Assessment of the Acute Abdomen Flashcards
acute abdomen
sudden, severe abdominal pain that is less than 24hours of duration
multiple possible diagnoses
peritonitis presentation
patient will be motionless, in fetal position, shallow respiration
guarding
VOLUNTARY
patient tightness muscles to avoid pain
INVOLUNTARY
spasm of abdominal muscles due to peritonitis
rigidity
involuntarily guarding
rebound tenderness
gentle and slow pressure applied to abdomen followed by quick release of the examining hand
85% sensitivity to peritonitis
leukocytosis
found in 70% of acute abdomens
CT scan
> 90% sensitive for appendicitis, cholecystitis, pancreatitis, diverticulitis, mesenteric ishaemia
abdominal USS
INDICTATIONS trauma - fast scan AAA - 70-80% sensitivity ectopic pregnancy cholelithiasis, cholecystitis obstructive uropathy and renal calculi
ECG/CxR
ECG is mandatory for patients with upper abdominal pain of uncertain ethyology
erect CxR mandatory for patients with upper abdominal pain for certain ethyology
acute pancreatitis
> 80% secondary to gallstones and alcohol
epigastric pain radiating to the back
> 75% elevated lipase
CT = test of choice
>95% diagnostic accuracy
toxic megacolon
patients usually hospitalised for exacerbation of Crohns, UC or Cl.Diff colitis
sudden onset of worsening of abdominal pain
abdominal distention, tender RIF
incarcerated hernia
sudden onset of pain
lump may not be obvious - think femoral hernia
elderly women
vomiting is an early feature
proper clinical examination usually gives clue (except obturator hernia)
ruptured AAA
clinical scenario
hypotensive with abdominal mass directly to OR
USS>90% diagnostic accuracy
Ct to plan type of repair
small bowel obstruction
2-3% of acute abdominal pains
70% due to adhesions
dilated loops of bowel, transitional point
treatment initially conservation with close, repeated examinations
