Lecture 2: Acute Abdomen

Question 1

What causes acute abdomen/peritonitis?

Answer 1

1) blood
2) bacteria
3) intestinal contents
4) bile
5) irritants
6) anything not belonging inside peritoneal cavity

*EMERGENCY! Act immediately

Question 2

Why is acute abdomen an emergency?

Answer 2

1) intra-abdominal infection
-systemic inflammatory response
-septic shock
hypotension
tachycardia
altered mental status
-multi-organ dysfunction

Question 3

What are red flags for physical exam for acute abdomen?

Answer 3

1) hypotension
2) confusion/impaired consciousness
3) septic looking
4) rigid abdomen

Question 4

What labs should you get for acute abdomen?

Answer 4

1) CBC
2) chem 6
3) coags: PTT, INR (3 C’s baby!)
4) ? liver panel, ? urinalysis, ? blood culture

Question 5

What kind of imaging should you do for acute abdomen?

Answer 5

1) chest x-ray-2 views
2) *ABDOMINAL X-RAY- 3 views, bowel gas, air fluid, pneumoperitoneum (free air in abdomen)
3) ultrasound
4) *CT SCAN- abdomen/pelvis, always get CT scan abdomen AND pelvis, always get IV contrast (if Cr normal)

Question 6

What are red flags on imaging for acute abdomen?

Answer 6

1) free air
2) pneumatosis (gas cysts in bowel wall)
3) portal venous gas