Perforation
- Obstruction
- Vascular
- Urological
- Trauma
- Cardio-respiratory disease
What are the inflammatory causes of acute abdominal pain?
- Appendicitis
- Cholecystitis
- GORD / peptic ulcer / gastritis
- Acute pancreatitis
- Diverticulitis
- IBD (UC and CD)
- Urinary infection
- Gynaecological causes
What are the perforative causes of acute abdominal pain?
- Peptic ulcer disease
- Diverticular disease
- Bowel cancer
- Obstruction / ischaemia
- Inflammatory bowel disease
What are the obstructive causes (in the small intestine) of abdominal pain?
What are the common symptoms?
- Adhesions
- Hernia: internal or external
- Volvulus
- Intraluminal (gallstone ileus, FB)
- Tumours (rare)
-
Symptoms
- Distension
- Pain
- Vomitting or nausea
- Symptoms depend on the site of the obstruction
What are the obstructive causes (in the large intestine) of abdominal pain?
What are the common symptoms?
- Tumour
- Diverticular disease
- Volvulus
- Faecal impaction
What are the vascular causes of acute abdominal pain?
- Aneurysms (abdo pain with radiation to the back)
- Ischaemic bowel
- Trauma
What are the urological causes of acute abdominal pain?
- Acute and chronic urinary retention
- Ureteric colic
- Urinary infections
- Testicular problems - some can refer pain to the abdomen
What questions should be asked in the history of a patient presenting with acute abdominal pain?
-
Pain
- How long?
- Severity?
- Whereabouts?
- Character (colicky / continuous)
- Radiation
- Exacerbating / relieving factors
- Anything like this in the past
- Associated symptoms: bowels, nausea vomiting, apetite, urinary.
- Drugs
- Allergies
Describe the examination of the acute abdomen.
- Observation?Distension
- Palpation?Tenderness and where is it worse
- ?Rigidity; Any masses?
- Specific signs? E.g. Murphy’s sign
- Always examine for ?Hernias in the groin
- Auscultation; percussion; ?PR ?PV
- Other places: legs, cardio-respiratory, scrotum.
What are the basic investigations for a patient with an acute abdomen?
- Blood tests:
- FBC
- U&E
- CRP
- Glucose, amylase, LFTs
- Pregnancy test
- ?CXR, AXR
What are the more specific investigations (after the basics) for a patient with the acute abdomen?
- USS (if the pain is mainly RUQ, or lower abdominal in females).
- CT scan (with or without contrast).
- ECG
- Endoscopy
Describe the features of this CXR.
- There is a perforation on the right side of the diaphragm. There is air under the right hemi-diaphragm.
- There is a gastric bubble under the left hemi-diaphragm.
Which is the most vulnerable part of the large bowel to perforation?
The caecum
What is abnormal about this abdominal X-ray?
The aorta is MASSIVE
What is the abnormality on this X-ray?
Renal calculi
What is ischaemic colitis?
- Inflammation and injury of the large intestine result from inadequate blood supply.
- Occurs with greater frequency in the elderly.
- Most common form of bowel ischaemia.
