Acute Surgical Abdomen - Sasek Flashcards
Causes of Pain by Location:
Suprapubic
- UTI
- Bladder Cancer
- Uterine Fibroids
- Bacterial Vaginosis
- Cervicitis
- Advanced Pregnancy
Peritonitis
inflammation of the peritoneum
signs:
- distended or rigid abdomen
- fever and chills
- fluid in abdomen
- passing few or no stools or gas
- excessive fatigue
- low urine output
- nausea and vomiting
Character: Colicky or Crampy
distension or stretching
Diarrhea
watery: gastroenteritis - medical conditions
blood: inflammatory bowel (Chron’s; UC)
Mesenteric Intestinal Ischemia
- Cause
- Signs
- Risk Factors
- Diagnosis
- Treatment
abrupt onset of pain out of proportion to examination
CAUSE
- emboli/thrombi
SIGNS
- nuaea and vomiting common
- acidosis common
RISK FACTORS:
- > 50
- A FIB
- Atherosclerotic Disease
- Hypercoagulability
DIAGNOSIS:
- CT - CTA or MRA
- Angiography ** Gold Standard **
- Elevated Serum lactate
- Heme positive stool
- Early surgical consult
TREATMENT:
- IV fluids
- surgical removal
- IV ABX
- Pain control
Pancreatitis
- acute upper abdominal pain
- band-like radiation to the back
- alcohol, gallstones
- nausea, vomiting
- toxic apearing - febrile
- patient is restless
- elevated: serum lipase and amylase
Appendicitis
- pain begins at umbilicus, shifts to right lower quadrant
- anorexia
- may have vomiting
- tenderness at McBurney’s point
- rebound tenderness
- obturator
- iliospsoas
diagnostics
- CT with contrast
- Ultrasound can rule in or rule out
Causes of pain by location:
Left Lower Quadrant
- Diverticulitis
- Ovarian Cyst
- Ectopic Pregnancy
- PID
- Renal Stones (L flank)
- Ovarian Torsion
- Inguinal Hernia
- Referred Hip Pain
Immediately Life Threatening Abdomen Conditions
- AAA
- Mesenteric Ischemia
- Perforation GI tract
- Acute bowel obstruction
- Volvulus
- Ectopic Pregnancy
- Placental Abruption
- MI
- Splenic Rupture
Character: Burning
ulcer
define: Acute Abdomen
sudden, spontanoues non-traumatic disorder whose chief manifestation is in the abdominal area and for which urgent operation may be necessary
delay in tx will adversly affect outcomes
25% discharged vs. 35-40% admitted
elderly - higher mortality rates
kids - 2/3 surgical appendectomy
Obstipation
absence of both stool AND flatus
indicative of mechanical bowel obstruction
Abdomen Imaging
Plain Film - low yield
Ultrasound - AAA, gallbladder, female GU
CT - acute abdomen
Angiography - mesenteric ischemia, AAA
Ruptured Ectopic Pregnancy
TRIAD
- Amenorrhea
- Crampy, unilateral abdominal pain
- Vaginal bleeding
Need transvaginal US or serial HCG - pelvic exam is non-diagnostic
Diagnostic Clues for Abdominal Disorders
- CXR - free air = perforation
- ABD XR - multiple air-fluid levels = obstruction
- CT scan - determine cause and site of obstruction more accurately
Bowel Obstruction
- Signs
- Risks
most often the small bowel
SIGNS:
- crampy/peristaltic pain
- distension
- vomiting
- absence of flatus
RISKS:
- pervious surgery
- elderly
- Chron’s
Acute Paralytic Ileus
Neurogenic failure or loss of peristalsis
common in hospitalizated patients
DX: CT & ABD films - gas filled loops
TX - treat primary cause
Acute Cholecysitis
5F predisposition
RUQ pain with nausea and vomiting
RUQ tenderness; guadring; + Murphy’s sign