Assessment of the Acute Abdomen Flashcards
Lower GI causes of acute abdomen
-IBD
-Acute appendicitis
-Diverticulitis +/- perforated diverticulum
-Acute mesenteric ischaemia
-Small/ large bowel obstruction
Types of abdominal pain
-Visceral= Vague, poorly localised/ afferent nerves from gut to spinal cord, strong autonomic reflex (vomiting, sweating)
=Distention of intrabdominal organs
=Obstruction of tube
=Spasm of smooth vessels of tubes
-Parietal pain= localised, inflammation of parietal peritoneum, dermatomal distribution
Acute appendicitis pain
-Visceral
=Vague, poorly localising around umbilicus (midgut)
=Gradually worse
=May be associated with vomiting
-Parietal pain when inflammation spreads to parietal peritoneum
=More localised
=Specific to right iliac fossa, over McBurney’s point
- What disease process if going on?
-Inflammation
=Foregut (cholangitis, cholecysitis, pancreatitis)
=Midgut (appendicitis)
=Hindgut (distal colitis, diverticulitis)
-Perforation
-Obstruction
-Ischaemia
-Haemorrhage
- What systems could be involved?
-GI
-Urological
-Vascular
-Gynaecological
Unusual presentations of abdominal pain
-Epigastrium pain= inferior MI
-Strangulated inguinal hernia or testicular torsion=lower
History for abdominal pain
- Onset
- Progression
- Duration
- Associated symptoms
- Risk factors
PMH
Past surgical
Drugs
Allergies
Family
Social
Systemic questions for history
-Nausea and vomiting
-Diarrhoea
-Chest pain
-Back pain
-Loss of appetite
-Urinary symptoms
-Last period
-Abnormal vaginal bleeding/ =vaginal discharge
-Any chance you could be pregnant
What does guarding and rebound tenderness suggest?
Peritonitis
Right upper quadrant pain/ hypochondria
-Cholecystitis
-Ascending Cholangitis
-RLL Pneumonia
-Hepatitis
Epigastric pain
-Gastritis
-Peptic ulcer disease
-Pancreatitis
-Inferior MI
Left hypochondrium pain
-Gastritis
-Pancreatitis
-LLL Pneumonia
-Splenic infarction (sickle cell)
Loin pain
-Pyelonephritis
-Ureteric obstruction
=Stones (in lumen)
=Cancer (in wall)
=Outside (retroperitoneal fibrosis= external compression=colic)
Periumbilical pain
-AAA
-Bowel obstruction
-DKA
-Pancreatitis
Right iliac fossa pain
-Appendicitis
-IBD (terminal ileitis)
-Strangulated Hernia
-Torsion of ovarian cyst
-Ectopic pregnancy
-Testicular torsion
-Salpingitis
