General: Acute Abdomen

Question 1

What is an acute abdo?

Answer 1

Sudden onset of severe abdominal pain of less than 24 hours duration

Question 2

What causes an acute abdo?

Answer 2

Ruptured AAA = surgical emergency

Ruptured ectopic pregnancy

Bleeding gastric ulcer

Trauma

Peritonitis = perforation (peptic ulcer, obstruction, diverticular disease, IBD)

Ischaemic bowel

Uretic obstruction

Bowel obstruction

Acute appendicitis

Question 3

What are the signs and symptoms an of acute abdo?

Answer 3

Bleeding = tachycardia, hypotension, pale, clammy, cool to touch, thready pulse

Peritonitis = lay completely still, tachycardia, hypotension, rigid abdo, involuntary guarding, reduced/absent bowel sounds

Ischaemic bowel = severe pain out of proportion to the clinical signs

Uretic obstruction = colic

Bowel obstruction = colic

Acute appendicitis = peritonism, peri-umbilical then RIF

Question 4

What investigations should be performed for an acute abdo?

Answer 4

Urine dip = asses for haematuria, microscopy, culture, preg test

ABG = assess sepsis

Bloods = FBC, U+Es, LFTs, CRP, amylase (pancreatitis), G+S

Blood cultures

US = KUB, biliary tree, liver, ovaries, fallopian tubes and uterus

eCXR = perforation

CT

ECG = exclude MI

Question 5

How should an acute abdo be managed?

Answer 5

Definitive management is dependent on the cause

A-E assess

IV fluids = monitor fluid balance

NBM

Analgesia

Antiemetics

VTE prophylaxis

Urinary catheter

NG tube

Question 6

Give a DDx for epigastric pain

Answer 6

Cholangitis 
Gastritis 
Peptic ulcer
GORD
Inferior MI
Basal pneumonia