Assess Acute Abdo Flashcards
Acute abdo
Recent or sudd onset of unexp signs and symps incl abdo pain Intra and extra perit processes NOT ALWAYS req surg Potential sev infec, fluid or blood loss Visceral or somatic or referred pain
Visceral pain
Stim of sm Rs Eg isch, distension, tension. Often colicky. Autonimic conduction- vagus Poorly localised midline pain Assoc malaise, NV, sweating
Embryology
Epig pain- stom to D2, liver, panc, spleen
Periumb- D2 to proximal 2/3 transv colon
Suprapubic- distal transv to anal verge
Somatic pain
Pain Rs in parietal perit
Segmental somatic N conduc
Accurately localised
Overrides visceral
Referred pain
Comm central neural paths in SC that are comm to somatic Ns and visceral organs.
Eg bil tract to R inferior scap.
Diaph irrit to ipsi shoulder tip.
Common causes
Non specif Acute appendicitis Acute cholecystitis and bil colic Peptic ulcer/CA/divertic perforat and bleed bowel obstruc Isch eg strang hernia, volvulus, TE Gynae dis Ureteric obstruc, urin reten Acute pancreatitis Rupt aneur
Ix
ABCDE Fluids Bm, urinalysis, preg test FBC, UE, amylase, LFT, ABG, CRP, clotting, GS O2 Hx Exam CXR, AXR US Contrast studies CT ECG Exploratory laparotomy/ laparoscopy Stool- faecal occult blood
px
Pain- char, locat, onset, prog, prev episodes, aggrav and relieving Appetite NV Distens Bowel habit Wl PV disch Urin freq, urgency, pain, blood
pain chars
Sudden onset- perforat, rupture, AAA, MI, mestenteric occlus
Rapidly accelerating- bil or ureteric colic, SI obstruc
Grad onset- IBD, obstruc, other mech
diffs
MI Pneumonia Pleurisy Herpes zoster Diabetic ketosis
Malig feats
Intermitt pain over 48hr Alt bowel habit Distension Mass Wl
Obstruc feats
Colicky sev pain No aggrav facs Vom and constip Prev surg Distension High pitch bowel sound
perforated viscus feats
Sudd onset Constant sev Aggrav by move or cough Diffuse tenderness Silent rigid abdo Check amylase
AAA
Sudd onset central pain
Collapse
Hypot
exam
ABCDE Appearance- pain, pallor, jaund etc Vital signs Inspec- distens, scars, bulging, bruising, igne Palpation- start away from pain, guarding, rigidity, mass, hernia Percuss Ausc- peritonitis no bowel sounds DRE, genitals eg testic torsion Sys rev- CVS, resp, vasc
gen mx
NBM Fluids Regul obs Catheter, NG Thromboprophylxais Analgesia- parenteral opioid Antiemetic AB Surg
abdo sign masking
Steroids Imm suppressants Anti inflamm Alc intox Alt conc
Acute append
Px- NV, central to RIF pain
Exam- fever, tend, gurading, RIF mass, pelvic perit.
Perf ulcer with acute perit
Px- Vom. Acute onset sev pain. Hx dyspepsia,ulcer dis, NSAID, CA
Exam- shallow breathing, guarding, rigid, distens, silent bowel.
Acute pancreatitis
Px- anorexia, NV, const sev epig pain, alc hx, cholelith hx.
Exam- fever, cullens, grey turner, epig tend, guarding, reduc sounds.
rupt AAA
Px- sudd sev tearing loin or abdo pain, hypot, hx vasc dis or HTN.
Exam- shock, hypot, pulsatile tender mass, asymm fem pulses.
acute mesenteric isch
Px- anorexia, NV, bloody diarr, const abdp pain, hx vasc dis and HTN.
Exam- AF, HF, asymm periph pulses, no sounds, tend, guarding.
obstruc
Px- colicky central pain, NV, constip
Exam- scars, hernia, mass, distens, visib peristalsis, incr sounds.
rupt ectopic preg
Px- delayed period, hypot, IF pain unilat, shoulder tip pain, prune juice discharge.
Exam- suprapubic tend, periumb bruising, VE pain, swelling fornix.
Signs
Murphys acute cholecystitis- RUQ pain when press on inhalation.
Rovsings acute append- LIF palp cause RIF pain.
Iliopsoas append or abcess- pain when flex thigh ag resis.
Grey turner and cullen haemorrhagic pancreatitis, aortic rupt, rupt ectopic- cullens bleed into falciform lig bruied umb, grey turner loin.
GI ix
CXR, AXR Barium meal, folow through, enema CT colonograph US CT MRCP UGI endosc Colonoscopy Capsule endosc ERCP Laparoscopy Biopsy
cirrhosis ix
High bili Low alb High PT Ascites Enceph
ascitic fluid
Blood stained- malig
Turbid- infec or high prot
Chlous and milky so high fat- lymphatic obstruc
Ix- prot, alb, cell count, cult, gluc, amylase, cytology for malig cells.
Exudate- inflamm, malig
Transudate- cirrhosis, portal HTN
