Lecture 11.1: Assessment of the Acute Abdomen Flashcards
Assessing the Patient : First Steps
- Get help if critically unwell
- Look, listen, feel
- Unconscious + unresponsive + abnormal breathing =
CPR - Otherwise proceed to ABCDE assessment
ABCDE Assessment
- Airway
- Breathing
- Circulation
- Disability
- Exposure
What to assess in the A of ABCDE (5)
- Speaking full sentences
- Snoring/quiet breath sounds
- Paradoxical chest movement/accessory muscle use
- No chest movement
- Give oxygen
What to assess in the B of ABCDE (5)
- Inspect
- Palpate
- Percussion
- Auscultation
- O2 sats/ABG
What to assess in the C of ABCDE (5)
- Inspect
- Palpate
- Palpate
- Take BP and attach 3 lead ECG
What to assess in the D of ABCDE (5)
- ACVPU
- Ensure review and treat ABCs
- Drug chart
- Examine pupils
What does ACVPU stand for?
- Alert
- Confusion
- Voice
- Pain
- Unresponsive
What to assess in the E of ABCDE (5)
- Examine patient fully
- Include aspects of abdominal exam
- Signs of bleeding
History from Critically Unwell Patients: SAMPLE
- Sign/symptoms
- Allergies
- Medical
- Past pertinent medical history
- Last oral intake
- Events leading up to present illness
Red Flags in GI (9)
- Unintentional weight loss
- Loss of appetite
- Change in bowel habit >3 weeks
- Dysphagia
- Persistent unexplained vomiting
- Chronic gastrointestinal bleeding
- Epigastric mass
- Over 55 with unexplained dyspepsia
- Unexplained rectal bleeding
Differential Diagnoses: Pain in RUQ (6)
- Cholecystitis
- Hepatitis
- Pyelonephritis
- Ureteric Colic
- Pneumonia
- Pancreatitis
Differential Diagnoses: Pain in RLQ (9)
- Appendicitis
- Inguinal/Femoral Hernia
- Ureteric Colic
- IBD
- UTI
- PID
- Ovarian Cyst
- Endometriosis
- Testicular Torsion
Differential Diagnoses: Pain in LUQ (5)
- Pneumonia
- Pancreatitis
- Gastric Ulcer
- Pyelonephritis
- Ureteric Colic
Differential Diagnoses: Pain in LLQ (9)
- Diverticulitis
- Inguinal/Femoral Hernia
- Ureteric Colic
- IBD
- UTI
- PID
- Ovarian Cyst
- Endometriosis
- Testicular Torsion
Differential Diagnoses: Pain in Epigastric Region (4)
- Peptic Ulcer Disease
- Cholecystitis
- Pancreatitis
- Myocardial Infarction
Differential Diagnoses: Pain in Umbilicus Region (4)
- Small Bowl Obstruction
- Large Bowl Obstruction
- Appendicitis
- Abdominal Aortic Aneurysms
What is Guarding?
- Tensing of the abdominal wall muscles to guard
inflamed organs from the pain of pressure upon them - Voluntary
What is Rigidity?
Involuntary tightening of the abdominal musculature that occurs in response to underlying inflammation
What is Rebound Tenderness?
Pain or discomfort on removal of pressure to the abdomen rather than application
Investigations for GI: Laboratory Tests (6)
- Urinalysis
- Pregnancy Test
- ABG
- FBC, U+E, LFT, CRP, amylase
- G+S/Cross-match
- Blood Cultures
Investigations for GI: Imaging (3)
- Erect CXR
- USS scan
- CT scan
Management of GI Conditions: General Measures (8)
- Oxygen
- IV access and fluids
- Nil by mouth
- Analgesia +/- antiemetic
- Organise investigations and imaging
- VTE prophylaxis
- Catheter
- Antibiotics
Urgent Surgery GI Conditions (3)
- Bleeding
- Perforations
- Ischaemic Bowel
What can cause bleeding in the GI System? (5)
- Ruptured AAA
- Ulcers
- Varices
- Ruptured Ectopic Pregnancy
- Trauma
What can cause perforations in the GI System? (4)
- Peptic Ulcers
- Bowel Obstruction
- Diverticular Disease
- IBD
Less Urgent GI Surgery Conditions (4)
- Peritonism
- Cholecystitis
- Bowel obstruction
- Renal colic
