Assess Acute Abdo

Question 1

Acute abdo

Answer 1

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

Question 2

Visceral pain

Answer 2

Stim of sm Rs
Eg isch, distension, tension. Often colicky.
Autonimic conduction- vagus
Poorly localised midline pain
Assoc malaise, NV, sweating

Question 3

Embryology

Answer 3

Epig pain- stom to D2, liver, panc, spleen
Periumb- D2 to proximal 2/3 transv colon
Suprapubic- distal transv to anal verge

Question 4

Somatic pain

Answer 4

Pain Rs in parietal perit
Segmental somatic N conduc
Accurately localised
Overrides visceral

Question 5

Referred pain

Answer 5

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.

Question 6

Common causes

Answer 6

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

Question 7

Ix

Answer 7

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

Question 8

px

Answer 8

Pain- char, locat, onset, prog, prev episodes, aggrav and relieving
Appetite
NV
Distens
Bowel habit
Wl
PV disch
Urin freq, urgency, pain, blood

Question 9

pain chars

Answer 9

Sudden onset- perforat, rupture, AAA, MI, mestenteric occlus
Rapidly accelerating- bil or ureteric colic, SI obstruc
Grad onset- IBD, obstruc, other mech

Question 10

diffs

Answer 10

MI
Pneumonia
Pleurisy
Herpes zoster
Diabetic ketosis

Question 11

Malig feats

Answer 11

Intermitt pain over 48hr
Alt bowel habit
Distension
Mass
Wl

Question 12

Obstruc feats

Answer 12

Colicky sev pain
No aggrav facs
Vom and constip
Prev surg
Distension
High pitch bowel sound

Question 13

perforated viscus feats

Answer 13

Sudd onset
Constant sev
Aggrav by move or cough
Diffuse tenderness
Silent rigid abdo
Check amylase

Question 14

AAA

Answer 14

Sudd onset central pain
Collapse
Hypot

Question 15

exam

Answer 15

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

Question 16

gen mx

Answer 16

NBM
Fluids
Regul obs
Catheter, NG
Thromboprophylxais
Analgesia- parenteral opioid
Antiemetic
AB
Surg

Question 17

abdo sign masking

Answer 17

Steroids
Imm suppressants
Anti inflamm
Alc intox
Alt conc

Question 18

Acute append

Answer 18

Px- NV, central to RIF pain

Exam- fever, tend, gurading, RIF mass, pelvic perit.

Question 19

Perf ulcer with acute perit

Answer 19

Px- Vom. Acute onset sev pain. Hx dyspepsia,ulcer dis, NSAID, CA
Exam- shallow breathing, guarding, rigid, distens, silent bowel.

Question 20

Acute pancreatitis

Answer 20

Px- anorexia, NV, const sev epig pain, alc hx, cholelith hx.
Exam- fever, cullens, grey turner, epig tend, guarding, reduc sounds.

Question 21

rupt AAA

Answer 21

Px- sudd sev tearing loin or abdo pain, hypot, hx vasc dis or HTN.
Exam- shock, hypot, pulsatile tender mass, asymm fem pulses.

Question 22

acute mesenteric isch

Answer 22

Px- anorexia, NV, bloody diarr, const abdp pain, hx vasc dis and HTN.
Exam- AF, HF, asymm periph pulses, no sounds, tend, guarding.

Question 23

obstruc

Answer 23

Px- colicky central pain, NV, constip

Exam- scars, hernia, mass, distens, visib peristalsis, incr sounds.

Question 24

rupt ectopic preg

Answer 24

Px- delayed period, hypot, IF pain unilat, shoulder tip pain, prune juice discharge.
Exam- suprapubic tend, periumb bruising, VE pain, swelling fornix.

Question 25

Signs

Answer 25

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.

Question 26

GI ix

Answer 26

CXR, AXR
Barium meal, folow through, enema
CT colonograph
US
CT
MRCP
UGI endosc
Colonoscopy
Capsule endosc
ERCP
Laparoscopy
Biopsy

Question 27

cirrhosis ix

Answer 27

High bili
Low alb
High PT
Ascites
Enceph

Question 28

ascitic fluid

Answer 28

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