Lecture 29 Acute Abdomen

Question 1

What is the definition of acute abdomen

Answer 1

A combination of symptoms and signs, including abdominal pain, which results in a patient being referred for an urgent general surgical opinion

Question 2

Main causes of acute abdomen

Answer 2

Acute appendicitis
Acute cholecystitis
Peptic ulcer

Question 3

What are the causes of peritonitis

Answer 3

• Perforation of GI/ biliary tract
• Female genital tract
• Penetration of abdominal wall
• Haematogenous spread- originating in the blood

Question 4

Are there anaerobes in stomach and small intestines

Answer 4

No

Question 5

What happens to the proportion of anaerobes during peritonitis

Answer 5

proportion of aerobes decreases while the percentage of anaerobes increases over a 5-day period

Question 6

What is generalised peritonitis

Answer 6

represents failure of localisation and occurs when:
o Contamination too rapid
o Contamination persists
o Abscess ruptures

Question 7

Cardinal features of intestinal obstruction

Answer 7

–	Pain
–	Vomiting
–	Distention
–	Constipation
–	Borborygmi (a rumbling or gurgling noise made by the movement of fluid and gas in the intestines)

Question 8

Describe visceral pain

Answer 8

–	Pain
–	Vomiting
–	Distention
–	Constipation
–	Borborygmi (a rumbling or gurgling noise made by the movement of fluid and gas in the intestines)

Question 9

Describe Somatic and Referred pain

Answer 9

• Receptors in parietal peritoneum or abdominal wall
• Afferent signals pass with segmental nerves
• Accurate localisation but can be referred

Question 10

Investigations for acute abdomen

Answer 10

o Ward tests: urine + bHCG (pregnancy)
o Lab tests: FBC, U+Es, LFTs & Amylase
o Radiology: plain,US, axial (CT) ?other
o Laparoscopy vs. laparotomy

Question 11

Resuscitation

Answer 11

• Restore circulating fluid volume
• Ensure tissue perfusion
• Enhance tissue oxygenation
• Treat sepsis
• Decompress gut
• Ensure adequate pain relief