The Acute Abdomen Flashcards
What is an acute abdomen?
Someone who becomes acutely ill and in whom symptoms and signs are chiefly related to the abdomen. Potentially life-threatening domino pathology requiring urgent surgical intervention.
What pathologies can be present in the right upper quadrant?
Right-sided pneumonia, hepatitis, congestive hepatomegaly, gallstone disease, duodenal ulcer, pyelonephritis, appendicitis.
What pathologies can be present in the epigastric region?
Myocardial infarction, gallstone disease, pancreatitis, perforated oesophagus, peptic ulcer.
What pathologies can be present in the left upper quadrant?
Left sided pneumonia, gastric ulcer, ruptured spleen, pyelonephritis, perforated colon.
What pathologies can be present in the umbilical region?
Aortic aneurysm, early appendicitis, pancreatitis, mesenteric thrombosis, intestinal obstruction.
What pathologies can be present in the right lower quadrant?
- GI - perforated caecum, Crohn’s disease, mesenteric adenitis, appendicitis, strangulated hernia, Meckel’s diverticulum
- Renal - renal colic, acute urinary retention.
- GU - ruptured ectopic pregnancy, ovulation pain (Mittelschmerz), ruptured ovarian cyst, tubo-ovarian abscess, salpingitis, ovarian torsion.
What pathologies can be present in the left lower quadrant?
Renal colic, perforated colon, ulcerative colitis, sigmoid diverticulitis, Crohn’s, strangulated hernia, ruptured ectopic pregnancy, ovulation pain (Mittelschmerz), ruptured ovarian cyst, tubo-ovarian abscess, salpingitis, ovarian torsion, acute urinary retention.
What is this a presentation of?
Central acute abdomen, referring to back, tachycardia, tachypnoea, pallor, cold sweat, hypotensive.
Ruptured AAA
What is this a presentation of?
Acute abdomen, tachycardia, tachypnoea, pallor, cold sweat, hypotensive, woman of childbearing age, PV bleeding.
Ruptured ectopic pregnancy
What is this a presentation of?
Acute abdomen, tachycardia, tachypnoea, pallor, cold sweat, hypotensive, recent history of trauma to left upper quadrant.
Splenic rupture
What is generalised peritonitis usually a manifestation of and what might you see on an erect chest X-ray?
- Perforated hollow viscus - perforated peptic/duodenal ulcer, appendix, bowel, gallbladder.
- Free air under the diaphragm.
What is this describing?
Severe non colicky pain worse on cough or deep inspiration, lying still, percussive tenderness, board like abdominal rigidity, no bowel sounds, shallow breaths.
Generalised peritonitis
What is the underlying pathology in localised peritonism?
- Parietal peritoneum is irritated by inflamed appendix/diverticular abscess resulting in focal abdominal rigidity.
- Progresses to generalised peritonitis if condition worsens.
What is this a presentation of?
Colicky abdominal pain accompanied by vomiting, absolute constipation and/or abdominal distension.
Intestinal obstruction
What is the difference between the clinical picture of a high small bowel obstruction and a low colonic obstruction and how are they diagnosed?
- High SBO - vomiting and pain predominant
- Low colonic - constipation and distention predominant
- AXR/CT to diagnose
What is this a presentation of?
Recent onset of acute diarrhoea with cramping abdominal pain +/- vomiting.
Gastroenteritis
What is this a presentation of?
Elderly, bloody diarrhoea with vascular disease/AF.
Ischaemic colitis
What is this a presentation of?
Severe, colicky unilateral pain that radiates to groin +/- testes/labia. Writhing in pain, able to find comfortable position. Haematuria.
Renal tract obstruction (exclude AAA with USS)
What blood test should you measure severe epigastric pain, and what is it trying to identify?
- Amylase
2. >1000U/L diagnostic of pancreatitis
What should you do if a patient presents with upper abdominal pain and jaundice?
Urgent abdominal USS to look for biliary obstruction.
What is this a presentation of?
Fever/high WCC, CRP and unremitting right upper quadrant pain.
Cholecystitis (could also be basal pneumonia)
What is this a presentation of?
Severe right upper quadrant pain with no systemic inflammatory signs. Comes on after big fatty meal then goes.
Biliary colic
What should be your immediate investigations in an acute abdomen with a positive pregnancy test?
Urgent gynaecology review and transvaginal USS
What is this a presentation of?
Migration of pain from periumbilical region to right iliac fossa, right iliac fossa tenderness with local peritonitis. Mild fever, high WCC/CRP.
Acute appendicitis
What is this a presentation of?
Elderly, left iliac fossa, evidence of systemic inflammation (fever, raised WCC/CRP).
Diverticulitis
What bedside test is done to confirm the diagnosis of a UTI?
Urinalysis - positive leukocytes or nitrites
What urgent imaging should you do in this presentation?
Woman of childbearing age (<35) with acute pelvic/lower abdominal pain. Nausea, vomiting, unilateral tenderness.
Urgent USS to look for ovarian torsion or cyst
If ovarian torsion or cyst is ruled out what diagnosis should be considered in this presentation?
Woman of childbearing age. Bilateral lower abdominal pain +/- fever. Abnormal discharge, tenderness on moving cervix during bimanual examination.
Pelvic inflammatory disease
What is this a presentation of?
Sudden onset pain out of proportion to clinical signs and risk factors of vascular disease.
Mesenteric ischemia
Which medications should you ask about in the drug history and abdominal pain?
Antibiotics, NSAIDs, PPIs, steroids.
Which pathologies cause absent bowel sounds and tinkling bowel sounds?
- Absent - peritonitis
2. Tinkling - bowel
