Surgical History and the Acute Abdomen Flashcards
What is the acute abdomen?
Onset of severe abdominal pain lasting less than 24 hours
What other symptoms can constitute part of an ‘acute abdomen’?
Change in bowel habit
GI bleeding (PR/haematemesis)
Why is the acute abdomen important?
Can be potentially life threatening
Can often be surgically managed
What diagnoses will need surgical intervention?
Bleeding
Perforation
Ischaemia
Peritonism (including RIF localised appendicitis)
Colic (potentially)
What is visceral pain?
Pain that occurs in a generalised area of the abdomen (i.e. upper, middle or lower) due to damage of viscera
How do visceral nerve fibres reach the structure that they innervate?
Hitchhike on autonomic nerve fibres
What do the general areas of innervation (and subsequently areas of pain) correspond to?
Embryological divisions:
Foregut - Upper 1/3 abdomen pain
Midgut - Middle 1/3 abdomen pain
Hindgut - Lower 1/3 abdomen pain
What stimuli can cause visceral pain?
Ischaemia
Stretch
Heat
What type of ‘activation’ is visceral pain associated with?
Badly worded question 🙃
Autonomic activation
How does autonomic activation occur due to visceral pain?
Stimulation of Vagus nerve
What are the symptoms associated with autonomic activation?
Malaise
Nausea
Sweating
What is the ‘Rule of Five’ when examining a patient?
- Consent
- Inspect
- Palpate
- Percuss
- Auscultate
(Special tests)
What are the 3 types of possible abdominal pain?
Somatic
Visceral
Referred
What assessments must be made when handling the acute abdomen?
Assess clinical state
Will they need surgery?
If the patient is clinically critically unwell what is next?
Begin immediate acute assessment (A-E)
Begin management
Call for help if needed
How should a critically unwell patient be managed?
Oxygen
Fluid balance
Pharmacological intervention (3 A’s)
VTE prophylaxis (if needing surgery)
Escalation (if needed)
What are the 3 A’s of pharmacological intervention in a critically unwell surgical patient?
Analgesia
Antiemetics
Antibiotics
If a patient is not critically unwell, what early management steps should be taken when dealing with the acute abdomen?
IV access
NBM (2/4/6 rule)
Three A’s (drugs)
Imaging (not strictly management but will dictate further treatment)
VTE prophylaxis
What is the 2/4/6 rule of NBM?
2 hours water
4 hours breast milk
6 hours food
What is referred pain?
Pain that is felt at a site distant to the structure being affected
Where does diaphragmatic irritation refer to?
Left shoulder-tip pain
How can visceral nerves create referred pain?
They cause pain at areas innervated by somatic nerves that leave the spinal cord at the same level as the autonomic fibres on which they hitchhike
What are some common causes of acute abdomen?
Appendicitis
Biliary colic
Bowel obstruction
Diverticulitis
Gynae pathology
What sieve can be used to generate differentials?
Metabolic Endocrine Degenerative Iatrogenic/idiopathic Congenital
Haematological
Autoimmune
Traumatic
Psychological
Infective/inflammatory
Neoplastic
